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A nurse is receiving a patient from the emergency room (ER) with an admitting diagnosis of hypothyroid disorder. 

Admitting diagnosis

acute hypothyroid disorder

Physician order

Synthroid 0.1 mg po daily

The receiving medical- surgical nurse would expect the patient to exhibit which signs and symptoms? Select all that apply

A.

cold intolerance

B.

depression dry skin

C.

weakness and fatigue

D.

constipation

E.

mental alertness

Question Solution

Correct Answer : A,B,C,D

A. Cold intolerance: Patients with hypothyroidism often have difficulty regulating body temperature, leading to a heightened sensitivity to cold.

 

B. Depression: Hypothyroidism can affect mood and cognitive function, often leading to symptoms of depression.

 

C. Weakness and fatigue: Low thyroid hormone levels can cause significant fatigue and muscle weakness due to a slower metabolism.

 

D. Constipation: A slowed metabolism can also affect gastrointestinal motility, resulting in constipation.

 

E. Mental alertness: This is typically not expected in hypothyroid patients. In fact, they may experience cognitive impairments, memory issues, or slowed thinking rather than mental alertness.


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Correct Answer is B

Explanation

A. Assessing the pedal pulses does not provide relevant information about the irregularity of the radial pulse.

B. Assessing the apical pulse for a full minute is appropriate in this situation, as it provides a more accurate measurement of the heart rate and rhythm, especially when the radial pulse is irregular.

C. Assessing the popliteal pulses with a Doppler device is not necessary and does not directly address the irregular radial pulse.

D. While a pulse oximeter can provide information about oxygen saturation, it does not assess heart rate or rhythm.

Correct Answer is A

Explanation

A. The bell of the stethoscope is best used to listen for low-pitched sounds, including some types of murmurs, and can help assess the quality and intensity of a cardiac murmur.

B. While palpation can provide some information about the heart's function (such as thrills), it is not the primary method for assessing the quality of a murmur.

C. A Doppler ultrasound device is used for measuring blood flow and can help in assessing murmurs but does not provide the quality assessment needed for characterizing a murmur.

D. Percussion is not typically used to evaluate murmurs; it is more useful for assessing the size and borders of organs.

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