Nokea
The nurse is caring for an older-adult patient who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
- A. Apical pulse rate
- B. Nutritional intake
- C. Intake and output
- D. Orientation and alertness
Correct Answer: A
Rationale: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
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The nurse is caring for a patient with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this patient?
- A. Insomnia related to frequent waking at night to void
- B. Impaired gas exchange related to fluid retention in lungs
- C. Excess fluid volume related to intake greater than output
- D. Risk for impaired skin integrity related to generalized edema
Correct Answer: A
Rationale: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
The nurse is caring for a patient with hyperthyroidism who is being treated with radioactive iodine (RAI) at the clinic. Which of the following information should the nurse provide to the patient prior to discharge?
- A. Symptoms of hyperthyroidism should be relieved in about a week.
- B. Hypothyroidism may occur as the RAI therapy takes effect.
- C. Discontinue the antithyroid medications taken before the radioactive therapy.
- D. Teach radioactive precautions to use with urine, stool, and other body secretions.
Correct Answer: B
Rationale: There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2-3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
The nurse is caring for a patient with a diagnosis of Cushing's syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
- A. Persistently low blood pressure
- B. Bronzed appearance of the skin
- C. Decreased axillary and pubic hair
- D. Purplish red streaks on the abdomen
Correct Answer: D
Rationale: Purplish-red striae on the abdomen are a common clinical manifestation of Cushing's syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.
The nurse is caring for a patient in a long-term care facility who has these medications prescribed. After the patient is diagnosed with hypothyroidism, which of the following medications should the nurse report to the health care provider?
- A. Docusate
- B. Diazepam
- C. Ibuprofen
- D. Cefoxitin
Correct Answer: B
Rationale: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older persons. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.
The nurse is planning teaching for a patient who was admitted with myxedema coma and diagnosed with hypothyroidism. Which of the following strategies is best for the nurse to use?
- A. Delay teaching until patient discharge.
- B. Ensure privacy by asking visitors to leave.
- C. Provide written handouts of all information.
- D. Offer multiple options for management of therapies.
Correct Answer: C
Rationale: Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Since the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.