Pump up on practice questions 309

After thyroidectomy
• Monitor vital signs every 15 to 30 minutes
until the client’s condition stabilizes. Stay alert
for signs of tetany secondary to accidental
parathyroid injury during surgery. Keep 10%
calcium gluconate available for I.M. use, if
needed. These measures help prevent serious
postoperative complications.
• Assess dressings frequently for excessive
bleeding to detect signs of hemorrhage.
• Monitor for signs of airway obstruction,
such as difficulty talking and increased swal-
lowing; keep tracheotomy equipment handy.
The airway may become obstructed because of
postoperative edema; tracheotomy equipment
should be handy to avoid treatment delay if the
airway becomes obstructed.

Teaching topics Pump up on practice

• Explanation of the disorder and treatment
plan
• Medication use and possible adverse
effects, including understanding the need
for lifelong thyroid hormone replacement
therapy if permanent hypothyroidism occurs
• Watching for and reporting signs of hypo-
thyroidism (lethargy, restlessness, sensitivity
to cold, forgetfulness, dry skin)—especially
if he has Hashimoto’s thyroiditis, which com-
monly causes hypothyroidism
• Recognizing the need to watch for signs
of hyperthyroidism, such as nervousness and
palpitations
questions
1. The nurse is assessing a client with
hypothyroidism and finds the client has a
temperature of 94° F (34.4° C) and exhibits
hypotension and hypoventilation. Based on
these findings, which nursing diagnosis is
most appropriate for this client?
1. Impaired gas exchange
2. Hypothermia
3. Disturbed thought processes
4. Deficient fluid volume
Answer: 1. Hypothermia, hypotension, and
hypoventilation are manifestations of myx-
edema coma, a potentially life-threatening
complication of hypothyroidism. Impaired gas
exchange is the most significant nursing diag-
nosis because a client with myxedema coma
may suffer from hypoventilation, bradypnea,
and respiratory failure caused by respiratory
muscle weakness and coma. Ensuring and
maintaining a patent airway always takes
precedence. Hypothermia occurs in a client in

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 310 Endocrine system
myxedema coma due to decreased metabo-
lism. Disturbed thought processes may result
from reduced cerebral perfusion secondary
to reduced cardiac output. Deficient fluid
volume may result from impaired free water
clearance.
➽ NCLEX keys
Client needs category: Physiological
integrity
Client needs subcategory: Physiological
adaptation
Cognitive level: Analysis
2. A client comes to the clinic because
she has experienced a weight loss of 20 lb
(9.1 kg) over the past month, even though her
appetite has been “ravenous” and she hasn’t
changed her activity level. She’s diagnosed
with Graves’ disease. What other signs and
symptoms support the diagnosis of Graves’
disease? Select all that apply.
1. Rapid, bounding pulse
2. Bradycardia
3. Heat intolerance
4. Mild tremors
5. Nervousness
6. Constipation
Answer: 1, 3, 4, 5. Graves’ disease, or hyper-
thyroidism, is a hypermetabolic state that’s
associated with rapid, bounding pulses;
heat intolerance; tremors; and nervousness.
Bradycardia and constipation are signs and
symptoms of hypothyroidism.
➽ NCLEX keys
Client needs category: Health promotion and
maintenance
Client needs subcategory: None
Cognitive Level: Analysis
3. In interpreting a radioactive iodine
uptake test, a nurse should know that:
1. uptake increases in hyperthyroidism
and decreases in hypothyroidism.
2. uptake decreases in hyperthy-
roidism and increases in hypothy-
roidism.
313419NCLEX-RN_Chap09.indd 310
3. uptake increases in both hyperthy-
roidism and hypothyroidism.
4. uptake decreases in both hyperthy-
roidism and hypothyroidism.
Answer: 1. Iodine is necessary for the
synthesis of thyroid hormones. In hyper-
thyroidism, more iodine is taken up by the
thyroid so more thyroid hormones may be
synthesized. In hypothyroidism, less iodine is
taken up because fewer thyroid hormones are
synthesized.
➽ NCLEX keys
Client needs category: Health promotion and
maintenance
Client needs subcategory: None
Cognitive level: Comprehension
4. A client is diagnosed with hyperthy-
roidism. The nurse should expect clinical
manifestations similar to:
1. hypovolemic shock.
2. adrenergic stimulation.
3. benzodiazepine overdose.
4. Addison’s disease.
Answer: 2. Hyperthyroidism is a hypermet-
abolic state characterized by such signs
as tachycardia, systolic hypertension, and
anxiety—all seen in adrenergic (sympathetic)
stimulation. Manifestations of hypovolemic
shock, benzodiazepine overdose, and
Addison’s disease are more similar to a
hypometabolic state.
➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Physiological
adaptation
Cognitive level: Analysis
5. A client with a history of mitral valve
replacement and chronic warfarin (Couma-
din) usage is diagnosed with hypothyroidism
and prescribed levothyroxine (Synthroid).
The nurse should expect the need for the war-
farin:
1. dosage to be decreased.
2. dosage to be increased.
4/8/2010 3:11:04 PM

3. frequency to be decreased.
4. frequency to be increased.
Answer: 1. Levothyroxine enhances the
effects of warfarin; therefore, the warfarin
dosage would need to be decreased.
➽ NCLEX keys
Client needs category: Physiological
integrity
Client needs subcategory: Pharmacological
and parenteral therapies
Cognitive level: Application
6. A client with thyroid cancer undergoes
a thyroidectomy. After surgery, the client
develops peripheral numbness and tingling
and muscle twitching and spasms. The nurse
should expect to administer:
1. thyroid supplements.
2. antispasmodics.
3. barbiturates.
4. I.V. calcium.
Answer: 4. Removing the thyroid gland can
cause hyposecretion of parathormone leading
to calcium deficiency; indicated by numb-
ness, tingling, and muscle spasms. Treatment
includes calcium administration. Thyroid
supplements will be necessary following thy-
roidectomy but aren’t specifically related to
the identified problem. Antispasmodics don’t
treat the problem’s cause. Barbiturates aren’t
indicated.
➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Pharmacological
and parenteral therapies
Cognitive level: Application
7. A client with intractable asthma
develops Cushing’s syndrome. This complica-
tion can most likely be attributed to chronic
use of:
1. prednisone.
2. theophylline.
3. metaproterenol.
4. cromolyn (Intal).
313419NCLEX-RN_Chap09.indd 311
Pump up on practice questions 311
Answer: 1. Cushing’s syndrome results from
excessive glucocorticoids. This excess can
occur from frequent or chronic use of cortico-
steroids such as prednisone. Theophylline,
metaproterenol, and cromolyn don’t cause
Cushing’s syndrome.
➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Pharmacological
and parenteral therapies
Cognitive level: Application
8. During treatment of a client in addiso-
nian crisis, it’s most appropriate for the nurse
to administer I.V.:
1. insulin.
2. normal saline solution.
3. dextrose 5% in half-normal saline
solution.
4. dextrose 5% in water.
Answer: 2. A client in addisonian crisis
has hyponatremia. It’s most appropriate to
administer normal saline solution. Hydrocor-
tisone, glucose, and vasopressors are also
used to treat addisonian crisis. Administering
dextrose 5% in half-normal saline solution,
dextrose 5% in water, or insulin would be inap-
propriate for this client.
➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Pharmacological
and parenteral therapies
Cognitive level: Application
9. A client with type 1 diabetes mellitus is
learning foot care. The nurse should include
which teaching point?
1. “It’s OK to go barefoot at home.”
2. “Trim your toenails with scissors
regularly.”
3. “Wear tight-fitting shoes without
socks.”
4. “Wear cotton socks and apply foot
powder to your feet to keep them
dry.”
Answer: 4. The nurse should instruct the
client to apply foot powder and to wear cotton
socks and properly fitting shoes. The nurse
4/8/2010 3:11:04 PM
 312 Endocrine system

should also instruct the client to avoid going

barefoot to prevent injury and avoid using
scissors to trim his nails.

➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Reduction of risk
potential
Cognitive level: Application

10. Which nursing diagnosis is most likely

for a client with an acute episode of diabetes
insipidus?
1. Imbalanced nutrition: More than
body requirements
2. Deficient fluid volume
3. Impaired gas exchange
4. Ineffective tissue perfusion
Answer: 2. Diabetes insipidus causes a pro-
nounced loss of intravascular volume. The
most prominent risk to the client is Deficient
fluid volume. Nutrition, as exchange, and
tissue perfusion are also at risk beause of
diabetes insipidus but this risk is a result of
the fluid volume deficit caused by diabetes
insipidus.

➽ NCLEX keys
Client needs category: Physiological integrity
Client needs subcategory: Reduction of risk
potential
Cognitive level: Application
It’s the end
of the endocrine
chapter! Aren’t
you “gland”
you’re done?

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