Hipertiroidismo

The nurse is teaching a client who has Graves’ disease about self-management. Which of the following should the nurse include in the teaching plan?

• A.Stool softeners can be taken daily to prevent constipation.

• B.Thyroid replacement should be taken first thing in the morning.

• C.Report any significant weight gain while taking the antithyroid medication.

• D.Maintain the prescribed fluid restriction to prevent fluid overload.

Answer explanation

Choice C is correct. Graves’ disease is the most common cause of hyperthyroidism. When a client is taking antithyroid medication, such as methimazole, they should be taught about the warning signs of hypothyroidism (weight gain, constipation, anorexia). This could indicate that the dose needs to be decreased.

Choices A, B, and D are incorrect. Constipation is a hallmark finding of hypothyroidism (Choice A). This would not be expected of Graves’ disease. Thyroid replacement (Choice B) would be contraindicated for Graves’ disease as this would worsen hyperthyroidism. Thyroid replacement should be taken first in the morning by patients with hypothyroidism, not hyperthyroidism. Fluid restrictions are not indicated for Graves’ disease (Choice D).

The nurse is caring for a client with Graves' disease who has exophthalmos.

The nurse should recommend that the client

• A.prevent eye dryness by applying artificial tears.

• B.use scanning techniques to move the head from side to side.

• C.take their thyroid hormone as prescribed.

• D.sleep flat on your back without any pillows.

Answer explanation

Choice A is correct. Exophthalmos is an abnormal protrusion of the eyes and is associated with Graves' disease (hyperthyroidism). Exophthalmos may cause a client to develop dry eyes which could also increase their risk for ocular infection. The nurse should recommend that the client prevent eye dryness by applying artificial tears.

Choice B is incorrect. Scanning the room is an intervention recommended for individuals with peripheral visual loss. Peripheral visual loss is not a finding associated with exophthalmos. Visual alterations associated with exophthalmos include light sensitivity and double-vision.

Choice C is incorrect. Thyroid hormone for a client with Graves' disease is not a plausible treatment. The treatment for Graves' disease is antithyroid medication such as methimazole or propylthiouracil.

Choice D is incorrect. The client with exophthalmos should be advised to sleep with their head elevated with extra pillows to reduce eye edema.

The nurse is caring for a client who reports diarrhea, unintentional weight loss, and nervousness. The primary healthcare provider (PHCP) orders a thyroid panel, and the nurse understands the client is at the highest risk for

• A.Myxedema

• B.Bell’s palsy

• C.Grave’s disease

• D.Cushing syndrome

Answer explanation

Choice C is correct. Grave's disease is the most common cause of hyperthyroidism. It is characterized by increased heart rate, excessive sweating, heat intolerance, exophthalmos (bulging eyeballs), fatigue, tachycardia, shortness of breath, fine muscle tremors, thin silky hair/skin, and infrequent blinking.

Choices A, B, and D are incorrect. Myxedema, or hypothyroidism, is characterized by severe, non-pitting edema, puffy, edematous face and periorbital area, coarse facial features, dry skin, and dry, coarse hair. Bell's palsy is caused by a lower motor neuron lesion resulting in damage to cranial nerve VII and is characterized by unilateral paralysis of the face. Cushing syndrome is caused by excessive secretion of ACTH and chronic steroid use. Clinical features of Cushing's syndrome include weight gain, truncal obesity, increased blood glucose, and hirsutism.

The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for

• A.enalapril

• B.calcium gluconate

• C.levothyroxine

• D.propranolol

Answer explanation

Choice D is correct. A thyroid storm is a medical emergency and a complication of hyperthyroidism. Manifestations of a thyroid storm include fever, tachycardia, hypertension, and cardiac dysrhythmias. Emergent treatments for a thyroid storm include prescribed dexamethasone (corticosteroids inhibit the peripheral conversion of T4 into T3), propranolol (blocks the beta-adrenegic receptors to reduce heart rate and blood pressure), and an antithyroid medication such as propylthiouracil.

Choice A is incorrect. Enalapril is an ACE inhibitor and has no role in treating a thyroid storm. While this medication may ameliorate hypertension found with a thyroid storm, it is not the preferred drug because both tachycardia and hypertension are present in this endocrine emergency. Thus, the prescribed propranolol should be used. ACE inhibitors are preferred drugs for heart failure and hypertension.

Choice B is incorrect. Calcium gluconate is not used in a thyroid storm. This may be an indicated medication following a thyroidectomy because of the risk of post-procedure hypocalcemia.

Choice C is incorrect. Levothyroxine is the treatment for hypothyroidism. Giving this medication in a thyroid storm would be catastrophic because it would further increase circulating thyroid levels.

The nurse is caring for a client who developed a thyroid storm.

The nurse should obtain a prescription for

• A.enalapril

• B.regular insulin

• C.levothyroxine

• D.dexamethasone

Answer explanation

Choice D is correct. A thyroid storm is a medical emergency and is a complication of hyperthyroidism. Manifestations of a thyroid storm include fever, tachycardia, hypertension, and cardiac dysrhythmias. Emergent treatments for a thyroid storm include prescribed dexamethasone (corticosteroids inhibit the peripheral conversion of T4 into T3), propranolol (to reduce heart rate and blood pressure), and an antithyroid medication such as propylthiouracil.

Choice A is incorrect. Enalapril is an ACE inhibitor and has no role in treating a thyroid storm. While this medication may ameliorate hypertension found with a thyroid storm, it is not the preferred drug because both tachycardia and hypertension are present in this endocrine emergency. Thus, the prescribed propranolol should be used. ACE inhibitors are preferred drugs for heart failure and hypertension.

Choice B is incorrect. Regular insulin is not used in the management of a thyroid storm. Regular insulin is one of the two treatments for diabetic ketoacidosis.

Choice C is incorrect. Levothyroxine is the treatment for hypothyroidism. Giving this medication would be catastrophic because it would further increase circulating thyroid levels.