Nokea
A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism?
- A. A 20-year-old female with pregnancy-induced hypertension
- B. A 41-year-old male receiving dialysis for end-stage kidney disease
- C. A 41-year-old male receiving dialysis for end-stage kidney disease
- D. A 27-year-old male who is prescribed home oxygen therapy
Correct Answer: B
Rationale: Clients with chronic kidney disease have impaired vitamin D activation and calcium absorption, leading to chronic hypocalcemia, which overstimulates the parathyroid glands, causing hyperparathyroidism. Pregnancy-induced hypertension and oxygen therapy do not increase this risk.
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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.
After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional instruction?
- A. I may need calcium replacement after surgery
- B. After surgery, I won't need to take thyroid medication
- C. I will need to take thyroid hormones for the rest of my life
- D. I can receive pain medication if I feel that I need it
Correct Answer: B
Rationale: After a complete thyroidectomy, clients require lifelong thyroid hormone replacement due to the removal of the thyroid gland. The statement indicating no need for thyroid medication is incorrect and requires further teaching.
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 plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client's plan of care?
- A. Monitor the electrolyte measurement once every shift
- B. Administer acetaminophen (Tylenol) for fever
- C. Ensure that working suction equipment is in the room
- D. Provide supplemental oxygen as needed
Correct Answer: C
Rationale: Clients with hypothyroidism and concurrent illness like pneumonia are at risk for myxedema coma, where maintaining an airway is critical. Ensuring working suction equipment is available is a priority to manage potential airway obstruction.
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.