1. A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which
assessment finding supports this diagnosis?
1.
... [Show More] Periorbital edema
2. Bradycardia
3. Exophthalmos
4. Hoarse voice - Ans: 3 Exophthalmos
Exophthalmos (abnormal protrusion of the eyes) is characteristic of patients with hyperthyroidism due to
Graves disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients with
hypothyroidism. Focus: Prioritization
2. Which change in vital signs would you instruct the UAP to report immediately for a patient with
hyperthyroidism?
1. Rapid heart rate
2. Decreased systolic blood pressure
3. Increased respiratory rate
4. Decreased oral temperature - Ans: 1 Rapid heart rate
The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood
pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased
body temperature related to increased metabolic rate. Respiratory changes are usually not symptomatic of
this condition. Focus: Delegation, supervision
3. For a patient with hyperthyroidism, which task will you delegate to an experienced UAP?
1. Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or chest pain
2. Monitoring the apical pulse, blood pressure, and temperature every 4 hours
3. Drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine, and thyroxine
4. Teaching the patient about side effects of the drug propylthiouracil - Ans: 2 Monitoring the apical pulse,
blood pressure, and temperature every 4 hours
Monitoring vital signs and recording their values are within the education and scope of practice of UAPs. An
experienced UAP should have been taught how to monitor the apical pulse. However, a nurse should
observe the UAP to be sure that the UAP has mastered this skill. Instructing and teaching patients, as well
as performing venipuncture to obtain laboratory samples, are more suited to the education and scope of
practice of licensed nurses. In some facilities, an experienced UAP may perform venipuncture, but only
after special training. Focus: Delegation, supervision, assignment
4. As the shift begins, you are assigned to care for the following patients. Which patient should you assess
first?
1. 38-year-old with Graves disease and a heart rate of 94 beats/min
2. 63-year-old with type 2 diabetes and fingerstick glucose level of 137 mg/dL
3. 58-year-old with hypothyroidism and a heart rate of 48 beats/min
4. 49-year-old with Cushing disease and dependent edema rated as 1+ - Ans: 3 58-year-old with
hypothyroidism and a heart rate of 48 beats/min
Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of
48 beats/min may have significant implications for cardiac output and hemodynamic stability. Patients with
Graves disease usually have a rapid heart rate, but 94 beats/min is within normal limits. The diabetic
patient may need sliding-scale insulin dosing. This is important but not urgent. Patients with Cushing
disease frequently have dependent edema. Focus: Prioritization
5. A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to a
UAP?... [Show Less]