Endocrine Question #7

Question

The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto’s thyroiditis. After analyzing assessment data, the nurse will select which of the following nursing diagnoses? (Select all that apply)

Answers

  1. Activity intolerance related to weakness and fatigue and slowed metabolism.
    • Rationale:
  2. Fluid volume deficit related to dehydration and poor skin turgor.
    • Rationale:
  3. Risk for insomnia related to hyperactive state
    • Rationale:
  4. Risk for infection related to compromised immunologic status
    • Rationale:

Overview

Explanation

Hypothyroidism causes fatigue and weakness, which may affect activity levels and risk for infection because of alterations in adrenal function. B is incorrect since Hypothyroidism may cause weight gain and swelling with fluid volume excess. C is incorrect since hypothyroidism causes fatigue and sleepiness not hyperactivity (caused by hyperthyroidism). The nurse will assess for activity tolerance and perceived exertion and will plan interventions to avoid prolonged bedrest. The nurse will assess for early indicators of infection such as any fever, discharge from any wounds or IV site, urinary symptoms (frequency, dysuria, pain on voiding, cloudy), respiratory congestion, complaints of sore throat.

Learning Outcomes

Test Taking Tip

Video Rationale