Thyroidectomy (17 Questions)

1.1 Ms. Isabelle Marchand is recovering on the surgical unit after a total thyroidectomy performed earlier today. Her surgery went smoothly, and she is currently stable with an IV running at maintenance rate and receiving postoperative monitoring.

Two hours into your shift, you notice intermittent muscle twitching, and Ms. Marchand reports numbness and tingling around her lips, fingers, and toes.

Question:
What do you suspect is happening to the patient? *
1.2 Given her numbness, tingling, and muscle twitching. You immediately notify the physician. The physician gives a verbal order.

Medical orders:
*Draw serum calcium and magnesium levels STAT
*Administer calcium gluconate 1 g IV over 10 minutes if symptomatic
*Monitor cardiac rhythm continuously

Question:
What is your next priority intervention? *
1.3 Ms. Marchand continues to speak in a strained and weak voice. She appears frustrated and tries to express herself, but speaking seems difficult. You want to ensure she can still communicate effectively while her voice is recovering.

Question:
What is the most appropriate nursing action to facilitate communication with Ms. Marchand? *
1.4 Ms. Marchand is being discharged home following her thyroidectomy. Before leaving, she asks what she should and shouldn’t do during her recovery at home.

Question:
What advice will you give her to support a safe and effective recovery? Choose TWO (2) answers *
1.5 During her follow up visit, she admits to stopping her Synthroid (levothyroxine) for the past two months.

She appears withdrawn, tearful, and expresses suicidal thoughts.

She also mentions that her boyfriend broke up with her on Facebook.

Question:
What do you suspect is happening to Ms. Marchand? *
2. Mme. Ginette Roy, 45 years old, is 2 hours post-total thyroidectomy. She presses the call bell urgently. When the nurse enters, Mme. Roy is sitting on the side of the bed, appearing terrified and gasping for air. Upon auscultation, the nurse hears high-pitched, harsh sounds (stridor) on inspiration. There is swelling noted at the anterior neck.

Medical Orders:
*Head of Bed (HOB) elevated 30-45 degrees.
*Vital signs q15min.
*Tracheostomy tray at bedside.
*Calcium Gluconate IV PRN.

Question:
What is the nurse’s priority action? *
3. M. Pierre Tremblay, 55 years old, is 24 hours post-total thyroidectomy. During the morning assessment, he complains to the nurse that his lips feel numb and tingling, and his fingertips feel "pins and needles." He is restless.

Medical Orders:
*Regular diet.
*Calcium Carbonate PO BID.
*Calcium Gluconate 10% IV PRN.
*Monitor for signs of hypocalcemia.

Question:
What is the nurse’s priority intervention? *
4. Mme. Lise Gagnon, 38 years old, is recovering from a subtotal thyroidectomy. While the nurse is measuring her blood pressure, the cuff is inflated above the systolic pressure. Suddenly, Mme. Gagnon’s hand flexes inward (carpal spasm) and she cannot voluntarily relax it.

Medical Orders:
*Vital signs q4h.
*Serum Calcium levels daily.

Question:
How should the nurse document this finding? *
5. M. Robert Bouchard, 29 years old, had a thyroidectomy for Graves' Disease (Hyperthyroidism) 6 hours ago. He suddenly becomes extremely agitated and confused.

Assessment:
*Temperature: 40.1°C.
*Heart Rate: 135 bpm (tachycardia).
*BP: 160/95 mmHg.
*Skin: Hot and flushed.

Medical Orders:
*Acetaminophen 650 mg PO/PR q4h PRN for fever.
*Notify MD for Temp > 38.5°C or HR > 120.
*Propranolol IV PRN.

Question:
What condition should the nurse suspect? *
6. Mme. Claire Turcotte, 62 years old, returns to the unit post-thyroidectomy. She is drowsy but follows commands. The nurse is positioning her in bed to ensure safety and comfort.

Medical Orders:
*Bed rest with bathroom privileges.
*Support head and neck with pillows.
*Ice pack to incision PRN.

Question:
What is the most appropriate position? *
7. M. Jean-Paul Cote, 50 years old, is 4 hours post-op. He complains of a sensation of "fullness" or pressure in his neck. The nurse inspects the anterior dressing and notes it is dry and intact with only a scant amount of serosanguinous drainage.

Medical Orders:
*Monitor dressing for bleeding.
*Vital signs q1h.

Question:
What is the nurse’s next action? *
9. M. Michel Fortin, 60 years old, had a Total Thyroidectomy for cancer. He is preparing for discharge. He asks the nurse, "How long will I have to take this Levothyroxine (Synthroid) pill?"

Medical Orders:
*Discharge home.
*Levothyroxine 100 mcg PO daily.
*Follow up TSH levels in 6 weeks.

Question:
What is the correct nursing response? *
10. The nurse is preparing the room to receive Mme. Valérie Desjardins, who is currently in the PACU following a thyroidectomy. The nurse ensures the bed is in the correct position and organizes the bedside table.

Medical Orders:
*Post-op Thyroidectomy protocol.

Question:
Which specific safety equipment must be available at the bedside before the patient arrives? *
11. M. Sylvain Lapointe, 35 years old, is being discharged. He is concerned about the appearance of his scar on his neck.

Medical Orders:
*Discharge instructions.
*No heavy lifting.

Question:
Which instruction should the nurse provide to minimize scarring and protect the incision? *
12. Mme. Isabelle Gagnon, 42 years old, is 18 hours post-total thyroidectomy. She calls the nurse to her bedside and says, "I feel strange. My lips feel numb and vibrating, and my fingertips are tingling like they are asleep." The nurse assesses her and notes she is slightly anxious and her facial muscles twitch slightly when she speaks.

Medical Orders:
*Vital signs q4h.
*Monitor calcium levels.
*Notify MD of significant changes.

Question:
What do you suspect is happening to the patient? *
13. M. Claude Tremblay, 55 years old, is 2 hours post-thyroidectomy. He is resting in a semi-Fowler’s position. The nurse observes that M. Tremblay is making frequent swallowing movements, even though he is not drinking or eating. When asked, he reports a sensation of "pressure" in his neck but no severe pain. The visible dressing is dry.

Medical Orders:
*Monitor airway and bleeding.
*Ice pack to neck PRN.

Question:
What do you suspect is happening to the patient? *