Thyroid Disorders
A patient presents with heat intolerance, weight loss, and tachycardia. What disorder is most likely?
A. Hypothyroidism
B. Hyperthyroidism
C. Addison's disease
D. SIADH
Answer: (B) Hyperthyroidism
Rationale: Hyperthyroidism speeds up metabolism, so the patient often has heat intolerance, weight loss, tremors, anxiety, and tachycardia.
Which condition is associated with excess cortisol?
A. Addison's disease
B. Cushing syndrome
C. Hypothyroidism
D. SIADH
Answer: (B) Cushing syndrome
Rationale: Cushing syndrome occurs when cortisol is too high. Cortisol excess causes hyperglycemia, hypertension, central weight gain, think skin, and infection risk.
Which condition causes excessive dilute urine?
A. SIADH
B. Diabetes insipidus
C. Hyperthyroidism
D. Cushing syndrome
Answer: (B) Diabetes insipidus
Rationale: DI is caused by too little ADH or poor kidney response to ADH. Without ADH effect, the kidneys cannot retain water, causing large amounts of dilute urine.
Which surgery removes part of all the thyroid gland?
A. Hypophysectomy
B. Thyroidectomy
C. Adrenalectomy
D. Cholecystectomy
Answer: (B) Thyroidectomy
Rationale: A thyroidectomy is removal of part of all of the thyroid gland, often done for thyroid cancer, severe hyperthyroidism, goiter, and nodules.
Which medication treats hypothyroidism?
A. Levothyroxine
B. Methimazole
C. PTU
D. Regular insulin
Answer: (A) Levothyroxine
Rationale: Levothyroxine is a synthetic thyroid hormone used to replace how thyroid hormone in hypothyroidism.
Which lab pattern indicates primary hypothyroidism?
A. Low TSH, high T4
B. High TSH, low T4
C. High sodium, low urine output
D. High cortisol, high glucose
Answer: (B) High TSH, low T4
Rationale: In primary hypothyroidism, the thyroid is not making enough hormone, so T4 is low. The pituitary gland responds by increasing TSH to stimulate the thyroid
Which finding is classic for Addison's disease?
A. Moon face
B. Hyperpigmentation
C. Tachycardia
D. Hypernatremia
Answer: (B) Hyperpigmentation
Rationale: Addison's disease causes low adrenal hormone levels. In primary adrenal insufficiency, ACTH rises, which can cause darkened skin or "bronzing."
Which lab finding is expected in SIADH?
A. High sodium
B. Low sodium
C. High potassium
D. Low calcium
Answer: (B) Low sodium
Rationale: SIADH causes excess water retention. The extra water dilutes the blood sodium, causing dilutional hyponatremia.
Which position is commonly used after thyroidectomy?
A. Flat with neck hyperextended
B. Semi-Fowler's with head and neck supported
C. Prone
D. Trendelenburg
Answer: (B) Semi-Fowler's with head and neck supported
Rationale: Semi-Fowler's helps reduce swelling and supports breathing. The neck should be supported to avoid tension on the incision.
Which medication treat hyperthyroidism by reducing thyroid hormone production?
A. Levothyroxine and insulin
B. Methimazole and PTU
C. Hydrocortisone and prednisone
D. Metformin and glipizide
Answer: (B) Methimazole and PTU
Rationale: Methimazole and PTU are antithyroid drugs, They decrease thyroid hormone production, helping treat hyperthyroidism.
After thyroidectomy, which finding indicates hypocalcemia?
A. Hypertension
B. Tingling around mouth and muscle cramps
C. Hyperglycemia
D. Dry skin
Answer: (B) Tingling around mouth and muscle cramps
Rationale: The parathyroid glands can be affected during thyroid surgery. Low calcium causes neuromuscular irritability, including tingling, cramps, tetany, and seizures.
Which electrolyte imbalance is expected in Addison's disease?
A. Hypernatremia
B. Hypokalemia
C. Hyponatremia and Hyperkalemia
D. Hypercalcemia
Answer: (C) Hyponatremia and Hyperkalemia
Rationale: Low aldosterone causes the body to lose sodium and retain potassium, so sodium drops and potassium rises.
What is the priority treatment for SIADH?
A. Increase fluids
B. Fluid restriction
C. Give insulin
D. Give potassium
Answer: (B) Fluid restriction
Rationale: SIADH means the body is retaining too much water. Restricting fluids helps reduce dilutional hyponatremia and prevents worsening neurologic symptoms.
After hypophysectomy, which action should the patient avoid?
A. Drinking fluid as allowed
B. Reporting clear nasal drainage
C. Blowing the nose
D. Keeping the head elevated
Answer: (C) Blowing the nose
Rationale: Blowing the nose increases pressure and can disrupt the surgical site, especially after a transsphenoidal hypophysectomy.
A patient taking methimazole reports fever and sore throat. What is the nurse concerned about?
A. Hypoglycemia
B. Agranulocytosis/infection risk
C. Fluid overload
D. Hypercalcemia
Answer: (B) Agranulocytosis/infection risk
Rationale: Antithyroid medications can rarely suppress white blood cells. Fever and sore throat may signal infection and need prompt follow up.
Which is the priority complication after thyroid surgery?
A. Mild nausea
B. Airway obstruction
C. Constipation
D. Fatigue
Answer: (B) Airway obstruction
Rationale: After thyroid surgery, swelling, bleeding, or laryngeal nerve damage can compromise the airway. Airway is always the priority.
A patient with adrenal crisis needs which priority medication?
A. Levothyroxine
B. Insulin
C. IV Hydrocortisone
D. Methimazole
Answer: (C) IV Hydrocortisone
Rationale: Adrenal crisis is a life-threatening cortisol deficiency. IV hydrocortisone replaces the missing cortisol and helps support blood pressure and stress response.
After hypophysectomy, what indicates possible complications?
A. Mild headache
B. Clear drainage from nose
C. Increased appetite
D. Constipation
Answer: (B) Clear drainage from nose
Rationale: Clear nasal drainage after hypophysectomy may indicate a cerebrospinal fluid leak, which increases risk for infection or meningitis.
After adrenalectomy, what complication should the nurse monitor for?
A. Adrenal insufficiency
B. Thyroid storm only
C. Retinopathy
D. Hypoglycemia from too much insulin only
Answer: (A) Adrenal insufficiency
Rationale: Removing adrenal tissue can reduce cortisol production. The patient may need corticosteroid replacement and monitoring for hypotension, weakness, and electrolyte/glucose changes.
Which medication is commonly used to reduce tachycardia and tremors in hyperthyroidism?
A. Beta blocker
B. Metformin
C. Glipizide
D. Desmopressin
Answer: (A) Beta blocker
Rationale: Beta blockers do not cure hyperthyroidism, but they control sympathetic symptoms like tachycardia, palpitations, anxiety, and tremors.
Which condition is a life-threatening exaggeration of hyperthyroidism?
A. Myxedema coma
B. Thyroid storm
C. SIADH
D. DI
Answer: (B) Thyroid storm
Rationale: Thyroid storm is severe, uncontrolled hyperthyroidism with fever, severe tachycardia, agitation, GI symptoms, and possible cardiovascular collapse.
Why should corticosteroids not be stopped abruptly?
A. Causes thyroid storm
B. Causes adrenal crisis
C. Causes DKA
D. Causes SIADH
Answer: (B) Causes adrenal crisis
Rationale: Long-term corticosteroids suppress the adrenal glands. Stopping suddenly can leave the body without enough cortisol, causing adrenal crisis.
Acromegaly is caused by excess of which hormone?
A. ADH
B. Cortisol
C. Growth hormone
D. Thyroid hormone
Answer: (C) Growth hormone
Rationale: Acromegaly occurs when excess growth hormone happens after the growth plates close, causing enlarged hands, feet, facial bones, and soft tissues.
Which finding after thyroidectomy requires immediate follow-up?
A. Mild incision discomfort
B. Slight sore throat
C. Frequent swallowing and swelling at the neck
D. Requesting ice chips
Answer: (C) Frequent swallowing and swelling at the neck
Rationale: Frequent swallowing can indicate bleeding, and neck swelling can threaten the airway. This needs immediate assessment.
A patient on a long-term corticosteroids should be taught to do what?
A. Stop the medication when symptoms improve
B. Take extra doses whenever tired
C. Taper only as prescribed
D. Avoid reporting infection symptoms
Answer: (C) Taper only as prescribed
Rationale: Corticosteroids must be tapered to allow adrenal function to recover and prevent adrenal crisis.