Nokea
The nurse is obtaining the health history from a patient. Which of the following statements by the patient indicates further assessment of thyroid function may be necessary?
- A. I notice my breasts are tender lately.
- B. I am so thirsty that I drink all day long.
- C. I get up several times at night to urinate.
- D. I feel a lump in my throat when I swallow.
Correct Answer: D
Rationale: Difficulty in swallowing can occur with a goitre. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or persistent kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.
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The nurse is caring for a patient who is preparing for a growth hormone stimulation test. Which of the following adverse effects should the nurse monitor for during the test?
- A. Bradycardia
- B. Hypotension
- C. Hyperglycemia
- D. Tachypnea
Correct Answer: B
Rationale: During a growth hormone stimulation test, the nurse should continually assess for hypoglycemia and hypotension. There is no indication to monitor for bradycardia or tachypnea.
The student nurse is caring for a patient with goitre and possible hyperthyroidism. Which of the following actions by the student nurse should cause the nursing instructor to intervene?
- A. Palpates the neck to check thyroid size.
- B. Checks the blood pressure on both arms.
- C. Administers nonmedicated eye drops to the patient's eyes.
- D. Lowers the thermostat to decrease the temperature in the room.
Correct Answer: A
Rationale: Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the student nurse are appropriate when caring for a patient with an enlarged thyroid.
The nurse is caring for a patient who has clinical manifestations of hypothyroidism. Which of the following laboratory tests is most accurate to evaluate thyroid function?
- A. Thyroxine (T4) level
- B. Triiodothyronine (T3) level
- C. Thyroid-stimulating hormone (TSH) level
- D. Thyrotropin-releasing hormone (TRH) level
Correct Answer: C
Rationale: The most sensitive and accurate laboratory test is measurement of TSH; thus it is often recommended as a first diagnostic test for evaluation of thyroid function. A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T4 and T3 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.
The nurse is caring for a patient who is scheduled for a 24-hour urine collection for 17-ketosteroids. Which of the following actions should the nurse implement?
- A. Keep the specimen on ice.
- B. Insert a retention catheter.
- C. Have the patient void and save that specimen to start the collection.
- D. Encourage the patient to drink 2-3 L of fluid during the 24 hours.
Correct Answer: A
Rationale: The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.
During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. Which of the following is the best action for the nurse to take?
- A. Palpate the patient's neck more deeply.
- B. Document that the thyroid was nonpalpable.
- C. Notify the health care provider immediately.
- D. Teach the patient about thyroid hormone testing.
Correct Answer: B
Rationale: The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.