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A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy?
- A. Blurred and double vision
- B. Increased thirst and urination
- C. Increased thirst and double vision
- D. Decreased attention and insomnia
Correct Answer: B
Rationale: Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.
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A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, 'I feel numbness and tingling around my mouth.' What action should the nurse take?
- A. Offer mouth care
- B. Loosen the dressing
- C. Assess for Chvostek's sign
- D. Ask the client orientation questions
Correct Answer: C
Rationale: 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 for Chvostek's sign and Trousseau's sign to confirm hypocalcemia and notify the provider.
A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
- A. Reassure the client that the voice change is temporary
- B. Notify the provider immediately
- C. Place the client in a high-Fowler's position and apply oxygen
- D. Prepare for emergency intubation
Correct Answer: D
Rationale: Stridor is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. The nurse should place the client in a high-Fowler's position and apply oxygen to maintain the airway while preparing to assist with emergency intubation or tracheostomy and notifying the provider or Rapid Response Team.
A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert 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 doesn't taste good without a lot of salt
- D. I am always tired, even with 12 hours of sleep
Correct Answer: D
Rationale: Clients with hypothyroidism often feel tired or weak despite adequate sleep. Thyroid problems are not necessarily inherited, heat intolerance suggests hyperthyroidism, and loss of taste is not a typical manifestation of hypothyroidism.
A nurse assesses a client who is prescribed thyroid hormone replacement. Which finding indicates a therapeutic response to the medication?
- A. Thirst is recognized and fluid intake is appropriate
- B. Weight has been the same for 3 weeks
- C. Total white blood cell count is 6000 cells/mm³
- D. Heart rate is 70 beats/min and regular
Correct Answer: D
Rationale: Hypothyroidism decreases body functioning, leading to effects like bradycardia. A heart rate of 70 beats/min and regular while on thyroid hormone replacement indicates adequate dosing. Thirst, fluid intake, weight stability, and white blood cell count are not direct indicators of therapeutic response.
A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL, Sodium 144 mEq/L, Magnesium 1.2 mEq/L, Potassium 5.7 mEq/L. Based on these results, which medications should the nurse anticipate administering?
- A. Oral potassium chloride
- B. Intravenous calcium chloride
- C. 50% normal saline IV solution
- D. 50% magnesium sulfate
- E. Oral calcitriol (Rocaltrol)
Correct Answer: B,D
Rationale: The client has hypocalcemia (calcium 7.2 mg/dL) and hypomagnesemia (magnesium 1.2 mEq/L), requiring intravenous calcium chloride and magnesium sulfate. Potassium is elevated, so potassium chloride is not needed. Sodium is normal, so saline is unnecessary, and no vitamin D deficiency is indicated.