MSN Exam for Hypothyroidism

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1) A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?

  1. Impaired physical mobility related to decreased endurance
  2. Hypothermia r/t decreased metabolic rate
  3. Disturbed thought processes r/t interstitial edema
  4. Decreased cardiac output r/t bradycardia

2) Despite the availability of a wide array of thyroid hormone products, it is clear that ___________ is the treatment of choice for almost all patients with hypothyroidism.

  1. Liothyronine (Cytomel)
  2. Liotrix (Thryolar)
  3. Synthetic levothyroxine (LT4)
  4. Desiccared Thyroid (Armour, etc)
  5. None of the above

3) High TSH but low FT4 suggests…Hint: TSH and FT4 levels going in opposite directions is usually what we expect to see, generally indicating a problem on the level of the thyroid.

  1. Primary hyperthyroidism
  2. Primary hypothyroidism
  3. Pituitary hyperthyroidism
  4. Pituitary hypothyroidism
  5. Hypothalamus hypothyroidism

4) A radioactive iodide uptake test helps determine intrinsic thyroid function. A thyroid scan can help distinguish etiology (such as cancer). A TRH stimulation test helps determine thyroid and ________ function.

  1. liver
  2. pituitary
  3. intestinal
  4. none of the above

5) A nurse gets back results on a pt who may have hyperthyroidism. What lab values might the nurse expect?

  1. decreased T3 and Increased T4
  2. Decreased TSH and Increased T3 and T4
  3. Increased TSH and decreased T3 and T4
  4. Increased T3 and Decreased T4

6) The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that:

  1. The medication will be needed only during times of rapid growth.
  2. The medication will be needed throughout the child’s lifetime.
  3. The medication schedule can be arranged to allow for drug holidays.
  4. The medication is given one time daily every other day.

7) A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:

  1. Should be taken in the morning
  2. May decrease the client’s energy level
  3. Must be stored in a dark container
  4. Will decrease the client’s heart rate

8) Iodine’s main function in therapy is to:

  1. Rapidly inhibits the synthesis/release of T3 & T4
  2. Blocks conversion of T4 to T3
  3. Damages or destroys thyroid tissue
  4. Decreases HR, BP, CO2, and O2 requirements

9) A nurse gets back results on a pt who may have hypothyroidism. What lab values might the nurse expect?

  1. decreased T3 and Increased T4
  2. increased TSH and Increased T3 and T4
  3. Increased TSH and decreased T3 and T4
  4. Increased T3 and Decreased T4

10) On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops:

  1. Intolerance to heat
  2. Dry skin and fatigue
  3. Progressive weight gain
  4. Insomnia and excitability

11) Which of the following potentially serious complications could occur with therapy for hypothyroidism?

  1. Acute hemolytic reaction.
  2. Angina or cardiac arrhythmia.
  3. Retinopathy.
  4. Thrombocytopenia.

12) Some causes of hypothyroidism include iatrogenic causes, drugs (such as amiodarone and lithium), and this (also known as autoimmune thyroiditis)….

  1. Grave’s
  2. Hashimoto’s
  3. Silent thyroiditis
  4. Hypothalamic disease
  5. Pituitary disease

13) A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse’s response is based on the knowledge that:

  1. There is no need to take thyroid medication because the fetus’s thyroid produces a thyroid-stimulating hormone.
  2. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy.
  3. It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism.
  4. Fetal growth is arrested if thyroid medication is continued during pregnancy.

14) A nurse understands calcitonin and parathormone when the nurse states:

  1. They work separately on calcium balance.
  2. They work together for blood clotting.
  3. They work together on bone growth.
  4. Calcitonin works on cellular function while parathormone works on neuromuscular function.

15) Mrs. Gilmour is complaining of being hot all the time, sweating, being thirsty, and losing hair. What could her symptoms indicate?

  1. Hypothyroidsim
  2. Hyperthyroidism
  3. Graves disease

16) Thyrotoxicosis is understood when the nurse states:

  1. Hypermetabolism from decrease in T3 and T4.
  2. Hypometabolism from decrease in T3 and T4.
  3. Hypermetabolism from increase in T3 and T4.
  4. Hypometabolism from increase in T3 and T4.

17) T3 and T4 are produced in which type of cell?

  1. Follicle
  2. Squamous
  3. Epithelial
  4. Glandular

18) A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize

  1. They can expect the child will be mentally retarded
  2. Administration of thyroid hormone will prevent problems
  3. This rare problem is always hereditary
  4. Physical growth/development will be delayed

19) What does tyrosine combine with to make T3 and T4?

  1. Serum K
  2. Serum Na
  3. Serum Iodine
  4. Serum Phosphoruse

20) Radioactive Iodine’s main function in therapy is to:

  1. Rapidly inhibits the synthesis/release of T3 & T4
  2. Blocks conversion of T4 to T3
  3. Damages or destroys thyroid tissue
  4. Decreases HR, BP, CO2, and O2 requirements

21) Michael comes into the ED. His HR is 150 and has a fever of 104.5. He is confused and anxious. What could be Michael’s problem?

  1. Thyroid infection.
  2. Thyroid Fire
  3. Thyroid Storm
  4. Thyroid Shut Down.

22) After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

  1. Primary hypothyroidism
  2. Graves’ disease
  3. Thyrotoxicosis
  4. Euthyroidism

23) A client is admitted with a diagnosis of hypothyroidism. An initial assessment of the client would reveal:

  1. Slow pulse rate, weight loss, diarrhea, and cardiac failure
  2. Weight gain, lethargy, slowed speech, and decreased respiratory rate
  3. Rapid pulse, constipation, and bulging eyes
  4. Decreased body temperature, weight loss, and increased respirations

24) A 58 year old woman has newly diagnosed with hypothyroidism. The nurse is aware that the signs and symptoms of hypothyroidism include:

  1. Diarrhea
  2. Vomiting
  3. Tachycardia
  4. Weight gain

25) A pt is given radioactive iodine for a thyroid scan. How often are the tests taken?

  1. one hour after ingestion
  2. 4-8-24 hours
  3. 2-4-24 hours
  4. 2-6-24 hours

26) T3 and T4 are similar, but different produced in equal amounts?

  1. True
  2. False

27) A client with hypothyroidism frequently complains of feeling cold. The nurse should tell the client that she will be more comfortable if she:

  1. Uses an electric blanket at night
  2. Dresses in extra layers of clothing
  3. Applies a heating pad to her feet
  4. Takes a hot bath morning and evening

28) A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

  1. Dysuria
  2. Leg cramps
  3. Tachycardia
  4. Blurred vision

29) Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

  1. Increased appetite and weight loss
  2. Puffiness of the face and hands
  3. Nervousness and tremors
  4. Thyroid gland swelling

30) An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of:

  1. Thyroid storm.
  2. Cretinism.
  3. myxedema coma.
  4. Hashimoto’s thyroiditis.

31) A 3-month-old client is in the pediatric unit. During assessment, the nurse is suspecting that the baby may have hypothyroidism when mother states that her baby does not:

  1. Sit up.
  2. Pick up and hold a rattle.
  3. Roll over.
  4. Hold the head up.
Answers and Rationales
  1. D. Decreased cardiac output r/t bradycardia . The decrease in pulse can affect the cardiac output and lead to shock, which would take precedence over the other choices
  2. C. Synthetic levothyroxine (LT4) 
  3. B. Primary hypothyroidism 
  4. B. pituitary 
  5. B. Decreased TSH and Increased T3 and T4 
  6. B. The medication will be needed throughout the child’s lifetime. The medication will be needed throughout the child’s lifetime. Answers A, C, and D contain inaccurate statements; therefore, they are incorrect.
  7. A. Should be taken in the morning . Should be taken in the morning Thyroid supplement should be taken in the morning to minimize the side effects of insomnia
  8. A. Rapidly inhibits the synthesis/release of T3 & T4
  9. C. Increased TSH and decreased T3 and T4 
  10. C. Progressive weight gain . Hypothyroidism, a decrease in thyroid hormone production, is characterized by hypometabolism that manifests itself with weight gain
  11. B. Angina or cardiac arrhythmia. Precipitation of angina or cardiac arrhythmia is a potentially serious complication of hypothyroidism treatment. Acute hemolytic reaction is a complication of blood transfusions. Retinopathy typically is a complication of diabetes mellitus. Thrombocytopenia doesn’t result from treating hypothyroidism.
  12. B. Hashimoto’s 
  13. B. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. During pregnancy, the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication.
  14. B. They work together for blood clotting. , C. They work together on bone growth. 
  15. B. Hyperthyroidism 
  16. C. Hypermetabolism from increase in T3 and T4. 
  17. A. Follicle 
  18. B. Administration of thyroid hormone will prevent problems . Early identification and continued treatment with hormone replacement corrects this condition.
  19. C. Serum Iodine 
  20. C. Damages or destroys thyroid tissue
  21. C. Thyroid Storm 
  22. A. Primary hypothyroidism. Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves’ disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn’t require any thyroid preparation.
  23. B. Weight gain, lethargy, slowed speech, and decreased respiratory rate . Symptoms of hypothyroidism include weight gain, lethargy, slow speech, and decreased respirations.
  24. D. Weight gain . Typical signs of hypothyroidism includes weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intolerance, constipation and numbness.
  25. D. 2-6-24 hours 
  26. B. False. T3 and T4 are similar, but they are produced in different amounts.
  27. B. Dresses in extra layers of clothing. Dressing in layers and using extra covering will help decrease the feeling of being cold that is experienced by the client with hypothyroidism. Decreased sensation and decreased alertness are common in the client with hypothyroidism; therefore, the use of electric blankets and heating pads can result in burns,
  28. C. Tachycardia . Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren’t associated with levothyroxine.
  29. B. Puffiness of the face and hands . Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
  30. C. myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
  31. D. Hold the head up. Development normally proceeds cephalocaudally; so the first major developmental milestone that the infant achieves is the ability to hold the head up within the first 8-12 weeks of life. In hypothyroidism, the infant’s muscle tone would be poor and the infant would not be able to achieve this milestone.

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