Exam 15: Thyroid and Parathyroid Surgery

What is the mechanism by which the parathyroid glands maintain calcium homeostasis?

A patient having a subtotal thyroidectomy for tracheal or esophageal obstruction is best served by a surgical team that recognizes and is prepared for patients who are at risk for difficult intubation.An example of a nursing intervention during the postoperative phase would be:

Anatomic exposure is promoted and supported by proper body alignment in collaboration with safe and secure surgical positioning.The optimal presentation of the thyroid and surrounding structures of the neck can be achieved with the patient in supine or beach-chair position.Select the positioning considerations that enhance visualization and access to important structures.

Norma Hightower,a 32-year-old thin and pale patient with hypothyroidism,is met by the Perioperative nurse for her preoperative assessment.The nurse notes Norma's thin frame and pale,fragile skin.Norma states that she is so cold that she has all of her clothes on under her patient gown.Based on her assessment,the nursing diagnosis for Norma will focus interventions on her:

The preoperative testing regimen for diagnosing thyroid disorders follows a structured plan of history taking,neck palpation,imaging scans,and fine needle aspiration.Select the statement from that is an appropriate reflection of a thyroid diagnostic study.

Thyroid surgery is considered surgery of the head and neck.There is a high risk for surgical fires because of the proximity of all three components of the fire triangle.Select the statement that best reflects an appropriate nursing action to prevent a surgical fire.

Patients with hyperthyroidism should be assessed and monitored for an abnormally elevated resting pulse rate,elevated systolic blood pressure,and cardiac symptoms.Atrial fibrillation is the most common cardiac complication of hyperthyroidism.An example of a nursing action during the nursing assessment phase would be:

Substernal or intrathoracic thyroidectomy is indicated for extensions of goiters that are encroaching into the substernal or intrathoracic regions,causing tracheal or esophageal obstruction.Access to the substernal compartment is typically facilitated by:

Postoperative hoarseness,obstructed airway,or paralysis of the vocal cords is a serious complication of thyroid surgery.During surgery,care is taken to identify and protect which nerve?

Open parathyroidectomy is currently being replaced with less invasive and more targeted techniques;however,the amount of parathyroid tissue that should be removed remains controversial and relates to whether single or multiple glands are involved.A portion of a gland must remain to:

Shari Donaldson is scheduled for a thyroidectomy.She is significantly underweight as a result of her thyroid disease.The perioperative nurse considers her to be at high risk for pressure and shearing injury to skin and tissues.An example of a nursing consideration in the preoperative phase for Shari would be:

An example of antithyroid drugs that would be administered during a thyroid storm crisis would be:

A number of symptoms and signs are well-established manifestations of thyroid dysfunction.The American Association of Clinical Endocrinologists (AACE)has established practice guidelines for the diagnostic evaluation and screening of hyperthyroidism and hypothyroidism.The AACE recommends the ___ as the single best screening test.A history of ___ are symptoms of concern,and patients with ___ require MRI or CT imaging because this may be indicative of metastasis.Select the clinical triad to complete this diagnostic screening guideline.

Hypothyroidism results from undersecretion of thyroid hormone.The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis (Hashimoto's disease).Select the set of symptoms that is most commonly associated with hypothyroidism.

The primary function of the three thyroid hormones is to regulate:

The patient with hyperthyroidism most likely has received appropriate drug therapy that has returned thyroid hormone levels and metabolic state to normal;however,the perioperative nurse should assess for any symptoms that relate to accelerated metabolism.Select the set of symptoms that is most commonly associated with hyperthyroidism.

Total thyroidectomy is the removal of both lobes of the thyroid and all thyroid tissue present.Total thyroidectomy is the desired surgical treatment for patients with:

Thyroid storm can occur in patients whose hyperthyroidism is partially controlled or untreated.Thyrotoxic crisis can be precipitated by a stressful event,such as surgery.An example of a nursing action(s)to reduce the risk of thyroid storm is:

A minimally invasive video-assisted thyroidectomy (MIVAT)procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup,a 30-degree endoscope,and an ultrasonic (harmonic)scalpel with scissors to ligate and divide the vessels.An important risk reduction strategy for any minimally invasive procedure would be (select all that apply):

Jennifer Peoples is a 41-year-old woman with suspected primary adenocarcinoma of the thyroid;she is scheduled for total thyroidectomy surgery.The scrub person,Joni,a new perioperative nurse,is determined to participate in employing risk reduction strategies in the scrub role.An example of risk reduction strategies for thyroid surgery,within the domain of the scrub role,would be: