Hypothyroidism
What medication is the treatment of choice for hypothyroidism?
Levothyroxine
What is the most common cause of hyperthyroidism?
Graves’ disease.
Rationale: Graves’ disease is an autoimmune disorder that stimulates continuous thyroid hormone production.
A nurse is teaching a client newly prescribed levothyroxine. Which instruction is most important?
Take the medication 30–60 minutes before breakfast
Why does polyuria occur in type 1 diabetes?
Excess glucose causes osmotic diuresis.
Rationale: Glucose pulls water into the urine, increasing urine volume.
What is the primary pathophysiologic problem in type 2 diabetes?
Insulin resistance.
Rationale: Cells are unable to respond appropriately to insulin, preventing glucose uptake.
What is the most common cause of peripheral neuropathy in clients with diabetes?
Chronic hyperglycemia.
Rationale: Persistently elevated glucose damages nerve fibers and small blood vessels supplying nerves.
Why is hypothyroidism typically treated for life?
Because thyroid hormone deficiency is usually permanent.
Rationale: The underlying gland dysfunction does not resolve, requiring ongoing replacement.
What cardiovascular findings are common in hyperthyroidism?
Tachycardia, palpitations, widened pulse pressure, and dysrhythmias.
Rationale: Increased thyroid hormones increase sympathetic stimulation and cardiac workload.
What medications inhibit thyroid hormone production in hyperthyroidism?
Methimazole and propylthiouracil.
Rationale: Thionamides block synthesis of thyroid hormones.
A 14-year-old client presents with recent onset of polyuria, polydipsia, and unintended weight loss.. The client reports a recent viral illness. Based on these findings, how would the nurse explain the underlying disease process of type 1 diabetes mellitus?
Type 1 diabetes mellitus is an autoimmune disorder in which immune system destruction of pancreatic beta cells leads to little or no insulin production.
Why is lifestyle modification a first-line treatment for type 2 diabetes?
Because diet and exercise can improve insulin sensitivity.
Rationale: Weight loss and activity reduce insulin resistance and lower blood glucose.
What sensory symptoms are commonly reported with peripheral neuropathy?
Numbness, tingling, burning pain, and loss of protective sensation.
Rationale: Sensory nerve damage alters pain, temperature, and touch perception.
Why is hypothyroidism often undiagnosed in older adults?
Because manifestations can mimic the normal aging process.
Fatigue, slowed thinking, weight gain, and cold intolerance are often attributed to aging rather than thyroid dysfunction.
What neurologic findings are associated with hyperthyroidism?
Nervousness, irritability, tremors, hyperreflexia, and insomnia.
Rationale: Thyroid hormone excess increases CNS stimulation.
Why are clients taught to rotate insulin injection sites?
To prevent lipohypertrophy or lipoatrophy.
Rationale: Repeated injections in one area alter insulin absorption.
What causes weight loss in clients with untreated type 1 diabetes?
Breakdown of fat and muscle for energy.
Rationale: The body enters a catabolic state without insulin.
Why is glycosylated hemoglobin (A1C) used to monitor type 2 diabetes management?
It reflects average blood glucose levels over approximately 3 months.
Rationale: A1C measures long-term glycemic control rather than daily fluctuations.
Why should clients with peripheral neuropathy avoid walking barefoot?
To prevent unnoticed injuries.
Rationale: Reduced sensation increases risk of cuts, burns, and foreign body injury.
What gastrointestinal manifestation is commonly seen in hypothyroidism?
Constipation.
Rationale: Decreased metabolic activity slows gastrointestinal motility.
What eye manifestation is specific to Graves’ disease?
Exophthalmos.
Rationale: Autoimmune inflammation causes edema and increased fatty tissue behind the eyes.
Why must metformin be held before and after iodinated contrast studies?
To prevent lactic acidosis from acute kidney injury.
Rationale: Impaired renal function increases the risk of metformin accumulation.
Why is insulin never withheld when a client with type 1 diabetes is ill?
Illness increases glucose and ketone production.
Rationale: Stress hormones increase insulin requirements even if food intake is decreased.
Why is weight loss not always present in type 2 diabetes?
Insulin is still present, preventing severe fat breakdown.
Rationale: Unlike type 1 diabetes, insulin deficiency is relative, not absolute.
What nutritional deficiency is associated with peripheral neuropathy?
Vitamin B12 deficiency.
Rationale: B12 is essential for nerve myelin integrity.
What are the most common manifestations of hypothyroidism?
Fatigue and lethargy, cold intolerance, weight gain without increased caloric intake, constipation, dry flaky skin, hair thinning
What is thyroid storm?
A life-threatening surge of thyroid hormones causing extreme hypermetabolism.
Rationale: Sudden hormone release overwhelms cardiovascular and neurologic systems.
Why can a client develop hypoglycemia shortly after receiving lispro insulin?
Because it is rapid-acting and begins lowering blood glucose quickly.
Rationale: Lispro has a fast onset and is designed to control postprandial glucose spikes; giving it without food increases the risk of hypoglycemia.
Why are clients with type 1 diabetes at increased risk for long-term complications such as nephropathy and retinopathy?
Chronic hyperglycemia damages blood vessels.
Rationale: Persistent elevated glucose causes microvascular injury.
Why is ongoing diabetes education critical for clients with type 2 diabetes?
Because the disease is progressive and management needs change over time.
Rationale: Insulin resistance and beta cell decline worsen, often requiring medication adjustments.
What is the primary nursing goal in caring for a client with peripheral neuropathy?
Prevention of injury and complications.
Rationale: Nerve damage is often irreversible, so care focuses on safety and preservation of function.
What are the expected T3 and T4 lab findings in hypothyroidism?
Answer: Decreased T3 and decreased T4.
Rationale: The defining feature of hypothyroidism is insufficient thyroid hormone production.
A client is in the first 12 hours following a total thyroidectomy. What nursing interventions are essential to prioritize during the immediate postoperative period?
Maintain a semi-Fowler’s position with head and neck supported
Monitor for respiratory distress and stridor, keep tracheostomy and suction equipment available,
Assess the client’s ability to speak
Monitor for signs of hypocalcemia
Rationale:
After a thyroidectomy, the client is at high risk for airway compromise, hemorrhage, laryngeal nerve damage, and hypocalcemia due to potential parathyroid injury. Elevating and supporting the head and neck reduces edema and strain on the incision, frequent assessments allow early detection of bleeding or respiratory compromise, voice checks identify nerve injury, and monitoring calcium-related symptoms ensures prompt treatment of life-threatening complications.
Why should insulin glargine (Lantus) not be adjusted daily based on blood glucose readings?
Because it provides basal insulin coverage, not correction dosing.
Rationale: Glargine has no peak and maintains steady glucose control over 24 hours.
Why do clients in DKA develop Kussmaul respirations?
To compensate for metabolic acidosis.
Rationale: Deep, rapid breathing helps eliminate carbon dioxide and acid.
A client with type 2 diabetes is recovering from abdominal surgery and has developed a postoperative wound infection. Over the next 24 hours, the nurse notes persistently elevated blood glucose levels despite the client receiving their usual diabetes medications. Why do blood glucose levels commonly increase after surgery or during infections in clients with diabetes?
Because surgery and infection trigger a stress response that increases counterregulatory hormones, leading to increased glucose production and decreased insulin effectiveness.
What assessment finding suggests worsening peripheral neuropathy?
Decreased sensation to monofilament testing.
Rationale: Loss of protective sensation indicates progression of nerve damage.