Symptoms and signs of primary hypothyroidism are often subtle and insidious. The most common presenting symptoms are fluid retention and puffiness, especially periorbitally; tiredness; cold intolerance; mental fogginess.
Various organ systems may be affected with many possible signs and symptoms, including:
Secondary hypothyroidism is characterized by skin and hair that are dry but not very coarse, skin depigmentation, only minimal macroglossia, atrophic breasts, and low blood pressure. Also, the heart is small, and serous pericardial effusions do not occur. Hypoglycemia is common because of concomitant adrenal insufficiency or growth hormone deficiency.
Myxedema coma is a life-threatening complication of hypothyroidism, usually occurring in patients with a long history of hypothyroidism. Its characteristics include coma with extreme hypothermia (temperature 24° to 32.2° C), areflexia, seizures, and respiratory depression with carbon dioxide retention. Severe hypothermia may be missed unless low-reading thermometers are used. Rapid diagnosis based on clinical judgment, history, and physical examination is imperative, because death is likely without rapid treatment. Precipitating factors include illness, infection, trauma, drugs that suppress the central nervous system, and exposure to cold.
Medical and Surgical Nursing (NCLEX Exams)
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Text Mode – Text version of the exam 1) A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?
2) Despite the availability of a wide array of thyroid hormone products, it is clear that ___________ is the treatment of choice for almost all patients with hypothyroidism.
3) High TSH but low FT4 suggests…Hint: TSH and FT4 levels going in opposite directions is usually what we expect to see, generally indicating a problem on the level of the thyroid.
4) A radioactive iodide uptake test helps determine intrinsic thyroid function. A thyroid scan can help distinguish etiology (such as cancer). A TRH stimulation test helps determine thyroid and ________ function.
5) A nurse gets back results on a pt who may have hyperthyroidism. What lab values might the nurse expect?
6) The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that:
7) A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:
8) Iodine’s main function in therapy is to:
9) A nurse gets back results on a pt who may have hypothyroidism. What lab values might the nurse expect?
10) On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops:
11) Which of the following potentially serious complications could occur with therapy for hypothyroidism?
12) Some causes of hypothyroidism include iatrogenic causes, drugs (such as amiodarone and lithium), and this (also known as autoimmune thyroiditis)….
13) A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse’s response is based on the knowledge that:
14) A nurse understands calcitonin and parathormone when the nurse states:
15) Mrs. Gilmour is complaining of being hot all the time, sweating, being thirsty, and losing hair. What could her symptoms indicate?
16) Thyrotoxicosis is understood when the nurse states:
17) T3 and T4 are produced in which type of cell?
18) A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize
19) What does tyrosine combine with to make T3 and T4?
20) Radioactive Iodine’s main function in therapy is to:
21) Michael comes into the ED. His HR is 150 and has a fever of 104.5. He is confused and anxious. What could be Michael’s problem?
22) After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
23) A client is admitted with a diagnosis of hypothyroidism. An initial assessment of the client would reveal:
24) A 58 year old woman has newly diagnosed with hypothyroidism. The nurse is aware that the signs and symptoms of hypothyroidism include:
25) A pt is given radioactive iodine for a thyroid scan. How often are the tests taken?
26) T3 and T4 are similar, but different produced in equal amounts? 27) A client with hypothyroidism frequently complains of feeling cold. The nurse should tell the client that she will be more comfortable if she:
28) A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?
29) Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
30) An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of:
31) A 3-month-old client is in the pediatric unit. During assessment, the nurse is suspecting that the baby may have hypothyroidism when mother states that her baby does not:
Answers and Rationales
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