A client had a subtotal thyroidectomy in the early morning. During evening rounds, the nurse assesses the client who now has nausea, a temperature of 105 degrees F (40.6 C), tachycardia, and extreme restlessness. What is the most likely cause of these signs and symptoms?

Tetany.

Hypoglycemia.

Thyroid crisis.

Diabetic Ketoacidosis.

Answer and Explanation

The Correct Answer is C

Choice A rationale: Tetany is a neuromuscular hyperexcitability disorder caused by hypocalcemia, which can be a complication of a thyroidectomy due to accidental removal or damage to the parathyroid glands. Symptoms include tingling sensations, muscle spasms, and carpopedal spasms. While a possible post-surgical complication, the client’s signs of high temperature, tachycardia, and restlessness point to a different, more severe condition.
Choice B rationale: Hypoglycemia is a state of low blood glucose, typically below 70 mg/dL. Symptoms include sweating, shakiness, confusion, and hunger. The client’s signs of a high temperature, tachycardia, and extreme restlessness are not classic symptoms of hypoglycemia. Furthermore, hypoglycemia is not typically a complication of a thyroidectomy unless the client has a pre-existing diabetic condition.
Choice C rationale: A thyroid crisis, or thyroid storm, is a life-threatening complication of hyperthyroidism that can be precipitated by surgery, particularly a thyroidectomy, in an inadequately prepared client. It is characterized by a massive release of thyroid hormones, leading to a hypermetabolic state with symptoms including extremely high fever, severe tachycardia, altered mental status, and cardiovascular collapse. The client's symptoms are classic signs of this condition.
Choice D rationale: Diabetic ketoacidosis (DKA) is a severe complication of uncontrolled diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketone body production. Symptoms include fruity breath, abdominal pain, and Kussmaul respirations. A thyroidectomy is not a direct cause of DKA. The client’s signs and symptoms, particularly the very high temperature, are not typical of DKA.

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Correct Answer is C

Explanation

Choice A rationale: While a high-fat diet can contribute to insulin resistance and is a risk factor for type 2 diabetes, it is not a primary cause of type 1 diabetes. Type 1 diabetes is an autoimmune disorder where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas.
Choice B rationale: A diet high in concentrated carbohydrates is a risk factor for developing type 2 diabetes, as it can lead to increased insulin demand and eventual insulin resistance. It does not, however, trigger the autoimmune destruction of pancreatic beta cells that is the hallmark of type 1 diabetes.
Choice C rationale: Type 1 diabetes is a T-cell mediated autoimmune disease where the body's own immune system mistakenly identifies the beta cells of the pancreas as foreign invaders and attacks them. This destruction leads to a severe deficiency of insulin, a hormone essential for glucose metabolism. The presence of autoantibodies against beta cells confirms this pathophysiology.
Choice D rationale: Obesity is a major risk factor for developing type 2 diabetes because it leads to increased insulin resistance in the body's tissues. It is not a direct cause of type 1 diabetes, which is fundamentally an autoimmune disorder. While obesity can coexist with type 1 diabetes, it is not the etiological factor.

A. Do not walk around barefoot. B. Soak your feet in a tub each evening. C. Trim toenails straight across with a nail clipper. D. Treat any blisters or sores with Epsom salts. E. Wash your feet every other day.

Correct Answer is ["A","C"]

Explanation

Choice A rationale: Peripheral neuropathy and decreased circulation make the feet of a person with diabetes susceptible to injury and infection. Walking barefoot increases the risk of stepping on sharp objects or sustaining cuts, which may go unnoticed due to sensory loss. Proper footwear is essential to protect the feet from injury.
Choice B rationale: Soaking the feet, especially in hot water, can lead to maceration of the skin, making it more prone to fungal infections and breakdown. Due to nerve damage, a client with diabetes may not accurately perceive water temperature, risking burns. It is recommended to wash the feet with lukewarm water and pat them dry.
Choice C rationale: Trimming toenails straight across prevents ingrown toenails, a common source of foot infections. Ingrown nails can cause skin breakdown, creating an entry point for bacteria. Diabetic clients should avoid cutting the nails in a curved fashion to prevent this complication and should be cautious to avoid cutting the cuticles.
Choice D rationale: Epsom salts are a magnesium sulfate solution. They can be very drying to the skin, which is already prone to cracking in diabetic individuals, increasing the risk of infection. Furthermore, they are not an effective treatment for blisters or sores and could exacerbate the problem by irritating the skin.
Choice E rationale: Washing the feet every day is crucial for maintaining hygiene and inspecting for any cuts, sores, or changes. Daily washing with mild soap and lukewarm water helps prevent bacterial and fungal infections. Waiting until every other day to wash the feet increases the risk of infection.

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A client had a subtotal thyroidectomy in the early morning. During evening rounds, the nurse assesses the client who now has nausea, a temperature of 105 degrees F (40.6 C), tachycardia, and extreme restlessness. What is the most likely cause of these signs and symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is a major factor in the development of type 1 diabetes?

Correct Answer is C

Explanation

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in this client's teaching? (Select all that apply).

Correct Answer is ["A","C"]

Explanation

A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day?

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day, the client states, "I feel numbness and tingling around my mouth." What action should the nurse take?

Which type of diabetes is frequently associated with obesity and aging and may or may not require insulin therapy?

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?

A client presents with diaphoresis, palpitations, nervousness, and tachycardia approximately 4 hours after taking his usual morning insulin. Which treatment is appropriate for this client?

While assessing a client with Graves disease, the nurse notes that the client's temperature has risen 1 degree Fahrenheit. Which action should the nurse take first?

The physician orders 1000 mL Lactated Ringer's to infuse at 125 mL/hr for a postoperative patient. Tubing drop factor is 20 gtt/mL. Calculate the flow rate in drops per minute.