Case Study #1

Patient Profile:

Name: Sarah Thompson

Age: 34

Diagnosis: Hyperthyroidism due to Graves' disease

Treatment: Scheduled to receive an oral dose of unsealed radioactive iodine (1-131)

Clinical Background: Sarah has experienced symptoms of hyperthyroidism for the past 6 months, including weight loss, heat intolerance, palpitations, and anxiety. Her lab results show elevated T3 and T4 levels and suppressed TSH. After unsuccessful management with methimazole, her endocrinologist recommended radioactive iodine therapy.

The nurse is conducting discharge teaching for Sarah about unsealed radioactive isotope therapy. Which of the following should the nurse include in her teaching session for Sarah? (Select 3 options)

"Eat foods high in vitamins such as apples, pears, and oranges."

"Wash your clothing separate from others in the household."

"Do not share utensils, plates, and cups with anyone else."

“You can play with your children for 1 hour each day."

"Flush the toilet at least 3 times after each use"

Answer and Explanation

Correct Answer : B,C,E

A. "Eat foods high in vitamins such as apples, pears, and oranges.": There is no specific dietary restriction related to vitamins following radioactive iodine therapy. The primary focus should be on radiation precautions and post-treatment care, not on specific food choices.

B. "Wash your clothing separate from others in the household.": Sarah should wash her clothes separately from others to minimize exposure to radiation. Radioactive iodine can be excreted in sweat, and separation helps reduce exposure to family members.

C. "Do not share utensils, plates, and cups with anyone else.": After receiving radioactive iodine therapy, Sarah should avoid sharing utensils, plates, and cups to limit potential exposure to radioactive material. This helps reduce the risk of radiation contamination.

D. "You can play with your children for 1 hour each day.": Direct contact with others, especially children, should be minimized after radioactive iodine therapy. Sarah should avoid close contact with children and others to minimize exposure to radiation.

E. "Flush the toilet at least 3 times after each use.": To reduce radiation exposure, Sarah should flush the toilet at least three times after each use to ensure that radioactive iodine is effectively cleared from the system. This helps prevent contamination of shared bathroom areas.

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Correct Answer is B

Explanation

A. Notify the night supervisor of the patient's deteriorating condition: While it’s important to keep supervisors informed, hypoglycemia needs to be treated immediately. The priority action is to raise the patient’s blood glucose level, not waiting to notify the supervisor.

B. The patient is experiencing symptoms of hypoglycemia, and the best initial action is to give a fast-acting carbohydrate like orange juice (about 15g of sugar). After 15 minutes, the blood sugar should be rechecked. Following the treatment with a complex carbohydrate and protein helps to maintain blood glucose levels and prevent recurrence of hypoglycemia.

C. Ambulate the patient in the hall to use up excess glucose with exercise: Exercise can lower blood glucose levels, which would be dangerous in a hypoglycemic patient. The priority is to raise the blood sugar rather than use exercise to manage glucose levels.

D. Give insulin by sliding scale based on glucometer reading: The patient’s blood sugar is low (51 mg/dL), which indicates hypoglycemia, not hyperglycemia. Insulin should not be administered in this situation, as it would further decrease the blood glucose levels.

A. Diarrhea B. Tachycardia C. Weight loss D. Cold intolerance

Correct Answer is D

Explanation

A. Diarrhea: This is more commonly associated with hyperthyroidism, where increased metabolism can lead to more frequent bowel movements. It is not typically a sign of hypothyroidism, which often leads to constipation.

B. Tachycardia: Tachycardia (increased heart rate) is a common sign of hyperthyroidism due to the increased metabolic rate. In hypothyroidism, the heart rate often slows down, leading to bradycardia.

C. Weight loss: Weight loss is typically associated with hyperthyroidism, where the increased metabolic rate causes the body to burn more calories. In contrast, hypothyroidism generally leads to weight gain due to a slowed metabolism.

D. Cold intolerance: Cold intolerance is a common symptom of hypothyroidism. People with hypothyroidism have a slowed metabolism, leading to difficulty regulating body temperature, and they often feel unusually cold, even in warm environments.

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Which assessment finding would indicate that Sarah is developing hypothyroidism post-treatment?

Correct Answer is D

Explanation

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

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