A patient is being treated with propylthiouracil (PTU) for hyperthyroidism, pending thyroidectomy. While the patient is taking this drug, what symptoms will the nurse teach the patient to report to the health care provider?
1. Tinnitus, altered taste, thickened saliva
2. Insomnia, nightmares, night sweats
3. Sore throat, chills, low-grade fever
4. Dry eyes, decreased blinking, reddened conjunctiva
Answer: 3
Rationale: Low-grade fever, chills, and sore throat are signs of possible infection. Because PTU may cause leukopenia or agranulocytosis, these symptoms should be reported to the health care provider for further assessment. Options 1, 2, and 4 are incorrect. Tinnitus, altered taste, thickened saliva, nightmares or night sweats, insomnia, dry eyes, decreased blinking, or reddened sclera are not symptoms related to PTU therapy
Answer: 4
Rationale: Myxedema is characterized by severely decreased cardiac output, fluid and electrolyte imbalance, acidosis, decreased respiratory function, tongue edema, and hypothermia. The client's airway, breathing, and circulation needs must be attended to first. The client would be on bedrest immediately after admission. The BP would be decreased, rather than elevated, because of reduced cardiac output. The client in myxedema coma has generally lost consciousness. Skin breakdown is a significant risk that needs to be managed concurrently with promotion of oxygenation, but the diet should be high in fiber once the client is stable enough to eat.
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Increased risk of thyroid disorder is found in individuals who are:
A. obese.
B. hypertensive.
C. treated with systemic corticosteroids.
D. elderly.
D. elderly.
A 48-year-old woman with newly diagnosed hypothyroidism asks about a "natural thyroid" medication she read about online and provides the drug's name: desiccated thyroid. As you counsel her about this medication, you consider all of the following except:
A. this product contains a fixed dose of T3 and T4.
B. the medication is a plant-based product.
C. its pharmacokinetics differ significantly when compared to levothyroxine.
D. the majority of the study on treatment for hypothyroidism has been done using levothyroxine.
B. the medication is a plant-based product.
Hypothyroidism most often develops as a result of:
A. primary pituitary failure.
B. thyroid neoplasia.
C. autoimmune thyroiditis.
D. radioactive iodine exposure.
C. autoimmune thyroiditis.
Which is following is the least helpful test for the assessment of thyroid disease?
A. total T4
B.
thyroid-stimulating hormone (TSH)
C. free T4
D. thyroid peroxidase (TPO) antibodies
A. total T4
Physical examination findings in patients with Graves' disease include:
A. muscle tenderness.
B. coarse, dry skin.
C. eyelid retraction.
D. delayed relaxation phase of the patellar reflex.
C. eyelid retraction.
The mechanism of action of radioactive iodine in the treatment of Graves' disease is to:
A. destroy the overactive thyroid tissue.
B. reduce production of TSH.
C. alter thyroid metabolic rate.
D. relieve distress caused by increased thyroid size.
A. destroy the overactive thyroid tissue.
Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism?
A. propranolol
B. diazepam
C. carbamazepine
D. verapamil
A. propranolol
In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true?
A. Elderly persons require a rapid initiation of levothyroxine therapy.
B. TSH should be checked about 2 days after dosage adjustment.
C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.
D. TSH should be suppressed to a nondetectable level.
C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.
TSH is released by the:
A. thyroid follicles.
B. adrenal cortex.
C. hypothalamus.
D. anterior lobe of the pituitary
D. anterior lobe of the pituitary
In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with:
A. autonomously functioning adenoma.
B. Graves' disease.
C. Hashimoto's disease.
D. thyroid cyst.
D. thyroid cyst.
You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with the patient except which instruction?
A. "Take the medication on an empty stomach."
B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication."
C. "You should take the medication at approximately the same time every day."
D. "Do not take your medication with soy milk."
B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication."
The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with:
A. autonomously functioning adenoma.
B. Graves' disease.
C. Hashimoto's disease.
D. thyroid malignancy.
A. autonomously functioning adenoma.
A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of:
A. adenomatous lesion.
B. Graves' disease.
C. Hashimoto's disease.
D. thyroid malignancy.
D. thyroid malignancy.
Which of the following is the most cost-effective method of distinguishing a malignant from a benign thyroid nodule?
A. ultrasound
B. magnetic resonance (MRI) imaging
C. fine-needle aspiration
biopsy
D. radioactive iodine scan
C. fine-needle aspiration biopsy
Possible consequences of excessive levothyroxine use include:
A. bone thinning.
B. fatigue.
C. renal impairment.
D. constipation.
A. bone thinning.
At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted?
A. 1 to 2 weeks
B. 2 to 4 weeks
C. 4 to 6 weeks
D. 6 to 8 weeks
D. 6 to 8 weeks
As part of an evaluation of a 3-cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-filled structure. The most likely
diagnosis is:
A. adenoma.
B. thyroid cyst.
C. multinodular goiter.
D. vascular lesion.
B. thyroid cyst.
Periodic routine screening for hypothyroidism is indicated in the presence of which of the following
clinical conditions?
A. digoxin use
B. male gender
C. Down syndrome
D. alcoholism
C. Down syndrome
Heat intolerance is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Smooth, silky skin are associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Goiter is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
C. both.
Frequent, low-volume and loose stools are associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Secondary hypertriglyceridemia is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism,
Amenorrhea or oligomenorrhea is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
coarse and dry skin are associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism,
Menorrhagia is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism
Hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Proximal muscle weakness is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Tachycardia with hypertension
A. hyperthyroidism
B. hypothyroidism
C. both.
A. hyperthyroidism
Hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism
Coarse hair with tendency to break easily is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism
Thick and dry nails are associated with which of the following?
A.
hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism
Constipation is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
B. hypothyroidism
Atypical presentation in an elderly person is associated with which of the following?
A. hyperthyroidism
B.
hypothyroidism
C. both.
C. both.
Change in mental status is associated with which of the following?
A. hyperthyroidism
B. hypothyroidism
C. both.
C. both.
The use of which of the following medications can induce thyroid dysfunction?
A. sertraline
B. venlafaxine
C. bupropion
D. lithium
D. lithium
Match the condition with the laboratory results:
TSH = 8.9 mIU/L (0.4 to 4.0 mIU/L); free
T4 = 15 pmol/L (10 to 27 pmol/L)
A. hypothyroidism
B. hyperthyroidism
C. subclinical hypothyroidism.
C. subclinical hypothyroidism.
Match the condition with the laboratory results:
TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4 = 79 pmol/L (10 to 27 pmol/L)
A. hypothyroidism
B. hyperthyroidism
C. subclinical hypothyroidism.
Hyperthyroidism
Match the condition with the laboratory results:
TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free
T4 = 3 pmol/L (10 to 27 pmol/L)
A. hypothyroidism
B. hyperthyroidism
C. subclinical hypothyroidism.
Hypothyroidism
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