Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect?
A. Flaccid muscles
Flaccid muscles are associated with conditions like hypokalemia, not hypoparathyroidism. In hypoparathyroidism, there is a deficiency of parathyroid hormone (PTH), which leads to low calcium levels and can result in muscle spasms and tetany, not flaccid muscles.
B. Client report of anorexia
While anorexia can occur in clients with various health conditions, it is not a specific finding associated with hypoparathyroidism.
C. Client report of numbness in his hands
Correct. Hypoparathyroidism is characterized by low levels of parathyroid hormone (PTH), which leads to low calcium levels in the blood. This can cause symptoms such as numbness, tingling, and muscle cramps, especially in the extremities.
D. Negative Chvostek's sign
A positive Chvostek's sign is associated with hypocalcemia, which can be caused by hypoparathyroidism. Therefore, a negative Chvostek's sign would not be an expected finding in a client with hypoparathyroidism.
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Full Explanation
A. Flaccid muscles are associated with conditions like hypokalemia, not hypoparathyroidism. In hypoparathyroidism, there is a deficiency of parathyroid hormone (PTH), which leads to low calcium levels and can result in muscle spasms and tetany, not flaccid muscles.
B. While anorexia can occur in clients with various health conditions, it is not a specific finding associated with hypoparathyroidism.
C. Correct. Hypoparathyroidism is characterized by low levels of parathyroid hormone (PTH), which leads to low calcium levels in the blood. This can cause symptoms such as numbness, tingling, and muscle cramps, especially in the extremities.
D. A positive Chvostek's sign is associated with hypocalcemia, which can be caused by hypoparathyroidism. Therefore, a negative Chvostek's sign would not be an expected finding in a client with hypoparathyroidism.
Similar Questions
A patient is scheduled for surgery to remove a tumor of the anterior pituitary. Which hormone should the nurse expect to be affected by this surgery? Select all that apply.
A. Thyroid stimulating hormone (TSH)
Thyroid stimulating hormone (TSH): The anterior pituitary gland secretes TSH, which regulates the thyroid gland's function. Surgery on the anterior pituitary can potentially disrupt the production and regulation of TSH.
B. Prolactin
Prolactin: The anterior pituitary gland also produces prolactin. Surgery on the anterior pituitary can affect prolactin production.
C. Oxytocin
Oxytocin: Oxytocin is produced by the posterior pituitary, not the anterior pituitary. Surgery on the anterior pituitary would not directly impact oxytocin production.
D. Gonadotropin hormones
Gonadotropin hormones: These include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are important for reproductive function. The anterior pituitary secretes these hormones, so surgery on the anterior pituitary can impact their production.
E. Adrenocorticotropic hormone (ACTH)
Adrenocorticotropic hormone (ACTH): ACTH is essential for the stimulation of cortisol release from the adrenal glands. The production of ACTH is regulated by the anterior pituitary, so surgery in this area can affect ACTH levels.
Full Explanation
A. Thyroid stimulating hormone (TSH): The anterior pituitary gland secretes TSH, which regulates the thyroid gland's function. Surgery on the anterior pituitary can potentially disrupt the production and regulation of TSH.
B. Prolactin: The anterior pituitary gland also produces prolactin. Surgery on the anterior pituitary can affect prolactin production.
C. Oxytocin: Oxytocin is produced by the posterior pituitary, not the anterior pituitary. Surgery on the anterior pituitary would not directly impact oxytocin production.
D. Gonadotropin hormones: These include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are important for reproductive function. The anterior pituitary secretes these hormones, so surgery on the anterior pituitary can impact their production.
E. Adrenocorticotropic hormone (ACTH): ACTH is essential for the stimulation of cortisol release from the adrenal glands. The production of ACTH is regulated by the anterior pituitary, so surgery in this area can affect ACTH levels.
A nurse is assessing a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect?
A. Drowsiness
Drowsiness is not a typical manifestation of thyrotoxicosis. Instead, individuals with thyrotoxicosis often experience restlessness and anxiety due to excessive thyroid hormone levels.
B. Dry skin
Dry skin is more commonly associated with hypothyroidism (insufficient thyroid hormone levels), rather than thyrotoxicosis (excessive thyroid hormone levels).
C. Bradycardia
Bradycardia (slower than normal heart rate) is a symptom of hypothyroidism, not thyrotoxicosis. In thyrotoxicosis, tachycardia (an abnormally rapid heart rate) is a common finding.
D. Heat intolerance
Correct. Heat intolerance is a classic symptom of thyrotoxicosis. Excessive thyroid hormone levels can lead to an increased metabolic rate, making individuals more sensitive to heat.
Full Explanation
A. Drowsiness is not a typical manifestation of thyrotoxicosis. Instead, individuals with thyrotoxicosis often experience restlessness and anxiety due to excessive thyroid hormone levels.
B. Dry skin is more commonly associated with hypothyroidism (insufficient thyroid hormone levels), rather than thyrotoxicosis (excessive thyroid hormone levels).
C. Bradycardia (slower than normal heart rate) is a symptom of hypothyroidism, not thyrotoxicosis. In thyrotoxicosis, tachycardia (an abnormally rapid heart rate) is a common finding.
D. Correct. Heat intolerance is a classic symptom of thyrotoxicosis. Excessive thyroid hormone levels can lead to an increased metabolic rate, making individuals more sensitive to heat.
A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis?
A. Administer aspirin as prescribed for any sign of hyperthermia.
Administering aspirin for hyperthermia is not a standard intervention for hyperthyroidism. Hyperthermia can occur in severe cases of hyperthyroidism, but the primary intervention is to address the underlying thyroid dysfunction and provide supportive care.
B. Keep the client NPO.
Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis in hyperthyroidism. It may be necessary for certain pre-operative preparations or if the client is undergoing specific procedures, but it does not address the prevention of a thyroid crisis.
C. Observe the client carefully for signs of hypocalcemia.
While monitoring for signs of hypocalcemia is important in some cases of thyroid dysfunction, it is not the primary action to prevent a thyroid crisis. In hyperthyroidism, the focus is on managing excessive thyroid hormone levels.
D. Provide a quiet, low-stimulus environment.
Correct. Providing a quiet, low-stimulus environment is a crucial nursing intervention for clients with hyperthyroidism. They can be highly sensitive to external stimuli due to their increased metabolic rate. A calm environment helps reduce stress and the risk of exacerbating symptoms, potentially preventing a thyroid crisis.
Full Explanation
A. Administering aspirin for hyperthermia is not a standard intervention for hyperthyroidism. Hyperthermia can occur in severe cases of hyperthyroidism, but the primary intervention is to address the underlying thyroid dysfunction and provide supportive care.
B. Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis in hyperthyroidism. It may be necessary for certain pre-operative preparations or if the client is undergoing specific procedures, but it does not address the prevention of a thyroid crisis.
C. While monitoring for signs of hypocalcemia is important in some cases of thyroid dysfunction, it is not the primary action to prevent a thyroid crisis. In hyperthyroidism, the focus is on managing excessive thyroid hormone levels.
D. Correct. Providing a quiet, low-stimulus environment is a crucial nursing intervention for clients with hyperthyroidism. They can be highly sensitive to external stimuli due to their increased metabolic rate. A calm environment helps reduce stress and the risk of exacerbating symptoms, potentially preventing a thyroid crisis.