Hormone Regulation: the Thyroid gland,Hypothyroidism, Hyperthyroidism, Hyper Treatment, Medications, Thyroid Storm. NUR 185 Exam Hondros College of Nursing

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Sample questions from Hormone Regulation: the Thyroid gland,Hypothyroidism, Hyperthyroidism, Hyper Treatment, Medications, Thyroid Storm. NUR 185 Exam Hondros College of Nursing

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 31-year-old with Graves disease who reports a 2-kg weight loss in 1 month, with HR 104/min and BP 138/76 mm Hg
   • B.A 55-year-old scheduled for thyroidectomy who reports anxiety about the procedure, with HR 92/min and SpO2 98% on room air
   • C.A 42-year-old taking methimazole who has a temperature of 38.4 C, a sore throat, and an absolute neutrophil count of 400/mm3
   • D.A 68-year-old taking levothyroxine who reports fatigue, with HR 54/min, temperature 36.1 C, and a TSH result of 8.2 mIU/L

   Rationale: The client taking methimazole has fever, sore throat, and severe neutropenia, which suggest agranulocytosis and require immediate precautions and provider notification. The elevated TSH and mild bradycardia require follow-up but do not indicate the same immediate risk. Weight loss with mild tachycardia is concerning for ongoing hyperthyroidism but is less urgent than possible infection with profound neutropenia. Anxiety before surgery can be addressed after the unstable client is assessed.

2. 2.During a home visit, a 74-year-old with hypothyroidism says, "I take my thyroid pill with breakfast and my calcium tablet." The client reports constipation and fatigue; HR is 58/min, BP is 128/74 mm Hg, and TSH is 9.6 mIU/L. Which instruction should the nurse give?

   • A.Stop levothyroxine until the constipation resolves, then restart it with the calcium tablet.
   • B.Take levothyroxine with breakfast to reduce stomach upset, and continue calcium at the same time.
   • C.Take an extra levothyroxine dose each day until the TSH returns to the reference range.
   • D.Take levothyroxine on an empty stomach and separate it from calcium by at least 4 hours.

   Rationale: Levothyroxine absorption is reduced by food and calcium, so taking it consistently on an empty stomach and separating calcium by at least 4 hours is appropriate. Taking both with breakfast can perpetuate under-replacement, as suggested by the elevated TSH and symptoms. Stopping therapy is unsafe because it can worsen hypothyroidism. Increasing the dose without a prescription risks over-replacement and should not be based on a single result without clinical review.

3. 3.Refer to the client's chart. The nurse is coordinating urgent care for a 36-year-old with Graves disease whose condition is worsening. Which actions should the nurse take now? Select all that apply.

   • A.Give the scheduled methimazole dose and wait 2 hours to evaluate the response before escalating care.
   • B.Place the client on continuous cardiac monitoring and establish IV access.
   • C.Encourage the client to walk in the hallway to reduce agitation.
   • D.Prepare to administer prescribed IV fluids and medications used to manage thyroid storm.
   • E.Activate the rapid response process and notify the provider of the acute deterioration.
   • F.Administer the prescribed acetaminophen and initiate external cooling measures.

   Rationale: The rapid rise in temperature and heart rate, altered mental status, and gastrointestinal symptoms indicate possible thyroid storm, so rapid escalation is needed. Continuous monitoring, IV access, cooling, and prescribed fluids and storm-directed medications support stabilization; the chart shows HR rising from 118 to 152/min and temperature from 38.2 C to 40.1 C. Giving only the scheduled methimazole and waiting delays emergency treatment, and ambulation increases metabolic demand and injury risk. The chart's acute neurologic and cardiovascular changes take priority over routine medication timing.

4. 4.The provider prescribes propranolol for a 29-year-old with symptomatic hyperthyroidism in an outpatient clinic. The client has HR 116/min, BP 104/66 mm Hg, and a history of asthma with recent wheezing. What should the nurse do?

   • A.Administer the medication as prescribed because tachycardia is the most urgent finding.
   • B.Hold the medication and contact the provider about the asthma and current wheezing.
   • C.Give the medication with food and reassess the heart rate in 1 hour.
   • D.Teach the client to use a rescue inhaler before each propranolol dose.

   Answer and rationale are in the full material.

5. 5.In a pediatric clinic, a parent of a 4-year-old with newly diagnosed hypothyroidism asks who may give the daily levothyroxine at the child's preschool. The prescription is for a consistent morning dose, and the child has no swallowing difficulty. Which plan is best?

   • A.Have the parent coordinate with the preschool and provide a written medication authorization and administration plan.
   • B.Ask the preschool teacher to change the dose on days when the child seems tired.
   • C.Tell the parent to give two doses at home on days when the preschool cannot administer the medication.
   • D.Have the child decide whether to take the medication based on how energetic the child feels.

   Answer and rationale are in the full material.