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A patient presents with weight gain, cold intolerance, lethargy and constipation. Laboratory results reveal elevated TSH and low T3 and T4. What is the most likely diagnosis?
A) Hyperthyroidism
B) Addison’s Disease
C) Hypothyroidism
D) Cushing’s Syndrome
Answer: C) Hypothyroidism
Rationale: Hypothyroidism is characterized by low T3 and T4, leading to a decreased basal metabolic rate, weight gain, cold intolerance, lethargy and constipation
Which of the following is a serious complication of hypothyroidism that requires immediate intervention?
A) Myxedema
B) Thyroid storm
C) Addisonian crisis
D) Cushing’s crisis
Answer: A) Myxedema
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism, leading to hypothermia, bradycardia, and altered mental status.
Which hormone is responsible for stimulating the thyroid gland to produce T3 and T4?
A) Adrenocorticotropic hormone (ACTH)
B) Thyroid-stimulating hormone (TSH)
C) Follicle-stimulating hormone (FSH)
D) Oxytocin
Answer: B) Thyroid-stimulating hormone (TSH)
Rationale: TSH, released by the anterior pituitary, stimulates the thyroid gland to produce T3 and T4.
Which dietary modification should be emphasized for a patient diagnosed with hypothyroidism?
A) High-calorie diet
B) Low-calorie, low-cholesterol diet
C) Low-fiber diet
D) High-protein diet
Answer: B) Low-calorie, low-cholesterol diet
Rationale: Patients with hypothyroidism often have a low metabolic rate, leading to weight gain; thus, a low-calorie, low-cholesterol diet is recommended.
A nurse is providing education to a patient with hyperthyroidism. Which statements indicate understanding? (Select all that apply.)
☐ A) "I should eat a high-calorie diet."
☐ B) "I need to avoid caffeine."
☐ C) "I will take my medications at bedtime."
☐ D) "I should weigh myself daily."
Answer: ☑ A, ☑ B, ☑ D
Rationale: Hyperthyroidism increases metabolism, so a high-calorie diet is needed. Caffeine should be avoided. Weighing daily monitors for changes.
Which assessment findings indicate Cushing’s syndrome? (Select all that apply.)
☐ A) Moon face
☐ B) Buffalo hump
☐ C) Hypoglycemia
☐ D) Thin extremities
☐ E) Hypertension
Answer: ☑ A, ☑ B, ☑ D, ☑ E
Rationale: Cushing’s syndrome causes moon face, buffalo hump, thin extremities, and hypertension. It is associated with hyperglycemia, not hypoglycemia.
A nurse is monitoring a patient after thyroidectomy. Which findings indicate a complication? (Select all that apply.)
☐ A) Hoarseness
☐ B) Chvostek’s sign
☐ C) Trousseau’s sign
☐ D) Increased urine output
Answer: ☑ B, ☑ C, ☑ D
Rationale: Positive Chvostek’s and Trousseau’s signs indicate hypocalcemia due to parathyroid gland damage
Which medication is used as a long-term treatment for hypoparathyroidism?
A) Levothyroxine
B) Parathormone
C) Calcitonin
D) Methimazole
Answer: B) Parathormone
Rationale: Parathormone (PTH replacement therapy) is used to regulate calcium and phosphate levels in hypoparathyroidism.
Which dietary restriction is necessary for a patient with hypoparathyroidism?
A) High-calcium diet
B) Low-phosphate diet
C) High-sodium diet
D) High-fat diet
Answer: B) Low-phosphate diet
In hypoparathyroidism, there is low parathyroid hormone (PTH), leading to:
Which interventions are appropriate for a patient post-thyroidectomy? (Select all that apply.)
☐ A) Place the patient in high Fowler’s position
☐ B) Monitor for signs of hypocalcemia
☐ C) Encourage talking to assess vocal cord function
☐ D) Monitor for bleeding
☐ E) Restrict fluid intake
Answer: ☑ B, ☑ C, ☑ D
Rationale: Assessing for bleeding, hypocalcemia, and voice changes are crucial after thyroidectomy. High Fowler’s is incorrect; semi-Fowler’s is preferred.
Which clinical manifestations are associated with hypothyroidism? (Select all that apply.)
☐ A) Fatigue
☐ B) Heat intolerance
☐ C) Weight gain
☐ D) Bradycardia
☐ E) Diarrhea
Answer: ☑ A, ☑ C, ☑ D
Rationale: Hypothyroidism slows metabolism, causing fatigue, weight gain, and bradycardia, but does not cause heat intolerance or diarrhea.
A patient receiving calcitonin for hyperthyroidism should be monitored for which side effect?
A) Hypocalcemia
B) Hyperkalemia
C) Hypernatremia
D) Hyperglycemia
Answer: A) Hypocalcemia
Rationale: Calcitonin lowers calcium levels, so hypocalcemia (numbness, tingling, muscle cramps) is a potential side effect.
The adrenal cortex is responsible for producing which hormones?
A) Epinephrine and norepinephrine
B) Cortisol and aldosterone
C) Insulin and glucagon
D) Calcitonin and thyroxine
Answer: B) Cortisol and aldosterone
Rationale: The adrenal cortex produces glucocorticoids (cortisol) and mineralocorticoids (aldosterone), which regulate metabolism, stress response, and fluid balance.
Which electrolyte imbalance is most concerning after a thyroidectomy?
A) Hyperkalemia
B) Hypocalcemia
C) Hypernatremia
D) Hypomagnesemia
Answer: B) Hypocalcemia
Rationale: During thyroidectomy, the parathyroid glands may be damaged, leading to hypocalcemia, which causes tetany and neuromuscular excitability.
A patient with Addison’s disease is being discharged. Which teaching points should the nurse include? (Select all that apply.)
☐ A) "Increase your sodium intake."
☐ B) "You may need to increase your corticosteroid dose during stress or illness."
☐ C) "Monitor for signs of hyperglycemia."
☐ D) "Do not stop taking steroids suddenly."
Answer: ☑ A, ☑ B, ☑ E
Rationale: Addison’s disease leads to hyponatremia, so patients need to increase sodium intake. They must adjust corticosteroid doses during stress, and avoid abrupt discontinuation of steroids to prevent adrenal crisis.
Which clinical manifestation is most characteristic of hyperthyroidism?
A) Bradycardia
B) Hypotension
C) Exophthalmos
D) Weight gain
Answer: C) Exophthalmos
Rationale: Hyperthyroidism, such as in Graves’ disease, can lead to exophthalmos (bulging eyes)
Which factors can trigger an Addisonian crisis?
A) Abrupt withdrawal of corticosteroids
B) Stress or infection
C) High sodium diet
D) Both A and B
Answer: D) Both A and B
Rationale: Addisonian crisis is caused by stress, infection, or sudden withdrawal of corticosteroids, leading to life-threatening hypotension and shock.
A patient with hypothyroidism is prescribed a sedative. Why should the nurse be concerned?
A) Sedatives increase metabolic rate
B) Sedatives can cause extreme drowsiness
C) Sedatives decrease thyroid hormone absorption
D) Sedatives worsen exophthalmos
Answer: B) Sedatives can cause extreme drowsiness
Rationale: Patients with hypothyroidism have a decreased metabolism, making them highly sensitive to sedatives and narcotics, which can cause respiratory depression.
A patient receiving radioactive iodine therapy for hyperthyroidism should be instructed to:
A) Limit contact with others
B) Take the medication on an empty stomach
C) Limit sodium intake
D) Avoid dairy products
Answer: A)limit contact with others
Rationale: Radioactive iodine therapy requires precautions such as avoiding close contact with others, stay 1 meter away, sleep alone
A nurse is caring for a patient with hyperthyroidism. Which interventions are appropriate? (Select all that apply.)
☐ A) Provide a cool, quiet environment
☐ B) Encourage a high-calorie diet
☐ C) Administer beta-blockers as prescribed
☐ D) Monitor for signs of thyroid storm
☐ E) Encourage high iodine intake
Answer: ☑ A, ☑ B, ☑ C, ☑ D
Rationale: Hyperthyroidism causes increased metabolism, heat intolerance, and anxiety, so a cool, quiet environment and high-calorie diet help. Beta-blockers control tachycardia, and monitoring for thyroid storm is crucial.
A patient with hypoparathyroidism presents with tetany and positive Trousseau’s and Chvostek’s signs. Which treatment should the nurse anticipate?
A) Calcium gluconate
B) IV potassium chloride
C) Oral magnesium sulfate
D) IV dextrose solution
Answer: A) calcium gluconate
Rationale: Hypoparathyroidism leads to hypocalcemia, which can cause tetany.
After a thyroidectomy, how should the nurse position the patient’s head to avoid stress on the suture line?
A) Hyperextend the neck
B) Keep the head midline with pillows
C) Place the patient in Trendelenburg position
D) Keep the head turned to one side
Answer: B) Keep the head midline with pillows
Rationale: Keeping the head midline with pillows prevents stress on sutures and reduces the risk of bleeding.
A nurse is assessing a patient with a visibly enlarged thyroid gland (goiter). Which statement best explains the possible causes of this condition?
A) A goiter only occurs in hyperthyroidism due to excessive thyroid hormone production.
B) A goiter is a sign of hypothyroidism caused by an overactive thyroid gland.
C) A goiter can occur in both hypothyroidism and hyperthyroidism due to abnormal stimulation of the thyroid gland.
D) A goiter is only caused by iodine deficiency and is unrelated to thyroid hormone levels.
Answer: C) A goiter can occur in both hypothyroidism and hyperthyroidism due to abnormal stimulation of the thyroid gland.
Which emergency equipment should be available after a thyroidectomy?
A) Defibrillator
B) Ventilator
C) Tracheostomy tray and suction
D) Chest tube setup
Answer: C) Tracheostomy tray and suction
Rationale: A trach set and suction must be available in case of airway obstruction from swelling or bleeding.
A nurse is educating a patient with Cushing’s syndrome. Which statements indicate the patient understands the teaching? (Select all that apply.)
☐ A) "I should monitor my blood glucose levels regularly."
☐ B) "I need to take extra calcium and vitamin D."
☐ C) "I should decrease my sodium intake."
☐ D) "I should abruptly stop my corticosteroid medications once my symptoms improve."
Answer: ☑ A, ☑ B, ☑ C
Rationale: Cushing’s syndrome causes hyperglycemia, osteoporosis, fluid retention (requiring low sodium intake). Steroid medications should NEVER be stopped abruptly.