Metabolism1
A sedentary patient with obesity, hypertension, and dyslipidemia presents with chronic hyperglycemia. What risk factor drives this disease?
Insulin resistance
The patient is hypotensive and tachycardic. What intervention must occur before insulin?
Fluid
An elderly patient with T2DM and limited fluid intake presents with glucose >700 and altered mental status. Which precipitating factor most contributed to this condition?
Dehydration
A patient taking levothyroxine reports taking their medication each morning with breakfast and a calcium supplement. Which response by the nurse is most appropriate?
A. “That is acceptable as long as you take it at the same time daily.”
B. “You should take levothyroxine with calcium to improve absorption.”
C. “You should separate levothyroxine and calcium by at least 4 hours.”
D. “You should switch to taking levothyroxine at bedtime.”
Correct Answer: C
Rationale:
Calcium and iron decrease levothyroxine absorption. Patients should take levothyroxine consistently and avoid calcium or iron supplements within 4 hours
Which mechanism best explains how methimazole lowers thyroid hormone levels?
A. Prevents release of stored T3 and T4 from the thyroid gland
B. Blocks iodine oxidation, inhibiting thyroid hormone synthesis
C. Suppresses pituitary release of TSH
D. Increases renal excretion of thyroid hormones
Correct Answer: B
Rationale:
Methimazole inhibits iodine oxidation, a critical step in the synthesis of thyroid hormones (T3 and T4). It does not affect hormone release or pituitary function.
Why are ketones absent in HHS?
Some insulin is still being produced
Which complication is the greatest immediate threat in HHS?
Hypovolemic shock
What is the primary nursing goal when managing gestational diabetes?
Fetal safety
Which patient history would require the nurse to clarify the prescription before administering levothyroxine?
A. History of hypothyroidism
B. History of untreated adrenal insufficiency
C. History of radioactive iodine therapy
D. History of myxedema coma
Correct Answer: B
Rationale:
Uncorrected adrenal insufficiency is a contraindication to levothyroxine therapy because thyroid hormone increases metabolic demand and can precipitate adrenal crisis if cortisol levels are inadequate.
Which patient history would cause the nurse to question a methimazole prescription?
A. Chronic kidney disease
B. First-trimester pregnancy
C. History of hypertension
D. Iron-deficiency anemia
Correct Answer: B
Rationale:
Methimazole is contraindicated in the first trimester of pregnancy due to the risk of congenital abnormalities. Propylthiouracil (PTU) is preferred early in pregnancy.
A patient with HHS is hypotensive and tachycardic. What intervention comes first?
IV FLUIDS
Why must sedatives be used cautiously in hypothyroid patients?
Respiratory Depression
A patient with insulin resistance, obesity, dyslipidemia, hypertension, and chronic hyperglycemia develops cardiovascular disease. Which overarching metabolic disorder explains this cascade?
Metabolic syndrome
The nurse is reviewing follow-up labs for a patient on levothyroxine therapy. Which lab trend indicates the medication is achieving its desired effect?
A. Increasing TSH levels
B. Decreasing TSH levels toward normal
C. Elevated serum calcium
D. Suppressed hemoglobin
Correct Answer: B
Rationale:
In hypothyroidism, effective levothyroxine therapy causes TSH levels to decrease toward the normal range, reflecting adequate thyroid hormone replacement.
A patient taking methimazole reports fever and sore throat. What is the nurse’s priority concern?
Agranulocytosis
A T1DM patient skips insulin during illness. What life-threatening complication develops first?
DKA
An elderly hypothyroid patient becomes comatose after cold exposure. What emergency is occurring?
Hypometabolism
The newborn of a mother with uncontrolled GDM develops jitteriness shortly after birth. What physiologic mechanism caused this?
Hyperinsulinemia
A patient receiving levothyroxine reports chest pain and palpitations. What is the priority nursing action?
A. Reassure the patient that symptoms will resolve
B. Hold the medication and notify the provider
C. Administer calcium carbonate
D. Encourage fluid intake
Correct Answer: B
Rationale:
Chest pain and palpitations suggest over-replacement and cardiac stress, especially dangerous in older adults. The nurse should hold the medication and notify the provider immediately.
Which laboratory value is most important for the nurse to monitor in a patient receiving methimazole?
WBC’s
Rationale:
Methimazole can cause bone marrow suppression, increasing the risk for infection. Monitoring WBCs is essential to detect agranulocytosis early.
A newly diagnosed T2DM patient asks what intervention most reduces complications. What should the nurse prioritize?
Lifestyle changes
A patient in thyroid storm is diaphoretic, anxious, and severely tachycardic. Before antithyroid medications take effect, what physiologic parameter must be controlled immediately with beta-blockers?
Heart Rate
A 64-year-old patient presents with profound fatigue, lethargy, cold intolerance, weight gain, constipation, and bradycardia. The nurse notes dry coarse skin, slowed cognition, hypoventilation, non-pitting edema of the face and hands, and a thickened tongue. Based on these assessment findings, which endocrine disorder best explains the patient’s condition?
Hypothyroidism
Which assessment finding in a patient taking levothyroxine requires immediate follow-up by the nurse?
A. Weight gain of 1 lb over 2 weeks
B. Heart rate of 108 beats/min
C. Mild hair loss
D. Dry skin
Correct Answer: B
Rationale:
A heart rate >100 bpm may indicate over-replacement and hyperthyroidism, increasing the risk for cardiac complications. This finding requires prompt evaluation. Hair loss and dry skin can occur during early therapy adjustment
A patient with hyperthyroidism is prescribed methimazole and propranolol. Which statement best explains the purpose of combining these medications?
A. Propranolol increases the effectiveness of methimazole
B. Propranolol provides immediate symptom control while methimazole takes effect
C. Methimazole prevents beta-blocker toxicity
D. Both medications directly reduce thyroid hormone synthesis
Correct Answer: B
Rationale:
Beta-blockers provide rapid control of adrenergic symptoms (tachycardia, tremors) while methimazole works to reduce hormone synthesis over time.