66

Chapter 66: Care of Patients with Problems of the Thyroid and Parathyroid Glands
Test Bank
MULTIPLE CHOICE
1. A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal
thyroid-stimulating hormone (TSH) levels. Which is the nurses priority intervention?

Administer levothyroxine (Synthroid).
Administer propranolol (Inderal).
Monitor the apical pulse.
Assess for Trousseaus sign.
a.
b.
c.
d.
ANS: C
The clients laboratory findings suggest that the client is experiencing hyperthyroidism. The
increased metabolic rate can cause an increase in the clients heart rate, and the client should
be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor
might also be a precaution. Synthroid is given for hypothyroidism. Propranolol is a beta
blocker often used to lower sympathetic nervous system activity in hyperthyroidism.
Trousseaus sign is a test for hypocalcemia.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies
Expected Actions/Outcomes)
MSC: Integrated Process: Nursing Process (Implementation)
2. Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?
a. You will have external beam radiation.
b. No radiation is used for this scan.
c. No special radiation precautions are needed.
d. Your thyroid will be radioactive for weeks.
ANS: C
The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life
that the client is not considered to be a radiation hazard. Thus, no radiation precautions are
necessary. The other statements are inaccurate.
DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1396
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests)
MSC:
Integrated Process: Teaching/Learning
3. Which dietary modification does the nurse provide for a client with hyperthyroidism?
a. Decreased calories and proteins and increased carbohydrates
b. Elimination of carbohydrates and increased proteins and fats
c. Increased calories, proteins, and carbohydrates
d. Supplemental vitamins and reduction of calories
ANS: C
The client is hypermetabolic and has an increased need for calories, carbohydrates, and
proteins. Proteins are especially important because the client is at risk for a negative nitrogen
balance. The other modifications are inappropriate for a client with hyperthyroidism.

REF: N/A
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness
Management)
4. A client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the
client is having side effects of this therapy?

a. Blurred vision
b. Increased thirst and urination
c. Increased sweating and diarrhea
d. Decreased attention span and insomnia
ANS: B
Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. The
other choices are not specific to lithium.
REF: N/A
Adverse Effects/Contraindications/Side Effects/Interactions)
MSC: Integrated Process: Nursing Process (Evaluation)
5. A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine
preparation before surgery. Which is the nurses best response?

Iodine will help make the internal surgical environment sterile.
It is given to stimulate the storage of excess thyroid hormones.
This will replace the hormones you will lose after your operation.
It will prevent excessive bleeding during surgery.
a.
b.
c.
d.
ANS: D
Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for
hemorrhage and the potential for thyroid storm during surgery. The other answers are not
accurate.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
6. Twelve hours after a total thyroidectomy, the client develops stridor. Which is the nurses
priority intervention?
a. Reassure the client that the voice change is temporary.
b. Document the finding and assess the client hourly.
c. Hyperextend the clients neck and apply oxygen.
d. Prepare for emergency tracheostomy and call the health care provider.
ANS: D
Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction

resulting from edema. One emergency measure is to remove the surgical clips to relieve the
pressure. This might be a physician function. The nurse should prepare to assist with
emergency intubation or tracheostomy while notifying the provider or the Rapid Response
Team. The other choices do not address the emergency situation.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical

Emergencies)
7. On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that
he feels numbness and tingling around his mouth. Which is the nurses priority intervention?
Offer mouth care.
Loosen the dressing.
Assess Chvosteks sign.
Assess the client hourly.
a.
b.
c.
d.
ANS: C
Numbness and tingling around the mouth or in the fingers and toes are manifestations of
hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should
assess the client further by testing for Chvosteks sign and Trousseaus sign. Then the nurse
should notify the provider. The other choices do not address the emergency situation.
REF: N/A
MSC: Integrated Process: Nursing Process (Analysis)
8. Which client statement alerts the nurse to the possibility of hypothyroidism?
a. My sister has thyroid problems.
b. I seem to feel the heat more than other people.
c. Food just doesnt taste good without a lot of salt.
d. I am always tired, even with 10 or 12 hours of sleep.
ANS: D
Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep.
Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of
taste is not a manifestation of hyperthyroidism.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)
MSC: Integrated Process: Nursing Process (Assessment)
9. A client has been diagnosed with hypothyroidism. Which medication is the nurse prepared to
administer to treat the clients bradycardia?

Atropine sulfate
Levothyroxine sodium (Synthroid)
Propranolol (Inderal)
Epinephrine (Adrenalin)
a.
b.
c.
d.
ANS: B
The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using
levothyroxine sodium. If the heart rate were so slow that it became an emergency, then
atropine or epinephrine might be an option for short-term management. Inderal is a beta
blocker and would be contraindicated for a client with bradycardia.
REF: N/A
Expected Actions/Outcomes)

10. A client has hypothyroidism. Which problem does the nurse address as a priority for this
client?
Heat intolerance
Body image problems
Depression and withdrawal
Obesity
a.
b.
c.
d.
ANS: C
Hypothyroidism causes many problems in psychosocial functioning. Depression is the most

common reason for seeking medical attention. Memory and attention span may be impaired.
The clients family may have great difficulty accepting and dealing with these changes. The
client is often unmotivated to participate in self-care. Lapses in memory and attention require
the nurse to ensure that the clients environment is safe. Heat intolerance is seen in
hyperthyroidism. Body image problems and weight issues do not take priority over mental
status and safety.
REF: N/A
11. A client has hypothyroidism and has been started on levothyroxine (Synthroid). Which
assessment finding leads the nurse to conclude that the treatment is effective?
Thirst is recognized and the client drinks fluids appropriately.
Weight has been the same for 3 weeks.
Total white blood cell count is 6000 cells/mm3.
Heart rate is 70 beats/min and regular.
a.
b.
c.
d.
ANS: D
Hypothyroidism decreases body functioning and can result in effects such as bradycardia,
confusion, and constipation. If a clients heart rate is bradycardic while on thyroid hormone
replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart
rate above 100 beats/min may indicate that the client is receiving too much of the thyroid
hormone. The other assessment findings do not give any indication as to whether treatment is
successful.
REF: N/A
Expected Actions/Outcomes) MSC:
Integrated Process: Nursing Process (Evaluation)
12. A client with hypothyroidism as a result of Hashimotos thyroiditis asks the nurse how long
she will have to take thyroid medication. Which is the nurses best response?
a. You will need to take the thyroid medication until the goiter is completely gone.
b. Thyroiditis is cured with antibiotics. Then you wont need thyroid medication.
c. Youll need thyroid pills for life because your thyroid wont start working again.
d. When blood tests indicate normal thyroid function, you can stop the medication.
ANS: C
Hashimotos thyroiditis results in a permanent loss of thyroid function. The client will need
lifelong thyroid replacement therapy. The other answers are incorrect.

REF: p. 1405
TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)
MSC: Integrated Process: Communication and Documentation
13. The nurse is reviewing client medical histories. Which client is at greatest risk for
hyperparathyroidism?
a. Client with pregnancy-induced hypertension
b. Client receiving dialysis for end-stage kidney disease
c. Older adult client with moderate heart failure
d. Older adult client on home oxygen therapy
ANS: B
Clients who have chronic kidney disease do not completely activate vitamin D and poorly
absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers
overstimulation of the parathyroid glands. The other factors do not place a client at higher risk
for hyperparathyroidism.
DIF: Cognitive Level: Knowledge/Remembering
REF: Table 66-3, p. 1406
MSC: Integrated Process: Nursing Process (Assessment)
14. A client has hyperparathyroidism. Which intervention is the priority for the nurse to add to the
clients plan of care?

Instruct the client to place both hands behind the neck when moving.
Use a lift sheet to assist the client with position changes.
Instruct the client to use a soft-bristled toothbrush.
Strain all urine for at least 24 hours and send stones to the laboratory.
a.
b.
c.
d.
ANS: B
Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the
risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead
of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney
stones, but not every client will need to have urine strained. The priority is preventing injury.
Supporting the neck with movement and using a soft toothbrush are not needed for this client.
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control
Accident/Injury Prevention)
15. When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the
clients hand has gone into flexion contractions. Which laboratory result does the nurse
correlate with this condition?
a. Serum potassium, 2.9 mEq/L
b. Serum potassium, 5.8 mEq/L
c. Serum sodium, 122 mEq/L
d. Serum calcium, 6.9 mg/dL
ANS: D
Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and
tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion
contractions (Trousseaus sign) that occur during blood pressure measurement are indicative
of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia,
hyperkalemia, and hyponatremia.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory
Values)
16. The client is receiving methimazole (Tapazole). Which statement by the client indicates good
understanding of teaching regarding this medication?

If I become pregnant, I need to notify my health care provider immediately.
Liver problems can occur with this drug so I need to report jaundice.
I will take my pulse daily, and if it is too fast, I will call my provider.
This medication may cause dyspnea or vertigo. I will be careful with activity.
a.
b.
c.
d.
ANS: A
Methimazole can cause birth defects, and clients should not take it if they are pregnant. Liver
problems can occur with propylthiouracil (PTU). The client does not need to take his or her
pulse daily. Dyspnea and vertigo are not side effects of methimazole.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)
17. A client has diabetes mellitus. Her daughter has recently been diagnosed with Graves disease.
The client asks the nurse if she is responsible for the fact that her daughter has Graves
disease. Which is the best response of the nurse?
a. No connection is known between Graves disease and diabetes, so you can be
certain that the fact that you have diabetes did not cause your daughter to have
Graves disease.
b. An association has been noted between Graves disease and diabetes, but the fact
that you have diabetes did not cause your daughter to have Graves disease.
c. Graves disease is associated with autoimmune diseases such as rheumatoid
arthritis, but not with a disease such as diabetes.
d. Unfortunately, Graves disease is associated with diabetes, and your diabetes could
have led to your daughter having Graves disease.
ANS: B
An association between autoimmune diseases such as rheumatoid arthritis and diabetes

mellitus has been noted. The predisposition is probably polygenic and the clients diabetes did
not cause her daughters Graves disease. The other statements are inaccurate.
REF: p. 1394
MSC: Integrated Process: Teaching/Learning
18. The nurse is assessing a client with Graves disease and finds that the clients temperature has
risen 1 F. Before notifying the health care provider, which action by the nurse takes priority?
a. Turn the lights down in the clients room and shut the door.
b. Call for an immediate electrocardiogram (ECG).

c. Calculate the clients apical-radial pulse deficit.
d. Administer a dose of acetaminophen (Tylenol).
ANS: A
A temperature increase of 1 F may indicate the development of thyroid storm, and the
provider needs to be notified. Before notifying the provider, the nurse should take measures to
reduce environmental stimuli that increase the risk of cardiac complications. The nurse can
then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is
not needed because the temperature increase is due to thyroid activity.
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care
Establishing Priorities)
19. A client has undergone a complete thyroidectomy. Which statement by the client indicates that
further instruction is needed?

I may need calcium replacement after surgery.
After surgery, I wont need to take thyroid medication.
Ill need to take thyroid hormones for life.
I can receive pain medication if I feel that I need it.
a.
b.
c.
d.
ANS: B
After the client undergoes a thyroidectomy, the client must be given thyroid replacement
medication for life. He or she may also need calcium if the parathyroid is damaged during
surgery and can receive pain medication postoperatively.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness
Management)
20. A client being treated for hypothyroidism has been admitted for pneumonia. Which activity
does the nurse include as a priority in this clients care plan?

Monitor the clients IV site every shift.
Administer acetaminophen (Tylenol) for fever.
Ensure that working suction equipment is in the room.
Assess vital signs every 4 hours.
a.
b.
c.
d.
ANS: C
A client with hypothyroidism who develops another illness is at risk for myxedema coma. In
this emergency situation, maintaining an airway is a priority. The nurse should ensure that
suction is available in the clients room because it may be needed if myxedema coma
develops. The other interventions are necessary for any client with pneumonia, but having
suction available is a safety feature for this client.
REF: N/A
MULTIPLE RESPONSE
1. A client has been admitted with hypoparathyroidism. The clients serum laboratory values are
as follows: calcium, 7.2 mg/dL; sodium, 144 mEq/L; magnesium, 1.2 mEq/L; potassium, 5.7
mEq/L. Which medications does the nurse anticipate administering? (Select all that apply.)
a. Potassium chloride orally
b. Calcium chloride IV
c. 3% NS IV solution
d. 50% magnesium sulfate
e. Calcitriol (Rocaltrol) orally
ANS: B, D
The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated
with magnesium sulfate). The potassium level is high, so replacement is not needed. The
clients sodium level is normal, so hypertonic IV solution is not needed. No information about
a vitamin D deficiency is available, so calcitriol is not needed.
REF: N/A
Expected Actions/Outcomes) MSC:
Integrated Process: Nursing Process (Analysis)

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Chapter 66: Care of Patients with Problems of the Thyroid and Parathyroid Glands

thyroid-stimulating hormone (TSH) levels. Which is the nurses priority intervention?

DIF: Cognitive Level: Application/Applying or higher

client is having side effects of this therapy?

preparation before surgery. Which is the nurses best response?

Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical

administer to treat the clients bradycardia?

MSC: Integrated Process: Nursing Process (Implementation)

Hypothyroidism causes many problems in psychosocial functioning. Depression is the most

DIF: Cognitive Level: Comprehension/Understanding

clients plan of care?

understanding of teaching regarding this medication?

An association between autoimmune diseases such as rheumatoid arthritis and diabetes

b. Call for an immediate electrocardiogram (ECG).

further instruction is needed?

does the nurse include as a priority in this clients care plan?

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