Chapter 2: Problem 48
The 45-year-old client is seen in the clinic with hyperthyroidism. What would the nurse expect the admitting assessment to reveal? A. Bradycardia B. Decreased appetite C. Exophthalmos D. Weight gain
Short Answer
Expert verified
Answer: C. Exophthalmos
Step by step solution
01
Understand hyperthyroidism
Hyperthyroidism is a condition where the thyroid gland produces excessive thyroid hormone, causing an increase in the body's metabolism. Typical symptoms include weight loss, increased appetite, sweating, nervousness, irritability, and rapid or irregular heartbeat.
02
Analyze the given symptoms
Now that we know the typical symptoms of hyperthyroidism, let's analyze the given symptoms:
A. Bradycardia: This refers to a slow heart rate, which is not consistent with hyperthyroidism.
B. Decreased appetite: Although hyperthyroidism leads to increased metabolism, it often increases appetite rather than decreasing it.
C. Exophthalmos: This term refers to the protrusion of the eyeball, which is a common symptom of hyperthyroidism, particularly in cases of Graves' disease.
D. Weight gain: This symptom is also inconsistent with hyperthyroidism, as the increased metabolism often results in weight loss instead.
03
Select the correct symptom
Based on our understanding of hyperthyroidism symptoms and analyzing the given options, we can conclude that option C. Exophthalmos is the correct symptom that a nurse would expect to find during the admitting assessment of a client with hyperthyroidism.
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Key Concepts
These are the key concepts you need to understand to accurately answer the question.
NCLEX-PN Exam Preparation
Preparing for the National Council Licensure Examination for Practical Nurses (NCLEX-PN) can be a daunting task, but with a systematic approach, candidates can enhance their chances of success. First and foremost, a thorough understanding of the exam format is crucial. The NCLEX-PN consists of multiple-choice questions designed to test the knowledge, skills, and abilities essential for safe and effective entry-level nursing practice.
- Begin by reviewing core nursing content areas, including pharmacology, medical-surgical nursing, pediatrics, maternity, and mental health nursing.
- Make use of study guides and practice tests to familiarize yourself with the style of questions you will encounter.
- Create a study schedule that allocates time for reviewing different topics and allows for repeated practice of test questions.
- Seek out resources that offer detailed explanations for both correct and incorrect answers to enhance understanding.
- Focus on areas such as prioritization, delegation, and the nursing process, as these are emphasized on the exam.
Symptoms of Hyperthyroidism
When assessing for hyperthyroidism, it is essential to recognize the common symptoms associated with this endocrine disorder. Individuals with hyperthyroidism typically exhibit signs that reflect an overactive thyroid gland leading to increased metabolism. Some hallmark symptoms include:
- Weight loss despite an increased appetite is a classic symptom due to the accelerated metabolism.
- Rapid or irregular heartbeat (tachycardia or palpitations) as the body tries to compensate for the heightened metabolic rate.
- Sweating and heat intolerance caused by the overstimulation of sweat glands.
- Nervousness or anxiety which may be a result of the excess thyroid hormones affecting the nervous system.
- Exophthalmos, the protrusion of the eyeballs, is a distinguished sign particularly associated with Graves' disease, an autoimmune form of hyperthyroidism.
Clinical Assessment in Nursing
Clinical assessment is a foundational aspect of nursing practice. It involves a systematic approach to gathering information about a patient's health status. This includes a detailed history, physical examination, and the integration of diagnostic test results. A rigorous clinical assessment will enable nurses to identify patient needs, formulate nursing diagnoses, and create appropriate care plans.
- Assessment begins with collecting subjective data, which includes patient-reported symptoms, health history, and social and emotional factors.
- Objective data collection follows, involving the measurement of vital signs, physical examination, and observing clinical manifestations.
- Special attention is given to systems affected by the patient’s presenting problem, using tools like inspection, palpation, percussion, and auscultation.
- Diagnostic reasoning and critical thinking are applied to interpret findings and identify patterns suggestive of specific health conditions.
- Effective communication skills are necessary to explain procedures, clarify patient concerns, and ensure the patient's understanding of their condition and care plan.