‼️MIDTERM (DKA, Myxedema, Thyrototoxiosis) Flashcards
Which of the following best characterizes DKA?
A. Hyperglycemia, lactic acidosis, edema
B. Hyperglycemia, ketosis, acidosis, dehydration
C. Hypoglycemia, respiratory alkalosis, bradycardia
D. Hyperinsulinemia, hypoglycemia, alkalosis
Answer: B. Hyperglycemia, ketosis, acidosis, dehydration
Rationale: DKA is defined by insulin deficiency, leading to high blood glucose, ketone production, metabolic acidosis, and dehydration.
What is the most common precipitating factor of DKA?
A. Alcohol use
B. High-protein diet
C. Infection
D. Allergies
Answer: C. Infection
Rationale: Infections increase insulin demand and are a common trigger for DKA in both type 1 and type 2 diabetics.
A patient with DKA has Kussmaul respirations. What is the cause of this symptom?
A. Hypoglycemia
B. Renal failure
C. Compensation for metabolic acidosis
D. Electrolyte imbalance
Answer: C. Compensation for metabolic acidosis
Rationale: Kussmaul respirations are deep, rapid breaths the body uses to blow off CO₂ and reduce acidosis.
Which lab finding confirms DKA?
A. Glucose < 70 mg/dL
B. Serum pH > 7.45
C. Serum bicarbonate > 26 mEq/L
D. Glucose > 250 mg/dL with ketonuria
Answer: D. Glucose > 250 mg/dL with ketonuria
Rationale: DKA is diagnosed with high blood glucose and the presence of ketones in urine or serum.
Which electrolyte must be checked before starting insulin therapy in DKA?
A. Calcium
B. Potassium
C. Sodium
D. Chloride
Answer: B. Potassium
Rationale: Insulin drives potassium into cells, risking severe hypokalemia if not corrected before insulin is started.
What initial IV fluid is used to treat a patient with DKA?
A. 5% Dextrose in Water
B. 0.9% Normal Saline
C. 3% Hypertonic Saline
D. Lactated Ringer’s with Dextrose
Answer: B. 0.9% Normal Saline
Rationale: NS is used first to restore volume and perfusion in DKA patients.
A fruity odor on the breath of a DKA patient is due to:
A. Urea
B. Ammonia
C. Acetone
D. Glucose
Answer: C. Acetone
Rationale: Acetone, a ketone body, causes the fruity odor in DKA.
Which symptom is NOT commonly associated with DKA?
A. Polyuria
B. Polydipsia
C. Bradycardia
D. Abdominal pain
Answer: C. Bradycardia
Rationale: Tachycardia, not bradycardia, is common due to dehydration.
A major complication of rapid correction of DKA with fluids and insulin is:
A. Hypertension
B. Cerebral edema
C. Cardiac tamponade
D. Pulmonary embolism
Answer: B. Cerebral edema
Rationale: Rapid drops in glucose and osmolarity can cause cerebral swelling.
Which insulin is typically used in IV form during DKA management?
A. NPH
B. Glargine
C. Lispro
D. Regular insulin
Answer: D. Regular insulin
Rationale: Regular insulin is the only insulin approved for IV use.
What is the typical blood pH in a patient with DKA?
A. >7.45
B. 7.35–7.45
C. <7.30
D. 7.30–7.34
Answer: C. <7.30
Rationale: DKA leads to metabolic acidosis, reflected in a pH below 7.30.
Which sign indicates dehydration in DKA?
A. Crackles in lungs
B. Bounding pulse
C. Dry mucous membranes
D. Decreased urine specific gravity
Answer: C. Dry mucous membranes
Rationale: Dehydration in DKA is evidenced by dry mucosa, tachycardia, and hypotension.
Why is dextrose added to IV fluids when glucose approaches 250 mg/dL during DKA treatment?
A. To prevent hypernatremia
B. To prevent cerebral edema
C. To prevent hypoglycemia
D. To stop ketone production
Answer: C. To prevent hypoglycemia
Rationale: Dextrose prevents glucose levels from dropping too fast, which can cause hypoglycemia and cerebral edema.
Which potassium trend is expected after starting insulin in a DKA patient?
A. Increase
B. Remain stable
C. Decrease
D. Fluctuate randomly
Answer: C. Decrease
Rationale: Insulin promotes cellular uptake of potassium, lowering serum levels.
What is the effect of insulin deficiency on fat metabolism?
A. Decreases ketone production
B. Increases lipogenesis
C. Increases ketone production
D. Increases glycogen stores
Answer: C. Increases ketone production
Rationale: Without insulin, fat is broken down for energy, producing ketones.
Which ketone body causes metabolic acidosis in DKA?
A. Acetaldehyde
B. Acetyl-CoA
C. Acetoacetic acid
D. Beta-hydroxybutyrate
Answer: D. Beta-hydroxybutyrate
Rationale: This ketone is a major contributor to acidosis in DKA.
Which symptom is a late sign of worsening DKA?
A. Blurred vision
B. Polyphagia
C. Lethargy progressing to coma
D. Polydipsia
Answer: C. Lethargy progressing to coma
Rationale: CNS depression from acidosis and dehydration can lead to coma.
What is the primary treatment goal in the first hour of DKA management?
A. Start long-acting insulin
B. Reduce glucose below 200 mg/dL
C. Correct fluid and electrolyte imbalance
D. Treat nausea
Answer: C. Correct fluid and electrolyte imbalance
Rationale: Restoring perfusion and correcting dehydration is the top priority.
A nurse monitors urine output during DKA treatment. What is the target output?
A. 5–10 mL/hr
B. 15–25 mL/hr
C. 30–60 mL/hr
D. >100 mL/hr
Answer: C. 30–60 mL/hr
Rationale: Adequate urine output indicates sufficient renal perfusion.
What is an important nursing intervention before insulin infusion in DKA?
A. Assess glucose tolerance
B. Administer antiemetics
C. Check potassium level
D. Record abdominal circumference
Answer: C. Check potassium level
Rationale: Hypokalemia must be corrected before insulin therapy begins.
Which electrolyte abnormality is most concerning during DKA treatment?
A. Hypernatremia
B. Hypomagnesemia
C. Hypokalemia
D. Hypochloremia
Answer: C. Hypokalemia
Rationale: Hypokalemia can cause fatal arrhythmias during insulin therapy.
What should be monitored continuously during IV insulin infusion for DKA?
A. Liver enzymes
B. Blood pressure
C. Blood glucose
D. Hemoglobin
Answer: C. Blood glucose
Rationale: Close monitoring prevents rapid changes and ensures target reduction rates.
Which patient is most at risk for DKA?
A. Type 1 DM with skipped insulin doses
B. Type 2 DM on oral meds with diet control
C. Type 2 DM on insulin with HbA1c of 5.8%
D. Non-diabetic with hyperthyroidism
Answer: A. Type 1 DM with skipped insulin doses
Rationale: Skipping insulin is a common cause of DKA in type 1 diabetics.
Which of the following is a sick-day rule for diabetics to prevent DKA?
A. Stop all insulin
B. Avoid fluids
C. Check glucose and ketones frequently
D. Exercise vigorously
Answer: C. Check glucose and ketones frequently
Rationale: Monitoring helps detect early changes and prevent DKA.
What is the best indicator that treatment for DKA is effective?
A. Decreased appetite
B. Normal ABG values
C. Increased thirst
D. Vomiting stopped
Answer: B. Normal ABG values
Rationale: Normalizing pH and bicarbonate indicates resolution of acidosis.
How do corticosteroids affect glucose levels?
A. Decrease insulin secretion
B. Increase insulin sensitivity
C. Increase blood glucose
D. Decrease glucose absorption
Answer: C. Increase blood glucose
Rationale: Steroids promote gluconeogenesis, raising glucose levels.
Which system failure is most life-threatening in untreated DKA?
A. Hepatic failure
B. Renal failure
C. Endocrine failure
D. Lymphatic failure
Answer: B. Renal failure
Rationale: Renal failure worsens acidosis by retaining ketones and glucose.
In DKA, what causes abdominal pain and nausea?
A. Elevated insulin levels
B. Gastric ulcers
C. Acidosis
D. Hypernatremia
Answer: C. Acidosis
Rationale: Metabolic acidosis irritates the GI tract, causing pain and vomiting.
What is the most appropriate nursing action if serum potassium is 2.8 mEq/L in a DKA patient?
A. Start insulin drip
B. Give sodium bicarbonate
C. Administer IV potassium
D. Give an antidiarrheal
Answer: C. Administer IV potassium
Rationale: Potassium must be corrected before insulin to prevent arrhythmias.
Which of the following helps differentiate DKA from HHS?
A. Higher glucose levels in DKA
B. Ketones present in DKA
C. Neurologic symptoms only in DKA
D. Acidosis only in HHS
Answer: B. Ketones present in DKA
Rationale: DKA is associated with ketone production and metabolic acidosis, while HHS typically is not.
Which hormone is deficient in DKA?
A. Glucagon
B. Cortisol
C. Insulin
D. ADH
Answer: C. Insulin
Rationale: A lack of insulin leads to the metabolic derangements seen in DKA.
What is the best fluid replacement strategy for a patient with a history of CHF and DKA?
A. Rapid bolus of 1 liter
B. D5W only
C. Slow IV infusion with cardiac monitoring
D. Encourage oral fluids only
Answer: C. Slow IV infusion with cardiac monitoring
Rationale: Patients with heart disease are at risk for fluid overload.
A DKA patient is irritable and confused. What should the nurse check first?
A. Blood glucose
B. WBC count
C. Urine specific gravity
D. pH
Answer: A. Blood glucose
Rationale: Altered mental status can result from hypoglycemia after insulin administration.
Which is a goal of DKA management?
A. Increase ketone production
B. Lower glucose by 100 mg/dL per hour
C. Prevent cerebral edema
D. Stop insulin once glucose is normal
Answer: C. Prevent cerebral edema
Rationale: Treatment should avoid rapid correction to reduce cerebral swelling.
What education should the nurse provide to prevent DKA recurrence?
A. Avoid taking insulin during illness
B. Limit fluid intake when sick
C. Check blood glucose every 4 hours when ill
D. Only call provider if vomiting persists for 3 days
Answer: C. Check blood glucose every 4 hours when ill
Rationale: Frequent monitoring during illness is a key prevention strategy.
Which of the following is the most life-threatening complication of hypothyroidism?
A. Thyroid storm
B. Hyperparathyroidism
C. Myxedema coma
D. Graves’ disease
Answer: C. Myxedema coma
Rationale: Myxedema coma is a medical emergency and the most serious complication of hypothyroidism.
Which finding is most commonly seen in patients with myxedema?
A. Fine tremors
B. Facial puffiness and periorbital edema
C. Increased appetite
D. Skin flushing
Answer: B. Facial puffiness and periorbital edema
Rationale: Myxedema is associated with non-pitting edema from mucopolysaccharide accumulation.
Which hormone is deficient in myxedema?
A. Cortisol
B. Thyroxine (T4)
C. Epinephrine
D. Parathyroid hormone
Answer: B. Thyroxine (T4)
Rationale: Myxedema results from severe deficiency of thyroid hormone, primarily T4.
Which of the following is NOT a symptom of hypothyroidism?
A. Cold intolerance
B. Weight loss
C. Constipation
D. Fatigue
Answer: B. Weight loss
Rationale: Patients with hypothyroidism often gain weight due to a slowed metabolism.
What is the most common cause of primary hypothyroidism in the U.S.?
A. Iodine deficiency
B. Pituitary tumor
C. Atrophy from autoimmune thyroiditis
D. Thyroid cancer
Answer: C. Atrophy from autoimmune thyroiditis
Rationale: Hashimoto’s thyroiditis causes destruction of thyroid tissue leading to hypothyroidism.
Which lab value pattern is indicative of primary hypothyroidism?
A. ↓TSH, ↑T4
B. ↑TSH, ↓T4
C. Normal TSH, ↑T4
D. ↓TSH, ↓T4
Answer: B. increased TSH, decreased T4
Rationale: In primary hypothyroidism, the thyroid fails to respond to TSH, causing low T4 and elevated TSH.
Which medication is used to treat hypothyroidism?
A. Propylthiouracil
B. Levothyroxine
C. Methimazole
D. Radioactive iodine
Answer: B. Levothyroxine
Rationale: Levothyroxine (Synthroid) is the drug of choice for thyroid hormone replacement.
Which of the following symptoms should the nurse immediately report in a patient on levothyroxine?
A. Mild fatigue
B. Weight gain
C. Chest pain
D. Dry skin
Answer: C. Chest pain
Rationale: Chest pain may indicate myocardial ischemia due to increased cardiac demand from levothyroxine.
What type of diet is recommended for a hypothyroid patient trying to lose weight?
A. High-fat, low-carb
B. Low-sodium
C. Low-calorie
D. High-calorie
Answer: C. Low-calorie
Rationale: A low-calorie diet helps prevent further weight gain in patients with a slow metabolism.
A patient with myxedema coma may present with:
A. Hypertension and tachycardia
B. Hyperthermia and restlessness
C. Hypotension and hypoventilation
D. Polyuria and polydipsia
Answer: C. Hypotension and hypoventilation
Rationale: Myxedema coma causes low BP and breathing rate, requiring ICU-level support.
What type of medication administration is used for a patient in myxedema coma?
A. Oral
B. Intramuscular
C. Subcutaneous
D. Intravenous
Answer: D. Intravenous
Rationale: Severe gastric hypomotility impairs oral absorption, so IV therapy is preferred.
What assessment is most important after initiating levothyroxine in a patient with heart disease?
A. Pedal pulses
B. Heart rate
C. Deep tendon reflexes
D. Urine output
Answer: B. Heart rate
Rationale: Increased heart rate may indicate cardiac strain or dysrhythmias due to increased metabolism.
How long does it typically take to see the full effect of levothyroxine?
A. 24 hours
B. 1–3 days
C. 1–2 weeks
D. 6–8 weeks
Answer: D. 6–8 weeks
Rationale: Levothyroxine has a slow onset; full effect takes up to two months.
What should the nurse include in discharge teaching for a patient newly diagnosed with hypothyroidism?
A. Stop medication when symptoms resolve
B. Take levothyroxine with food
C. Avoid abrupt medication withdrawal
D. Switch brands frequently for best effect
Answer: C. Avoid abrupt medication withdrawal
Rationale: Stopping levothyroxine can cause recurrence or worsening of hypothyroidism.
Which lab value indicates the effectiveness of levothyroxine therapy?
A. TSH
B. Hemoglobin
C. Serum calcium
D. Creatinine
Answer: A. TSH
Rationale: TSH levels guide dose adjustments and treatment effectiveness.
The nurse should be most concerned about which lab value in a patient with myxedema?
A. Sodium 134 mEq/L
B. Potassium 4.0 mEq/L
C. Glucose 58 mg/dL
D. Hematocrit 40%
Answer: C. Glucose 58 mg/dL
Rationale: Hypoglycemia is common in myxedema coma and may contribute to mental status changes.
Which of the following findings in an older adult might be attributed to hypothyroidism instead of aging?
A. Constipation and fatigue
B. Increased appetite and anxiety
C. Tachycardia and insomnia
D. Warm, moist skin
Answer: A. Constipation and fatigue
Rationale: These common aging symptoms should be evaluated for possible thyroid dysfunction.
What skin change is commonly associated with myxedema?
A. Oily skin
B. Thick, dry skin
C. Petechiae
D. Sweating
Answer: B. Thick, dry skin
Rationale: Myxedema causes skin thickening and dryness due to fluid retention and mucopolysaccharides.
Which drug can induce hypothyroidism by interfering with thyroid hormone production?
A. Prednisone
B. Lithium
C. Acetaminophen
D. Furosemide
Answer: B. Lithium
Rationale: Lithium blocks thyroid hormone synthesis and may cause hypothyroidism.
What is the earliest sign of hypothyroidism in most patients?
A. Diarrhea
B. Bradycardia
C. Fatigue
D. Tremors
Answer: C. Fatigue
Rationale: Fatigue is usually the first and most common symptom reported.
Which cardiovascular manifestation is commonly seen in hypothyroidism?
A. Increased cardiac output
B. Tachycardia
C. Bradycardia
D. Ventricular hypertrophy
Answer: C. Bradycardia
Rationale: Hypothyroidism causes decreased metabolism, leading to slower heart rate and reduced cardiac output.
What is the best action when a patient taking levothyroxine reports palpitations and nervousness?
A. Reassure the patient that it’s normal
B. Hold the dose and notify the provider
C. Encourage fluids
D. Schedule a follow-up in 6 months
Answer: B. Hold the dose and notify the provider
Rationale: These are signs of levothyroxine overdose (i.e., hyperthyroidism), and the provider must adjust the dose.
Which finding indicates improvement in a patient receiving treatment for hypothyroidism?
A. Increased fatigue
B. Slower speech
C. Weight loss and improved mental clarity
D. Worsening constipation
Answer: C. Weight loss and improved mental clarity
Rationale: Return to euthyroid state improves cognition and normalizes metabolism.
What should the nurse instruct a patient taking levothyroxine daily?
A. Take the medication with meals
B. Take it at bedtime for better absorption
C. Take in the morning on an empty stomach
D. Split the dose into two equal parts
Answer: C. Take in the morning on an empty stomach
Rationale: Food affects absorption. Taking it 30–60 minutes before breakfast ensures optimal effect.
What is a priority nursing diagnosis for a patient in myxedema coma?
A. Risk for injury
B. Ineffective airway clearance
C. Deficient fluid volume
D. Acute pain
Answer: B. Ineffective airway clearance
Rationale: Myxedema coma leads to hypoventilation and respiratory depression, making airway management critical.
Which instruction is most appropriate regarding brand changes of levothyroxine?
A. Rotate between generics
B. It’s fine to switch based on price
C. Use the same brand consistently
D. Discontinue if switching to natural therapy
Answer: C. Use the same brand consistently
Rationale: Bioavailability may differ between brands, affecting hormone levels and patient outcomes.
Which sign differentiates myxedema from general hypothyroidism?
A. Cold intolerance
B. Puffy face and mask-like expression
C. Weight gain
D. Constipation
Answer: B. Puffy face and mask-like expression
Rationale: Myxedema specifically includes thickened skin and facial edema.
The nurse expects which lab value to be elevated in untreated hypothyroidism?
A. Free T4
B. TSH
C. T3
D. Serum calcium
Answer: B. TSH
Rationale: The pituitary increases TSH in response to low thyroid hormone levels.
Which population is at higher risk for subclinical hypothyroidism?
A. Teenage girls
B. Elderly men
C. Women over 60
D. Newborn boys
Answer: C. Women over 60
Rationale: Subclinical hypothyroidism is more common in aging women due to autoimmune thyroid changes.
What is a common complication of long-standing hypothyroidism?
A. Hepatitis
B. Coronary atherosclerosis
C. Osteoporosis
D. Hyperkalemia
Answer: B. Coronary atherosclerosis
Rationale: Hypothyroidism increases cholesterol and triglycerides, contributing to plaque formation.
Which mental health change is most associated with hypothyroidism?
A. Mania
B. Delusions
C. Depression
D. Euphoria
Answer: C. Depression
Rationale: Decreased hormone levels slow neural processes, often resulting in lethargy and depressive symptoms.
The nurse should screen for hypothyroidism in which patient?
A. A 24-year-old male with athlete’s foot
B. A 60-year-old female with Down syndrome and fatigue
C. A 30-year-old woman with migraine headaches
D. A 22-year-old with acne
Answer: B. A 60-year-old female with Down syndrome and fatigue
Rationale: Down syndrome and age >60 are both risk factors for thyroid disease.
What action should the nurse take first when caring for a patient in myxedema coma?
A. Administer oral thyroid hormone
B. Perform a thyroid ultrasound
C. Establish IV access and support airway
D. Place patient in high Fowler’s position
Answer: C. Establish IV access and support airway
Rationale: Airway, breathing, and circulation are priority in any coma or critically ill state.
What should the nurse monitor closely after starting levothyroxine therapy in an elderly patient with hypothyroidism and heart disease?
A. Blood glucose
B. Oxygen saturation
C. Blood pressure and pulse
D. Bowel sounds
Answer: C. Blood pressure and pulse
Rationale: Hormone therapy increases metabolic demand, which may strain the cardiovascular system.
A patient says, “I feel great since I doubled my levothyroxine dose.” What is the best nursing response?
A. “That’s wonderful!”
B. “Let’s reduce the dose even more.”
C. “You shouldn’t adjust the dose without your provider’s approval.”
D. “You probably need more—let me call it in.”
Answer: C. “You shouldn’t adjust the dose without your provider’s approval.”
Rationale: Patient education should reinforce the risks of self-adjusting hormone therapy, including arrhythmias and hyperthyroidism.
What is the most common cause of hyperthyroidism?
A. Thyroid cancer
B. Hashimoto thyroiditis
C. Graves disease
D. Pituitary tumor
Answer: C. Graves disease
Rationale: Graves disease accounts for about 75% of hyperthyroidism cases and is an autoimmune disorder that stimulates excess thyroid hormone production.
Which clinical finding is most specific to Graves disease?
A. Goiter
B. Cold intolerance
C. Exophthalmos
D. Bradycardia
Answer: C. Exophthalmos
Rationale: Exophthalmos (protruding eyeballs) is a hallmark of Graves disease due to orbital fat and muscle inflammation.
What is the primary physiologic effect of thyrotoxicosis?
A. Hypometabolism
B. Hypermetabolism
C. Metabolic alkalosis
D. Acidosis
Answer: B. Hypermetabolism
Rationale: Thyrotoxicosis causes excess circulating thyroid hormones, increasing the body’s metabolic rate.
Which lab pattern is indicative of overt hyperthyroidism?
A. ↑TSH, ↓T4
B. ↓TSH, ↑T4 and ↑T3
C. ↑TSH, ↑T4
D. Normal TSH, ↓T4
Answer: B. decrease TSH, increased T4 and increased T3
Rationale: Low TSH with elevated T4/T3 confirms hyperthyroidism.
What symptom should the nurse expect in a patient with thyrotoxicosis?
A. Constipation
B. Weight gain
C. Heat intolerance
D. Decreased appetite
Answer: C. Heat intolerance
Rationale: Hyperthyroidism increases metabolic activity, resulting in sensitivity to heat.
Which cardiovascular finding is associated with thyrotoxicosis?
A. Bradycardia
B. Bounding pulses
C. Tachycardia
D. Distant heart sounds
Answer: C. Tachycardia
Rationale: Increased sympathetic stimulation causes elevated heart rate.
What is the initial drug of choice in acute thyrotoxicosis?
A. Methimazole
B. Propylthiouracil
C. Levothyroxine
D. Iodine
Answer: B. Propylthiouracil
Rationale: PTU is preferred in thyroid storm because it blocks peripheral conversion of T4 to T3.
Which finding is a potential complication after thyroidectomy?
A. Hyperkalemia
B. Vocal cord paralysis
C. Diarrhea
D. Increased appetite
Answer: B. Vocal cord paralysis
Rationale: Injury to recurrent laryngeal nerve can cause voice changes or airway obstruction.
Which medication provides symptomatic relief by blocking sympathetic effects in hyperthyroidism?
A. Metoprolol
B. Propranolol
C. Lisinopril
D. Digoxin
Answer: B. Propranolol
Rationale: Propranolol is a beta-blocker that reduces tremors, anxiety, and heart rate in thyrotoxicosis.
Which sign indicates severe acute thyrotoxicosis (thyroid storm)?
A. Hypothermia
B. Pulse 120 bpm
C. Temp 106°F and delirium
D. Bradycardia
Answer: C. Temp 106°F and delirium
Rationale: Thyroid storm presents with hyperthermia, altered mental status, and cardiovascular collapse.
A nurse notes a harsh, vibratory stridor in a post-thyroidectomy patient. What is the priority action?
A. Reassess in 30 minutes
B. Suction the airway
C. Notify the provider immediately
D. Administer oxygen and call a code
Answer: C. Notify the provider immediately
Rationale: Stridor may indicate airway obstruction, a surgical emergency.
Which test differentiates Graves disease from thyroiditis?
A. TSH only
B. Radioactive iodine uptake (RAIU)
C. T3 resin uptake
D. Thyroid ultrasound
Answer: B. Radioactive iodine uptake (RAIU)
Rationale: Graves disease shows diffuse uptake, whereas thyroiditis has low uptake on RAIU scan.
Which teaching is appropriate for radioactive iodine therapy (RAI)?
A. Increase calcium intake
B. Limit caffeine
C. Avoid close contact with pregnant women for 7 days
D. Eat a low-iodine diet during treatment
Answer: C. Avoid close contact with pregnant women for 7 days
Rationale: Radiation can harm fetuses; safety precautions must be followed post-treatment.
Which food should a hyperthyroid patient avoid?
A. Eggs
B. Steak
C. Spicy chili
D. White rice
Answer: C. Spicy chili
Rationale: High-spice and high-fiber foods increase GI motility, which is already elevated in thyrotoxicosis.
Which nutrient is recommended for a patient with hyperthyroidism?
A. Low-calorie meals
B. High-fat diet
C. High-protein, high-calorie meals
D. High-fiber, low-protein diet
Answer: C. High-protein, high-calorie meals
Rationale: Increased metabolism causes protein breakdown and weight loss.
Which eye care instruction is appropriate for a patient with exophthalmos in hyperthyroidism?
A. Apply cold compresses every 2 hours
B. Use artificial tears frequently
C. Wear contact lenses at night
D. Keep the eyes closed at all times
Answer: B. Use artificial tears frequently
Rationale: Lubrication prevents corneal dryness and ulceration from eye exposure.
A priority nursing diagnosis for a patient with acute thyrotoxicosis is:
A. Risk for imbalanced nutrition: more than body requirements
B. Decreased cardiac output
C. Activity intolerance
D. Fluid volume excess
Answer: B. Decreased cardiac output
Rationale: Thyroid storm can severely stress the heart, causing dysrhythmias and failure.
What is the expected time for therapeutic effects to begin after starting antithyroid medications?
A. 12 hours
B. 1–2 days
C. 1–2 weeks
D. 6–8 months
Answer: C. 1–2 weeks
Rationale: Clinical improvement begins after 1–2 weeks, with full effect by 4–8 weeks.
What should a nurse assess for in a patient on iodine therapy?
A. Weight gain
B. Mucosal swelling and excessive salivation
C. Diarrhea
D. Bradycardia
Answer: B. Mucosal swelling and excessive salivation
Rationale: These are signs of iodine toxicity and require immediate intervention.
What instruction should be given to a patient taking iodine solution?
A. Take on an empty stomach
B. Mix with water or juice and use a straw
C. Take with dairy
D. Swallow tablets whole
Answer: B. Mix with water or juice and use a straw
Rationale: Mixing and using a straw prevents teeth staining and enhances tolerability.
Which medication is preferred for hyperthyroid patients with asthma or heart disease?
A. Propranolol
B. Atenolol
C. Metoprolol
D. Carvedilol
Answer: B. Atenolol
Rationale: Atenolol is cardioselective and safer for patients with respiratory or cardiac issues.
What is a key teaching point for a patient post-thyroidectomy?
A. Lay flat with neck extended
B. Expect lifelong calcium therapy
C. Support the head when turning
D. Limit speech for 7 days
Answer: C. Support the head when turning
Rationale: Reduces strain on the incision and prevents complications.
Which sign suggests hypocalcemia following thyroid surgery?
A. Abdominal distension
B. Tingling around the mouth
C. Constipation
D. Weight gain
Answer: B. Tingling around the mouth
Rationale: Hypocalcemia from parathyroid damage presents with perioral numbness and tingling.
What is a major complication of removing the parathyroid glands during thyroidectomy?
A. Hypothyroidism
B. Hypertension
C. Hypocalcemia
D. Hyperkalemia
Answer: C. Hypocalcemia
Rationale: Loss of parathyroid function disrupts calcium regulation.
Which finding is expected during thyroid auscultation in Graves disease?
A. Rales
B. Friction rub
C. Bruit
D. S3 gallop
Answer: C. Bruit
Rationale: Increased vascular flow through the thyroid in Graves disease causes a bruit.
Which assessment finding requires immediate intervention after thyroid surgery?
A. Hoarse voice
B. Sore throat
C. Laryngeal stridor
D. Neck tenderness
Answer: C. Laryngeal stridor
Rationale: Stridor signals airway obstruction and is a medical emergency.
What is an expected symptom of subclinical hyperthyroidism?
A. Normal labs, no symptoms
B. Low TSH, normal T3/T4
C. High TSH, low T4
D. High TSH, high T3
Answer: B. Low TSH, normal T3/T4
Rationale: Subclinical hyperthyroidism shows suppressed TSH with normal thyroid hormones.
What is the expected TSH result in overt thyrotoxicosis?
A. High
B. Normal
C. Low or undetectable
D. Fluctuating
Answer: C. Low or undetectable
Rationale: Feedback inhibition suppresses TSH in thyrotoxicosis.
What is an early symptom of thyrotoxicosis in older adults?
A. Diarrhea
B. Confusion and agitation
C. Skin rash
D. Vomiting
Answer: B. Confusion and agitation
Rationale: Older adults may present with atypical signs like altered mental status.
How does PTU help in acute thyrotoxicosis?
A. Decreases iodine absorption
B. Inhibits T3 to T4 conversion
C. Blocks T4 to T3 conversion
D. Destroys thyroid follicles
Answer: C. Blocks T4 to T3 conversion
Rationale: PTU helps reduce circulating active hormone levels in crisis.
What lab value should be monitored closely in thyrotoxicosis?
A. Calcium
B. White blood cell count
C. Glucose
D. TSH
Answer: D. TSH
Rationale: TSH helps guide diagnosis and monitor treatment efficacy.
Which action helps reduce periorbital edema in exophthalmos?
A. High protein diet
B. Restricting salt
C. Increasing iodine
D. Wearing warm compresses
Answer: B. Restricting salt
Rationale: Lower sodium intake helps reduce fluid retention around the eyes.
Which instruction is correct for a patient with exophthalmos?
A. Avoid eye movement
B. Sleep with the head elevated
C. Wear contact lenses daily
D. Apply pressure to the eyes
Answer: B. Sleep with the head elevated
Rationale: Promotes drainage of fluid and reduces orbital swelling.
When should a patient report symptoms immediately after RAI therapy?
A. Increased hunger
B. Cold intolerance and fatigue
C. Weight loss
D. Constipation
Answer: B. Cold intolerance and fatigue
Rationale: These may indicate post-treatment hypothyroidism.
What outcome indicates improvement in thyrotoxicosis?
A. Pulse rate 110 bpm
B. Anxiety and diarrhea
C. Weight gain and improved sleep
D. Sweating and restlessness
Answer: C. Weight gain and improved sleep
Rationale: Normalizing metabolism leads to weight stability and rest.
