Exam 1 Case Study Questions & Answers
100% Correct!!
The patient is a 29-year-old woman who comes to the emergency department with a history of
diaphoresis, unplanned weight loss despite increased appetite, and palpitations. Assessment reveals
a wide-eyed look, a small thyroid mass, and vital signs including blood pressure (BP) 148/92, heart
rate (HR) 104 beats/minute, temperature 98.4°F (36.9°C), and respiratory rate (RR) 24
breaths/minute. Her history includes decreased menstrual flow, increased fatigue, and weakness.
*Which nursing concept will the nurse use to interpret data and plan care for this patient?*
A.Safety
B.Hormonal regulation
C.Perfusion
D.Cellular regulation - ANSWERANS: B
Focus: Prioritization
The thyroid gland produces thyroid hormones (T3 and T4) which are important in control of
metabolism. Both hormones increase metabolism.
Weight loss, diaphoresis (heat intolerance), palpitations, exophthalmos (wide-eyed, startled look),
presence of goiter (thyroid mass), decreased menstrual, as well and increased BP, HR, and RR are all
classic manifestations of hyperthyroidism. A patient with hypothyroidism would present with the
opposite picture such as weight gain, cold intolerance, bradycardia, hypotension, and decreased
respiratory function.
What lab values would support the diagnosis of hyperthyroidism? *(Select all that apply.)*
A.Increased T3 and T4
B.Decreased T3 and T4
C.Increased thyroid-stimulating hormone (TSH)
D.Decreased TSH
E.Thyroid antibodies—high titer
F.Thyroid scan—increased uptake of radioactive iodine (RAI) - ANSWERANS: A, D, E, F
,Focus: Prioritization
Thyroid hormones T3 (triiodothyronine) and T4 (thyroxine) are increased; TSH is low in
hyperthyroidism caused by Graves disease (most common cause); high titer of antithyroglobulin
occurs with hyperthyroidism; a thyroid scan demonstrates an increased uptake of RAI.
The nurse is preparing a nursing care plan for the patient with focused areas on nutrition,
hyperthermia, and fatigue. Which interventions would be appropriate to delegate to the unlicensed
assistive personnel (UAP) working with you? *(Select all that apply.)*
A.Checking and reporting the patient's vital signs every 4 hours
B.Assisting the patient to the bathroom as needed
C.Assessing for signs and symptoms of infection
D.Recording intake from every meal
E.Administering propylthiouracil (PTU) 50 mg every 8 hour
F.Ensuring the patient always has fresh ice water at the bedside - ANSWERANS: A, B, D, F
Focus: Delegation
Checking and reporting vital signs is within the scope of practice for UAPs (be sure to instruct the
UAP to report any temperature increase immediately and assess cardiac status if this occurs); patient
care assistance, recording intake, and providing ice water are within the scope of practice for UAPs.
The administration of medications is appropriate to the RN or the licensed practical nurse/licensed
vocational nurse (LPN/LVN) scope of practice, and assessing for manifestations of infection is within
the RN scope of practice.
The UAP reports that the patient's oral temperature with 8 AM vital signs is 99.8°F (37.7°C). What is
the nurse's priority action at this time?
A.Administer two tablets of acetaminophen.
B.Lower the patient's room temperature.
C.Notify the health care provider.
D.Instruct the patient to rest quietly. - ANSWERANS: C
Focus: Prioritization
, Increases in the temperature of a patient with hyperthyroidism may indicate the onset of thyroid
storm, a life-threatening event that occurs with uncontrolled hyperthyroidism, characterized by high
fever and hypertension. You should immediately report a temperature increase of even one degree.
If a UAP is checking vital signs, be sure to instruct them to report the patient's temperature as soon
as it is obtained. If the temperature is elevated, immediately assess the patient's cardiovascular
status and if the patient is on a cardiac monitor, check for dysrhythmias.
The health care provider orders RAI therapy for the patient. What priority question would the nurse
be sure to ask the patient before this therapy is given?
A."Have you noticed any increased tearing or a bloodshot appearance of your eyes?"
B."Do you have periods of amenorrhea or decreased menstrual flow?"
C."How many bowel movements do you have in a typical day?"
D."Are you pregnant or trying to become pregnant?" - ANSWERANS: D
Focus: Prioritization
RAI therapy is not used with pregnant women because it crosses the placenta and can damage the
fetal thyroid gland. It is important to ask all of these questions, but the question about pregnancy is a
priority.
Which information is key to include when teaching the patient about RAI therapy? *(Select all that
apply.)*
A. RAI is performed on an inpatient basis.
B. RAI may be administered orally.
C. Complete symptom relief may take 6 to 8 weeks.
D. Some patients may need a second or third dose of RAI.
E. The radiation dose is usually eliminated within a week.
F. Some patients require lifelong therapy with thyroid hormone replacement. - ANSWERNS: B, C, D, F
Focus: Prioritization
RAI therapy is usually performed on an outpatient basis. The radiation dose is usually eliminated
within a month. All of the other statements about RAI are accurate and should be included in a
teaching plan for a patient who is to receive RAI therapy.
