Hyper/Hypo - Thyroidism - NCLEX Question

The nurse is planning health teaching for a client starting on levothyroxine. What health teaching about this drug would the nurse include?

Options:

A. The need to take the drug when the client feels fatigued and weak

B. The need to report chest pain and dyspnea when starting the drug

C. The need to check blood pressure and pulse every day

D. The need to rotate injection sites when giving self the drug

B. The need to report chest pain and dyspnea when starting the drug

Explanation:

Levothyroxine is a replacement hormone for hypothyroidism. While daily vital signs aren't required, chest pain or dyspnea may indicate cardiac side effects and should be reported immediately.

A nurse assesses a client who is recovering from a subtotal thyroidectomy and observes the development of stridor. What is the priority action for the nurse to take?

Options:

A. Apply oxygen via nasal cannula at 2 L/min

B. Document the finding and assess the client hourly

C. Place the client in high-Fowler position in the bed

D. Contact the Rapid Response Team and prepare for intubation

D. Contact the Rapid Response Team and prepare for intubation

Explanation:

Stridor is a sign of airway obstruction, often from postoperative edema. This is an emergency requiring immediate intervention—oxygen alone is not enough.

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the first postoperative day before discharge, the client states, "I feel numbness and tingling around my mouth." What action does the nurse take?

Options:

A. Offer mouth care

B. Loosen the dressing

C. Assess for muscle twitching

D. Ask the client orientation questions

C. Assess for muscle twitching

Explanation:

Numbness and tingling may indicate hypocalcemia from parathyroid injury. The nurse should assess for Chvostek's or Trousseau's sign (twitching) as part of calcium evaluation.

A nurse assesses a client on the medical-surgical unit. Which statement made by the client alerts the nurse to assess the patient for hypothyroidism?

Options:

A. "My sister has thyroid problems."

B. "I seem to feel the heat more than other people."

C. "Food just doesn't taste good without a lot of salt."

D. "I am always tired, even with 12 hours of sleep."

D. "I am always tired, even with 12 hours of sleep."

Explanation:

Extreme fatigue despite sufficient rest is a classic sign of hypothyroidism. The other statements do not directly reflect thyroid function.

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer?

Options:

A. Atropine sulfate

B. Levothyroxine

C. Propranolol

D. Epinephrine

B. Levothyroxine

Explanation:

Bradycardia caused by hypothyroidism is treated by correcting the hormone imbalance. Levothyroxine is the thyroid hormone replacement.

A nurse plans care for a client with hypothyroidism. Which priority problem does the nurse address first for this client?

Options:

A. Heat intolerance

B. Body image problems

C. Depression and withdrawal

D. Obesity and water retention

C. Depression and withdrawal

Explanation:

Psychosocial changes like depression, apathy, and withdrawal can impair safety and self-care. These issues take priority over physical concerns.

A nurse assesses a client who is prescribed levothyroxine for hypothyroidism. Which assessment finding alerts the nurse that drug therapy is effective?

Options:

A. Thirst is recognized and fluid intake is appropriate

B. Weight has been the same for 3 weeks

C. Total white blood cell count is 6000 cells/mm³

D. Heart rate is 76 beats/min and regular

D. Heart rate is 76 beats/min and regular

Explanation:

A normal heart rate reflects improved metabolic function and is a sign of effective thyroid replacement. Bradycardia would indicate under-treatment.

A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How would the nurse respond?

Options:

A. "You will need to take the thyroid medication until the goiter is completely gone."

B. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication."

C. "You'll need thyroid pills for life because your thyroid won't start working again."

D. "When blood tests indicate normal thyroid function, you can stop the medication."

C. "You'll need thyroid pills for life because your thyroid won't start working again."

Explanation:

Hashimoto's causes permanent destruction of thyroid tissue, requiring lifelong hormone replacement.

The nurse is caring for a client who is starting on propylthiouracil for hyperthyroidism. What statement by the client indicates a need for further teaching?

Options:

A. "I will let my provider know if I have weight gain and cold intolerance."

B. "I will let my provider know if I have a metallic taste or stomach upset."

C. "I will avoid crowds and other people who have infection."

D. "I am aware that if the drug changes the color of my urine, I should stop it."

D. "I am aware that if the drug changes the color of my urine, I should stop it."

Explanation:

A change in urine color is not an expected adverse effect of propylthiouracil. Statements A-C reflect important side effects or precautions.

A nurse plans care for a client with hyperparathyroidism. Which intervention does the nurse include in this client's plan of care?

Options:

A. Use a lift sheet to assist the client with position changes in bed

B. Ask the client to ambulate in the hallway twice a day

C. Provide the client with a soft-bristled toothbrush for oral care

D. Instruct the assistive personnel to strain the patient's urine for stones

A. Use a lift sheet to assist the client with position changes in bed

Explanation:

Hyperparathyroidism weakens bones due to increased calcium loss, making clients prone to fractures. Lift sheets prevent injury during movement.

While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1°F (0.5°C). What does the nurse do first?

Options:

A. Turn the lights down and shut the patient's door.

B. Call for an immediate electrocardiogram (ECG).

C. Calculate the client's apical-radial pulse deficit.

D. Administer a dose of acetaminophen.

A. Turn the lights down and shut the patient's door.

Explanation:

A temperature rise in a client with Graves' disease may signal thyroid storm, a life-threatening condition. The nurse must first reduce environmental stimulation (lights, noise) before taking other actions.

The nurse is caring for a client who has possible hypothyroidism. What possible risk factors can cause this health problem? (Select all that apply.)

Options:

A. Lithium drug therapy

B. Thyroid cancer

C. Autoimmune thyroid disease

D. Iodine deficiency

E. Laryngitis

F. Pituitary tumors

A. Lithium drug therapy

B. Thyroid cancer

C. Autoimmune thyroid disease

D. Iodine deficiency

F. Pituitary tumors

Explanation:

Laryngitis (E) is not a cause of hypothyroidism. All other options are recognized risk factors, including drug use, cancer, autoimmune causes, nutritional deficiency, and endocrine abnormalities.

A nurse is caring for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. What actions does the nurse take? (Select all that apply.)

Options:

A. Administer levothyroxine

B. Administer propranolol

C. Monitor the apical pulse

D. Assess for Trousseau sign

E. Initiate telemetry monitoring

B. Administer propranolol

C. Monitor the apical pulse

E. Initiate telemetry monitoring

Explanation:

These findings suggest hyperthyroidism. The nurse should monitor for cardiac effects. Levothyroxine is for hypothyroidism, and Trousseau sign is for hypocalcemia.

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's health teaching? (Select all that apply.)

Options:

A. Increased carbohydrates

B. Decreased fats

C. Increased calorie intake

D. Supplemental vitamins

E. Increased proteins

A. Increased carbohydrates

C. Increased calorie intake

E. Increased proteins

Explanation:

Clients with hyperthyroidism have a hypermetabolic state, so they need more calories, carbohydrates, and protein. Fat does not need to be limited, and supplemental vitamins are not routinely required.

Which statements regarding hypothyroidism are accurate? Select all that apply.

Options:

A. Has a sudden onset of symptoms

B. Can be diagnosed by the presence of a goiter

C. Reduces cardiac and central nervous system function

D. Often occurs weeks after a bacterial or viral infection

E. Is much more common among women than among men

F. Most common form has an autosomal dominant pattern of inheritance

C, D, E

Explanation:

• C: Hypothyroidism slows down all systems, especially cardiac and CNS.

• D: It often follows infections like viral or bacterial illness.

• E: It is significantly more common in women.

• A, B, and F are incorrect—onset is slow and insidious; goiters can occur in other conditions; inheritance is not a major factor.

Which history information provided by a client with hypothyroidism will the nurse consider as a possible cause of the disorder?

Options:

A. Egg and peanut allergy

B. Has received radiation to the neck

C. Mother with Graves disease

D. Has been pregnant three times in the past 4 years

B

Explanation:

Radiation therapy to the neck is a leading cause of hypothyroidism due to thyroid tissue damage. Allergies, family history of Graves, and multiple pregnancies are not major risk factors.

Which symptoms will the nurse expect to find on assessment of a client with hypothyroidism? Select all that apply.

Options:

A. Increased appetite

B. Cold intolerance

C. Constipation

D. Hypotension

E. Exophthalmia

F. Palpitations

G. Tremors

H. Weight gain

B, C, D, H

Explanation:

• Cold intolerance, constipation, low blood pressure, and weight gain are common due to slowed metabolism.

• Increased appetite, tremors, palpitations, and exophthalmia are linked to hyperthyroidism.

Which laboratory values does the nurse specifically expect to find in a client who has primary hypothyroidism?

Options:

A. Total serum T4 1 mcg/dL (22 nmol/L)

B. Thyrotropin receptor antibodies (TRAbs) 0%

C. Thyroid-stimulating hormone (TSH) 8 mU/mL

D. White blood cell (WBC) count 6200/mm³ (6.2 × 10⁹/L)

C

Explanation:

In primary hypothyroidism, TSH is elevated due to negative feedback loop trying to stimulate the underactive thyroid gland. TRAbs relate to Graves disease, and other labs are normal.

Which precaution has the highest priority for the nurse to teach a client starting thyroid hormone replacement therapy (HRT) to prevent harm?

Options:

A. "Take the drug at the same time every day."

B. "Avoid caffeinated beverages and foods."

C. "Take the drug exactly as prescribed."

D. "Get plenty of sleep and rest."

C

Explanation:

Strict adherence to prescription is essential to avoid under- or overdosing, which can lead to serious complications such as cardiac issues or myxedema coma.

Which condition does the nurse recognize as a life-threatening emergency and serious complication when a client's hypothyroidism is not treated or is undertreated?

Options:

A. Exophthalmos

B. Myxedema coma

C. Toxic multinodular goiter

D. Hashimoto thyroiditis

B

Explanation:

Myxedema coma is a severe, life-threatening form of hypothyroidism, leading to decreased cardiac output and CNS depression.

Which laboratory value in a client being managed for hypothyroidism will the nurse report to the primary health care provider immediately?

Options:

A. Sodium 125 mEq/L

B. Potassium 3.0 mEq/L

C. Fasting blood glucose 68 mg/dL

D. Platelet count of 220,000/mm³

A

Explanation:

Severe hyponatremia (Na+ = 125) is dangerous and could lead to neuro complications. The other values are within safe ranges.

Which assessment findings in a client with myxedema coma indicate to the nurse that therapy is effective? Select all that apply.

Options:

A. SpO₂ is 89%

B. Skin is cool and dry

C. Pulse is 62 beats/min

D. Blood pressure is 98/60

E. Urine output is greater than 10 mL/hr

F. Core body temperature is 98.6°F (36.8°C)

E, F

Explanation: Increasing core temperature and urine output indicate improved perfusion and metabolism from therapy. The SpO₂, pulse, and BP are still too low, and skin remains cool and dry during myxedema.

Which report from a client who has hypothyroidism and is taking synthetic thyroid hormone replacement therapy indicates to the nurse that more teaching is necessary?

Options:

A. "I take the drug at the same time every day."

B. "I always drink a full glass of water when I take the pill."

C. "The pill is small, I mix it with pudding to make it easier to swallow."

D. "Most often, I take the drug early in the morning to prevent it from keeping me awake at night."

C

Explanation: Levothyroxine should be taken on an empty stomach with water to ensure full absorption. Mixing with pudding may impair its effect.

Which assessments have the highest priority for the nurse to perform on a 76-year-old client who started hormone replacement therapy (HRT) 2 weeks ago?

Select all that apply.

A. Checking for tremors

B. Measuring blood pressure

C. Checking oxygen saturation

D. Asking about sleep patterns

E. Asking about changes in appetite

F. Determining the presence or absence of chest pain

A, F

Rationale: Older adults on thyroid therapy must be monitored closely for signs of overmedication, which may include tremors and chest pain due to cardiac and CNS stimulation.

What is the nurse's best response when a client with hypothyroidism asks how long hormone replacement therapy will be needed?

A. "After your goiter is surgically removed, you should be able to stop HRT."

B. "HRT will be needed for the rest of your life because hypothyroidism has no cure."

C. "You will be able to stop HRT as soon as your blood levels of thyroid hormones rise to normal ranges."

D. "Regardless of when your blood levels of thyroid hormones return to normal, HRT must be continued until all your symptoms subside."

B

Rationale: Hypothyroidism is lifelong, so the client will require lifelong HRT to maintain normal metabolism and prevent complications like myxedema coma.

The client who has been taking synthetic thyroid hormone replacement therapy (HRT) for 3 months reports all of the following conditions. Which condition indicates to the nurse that the drug dosage may need to be adjusted?

A. Difficulty sleeping

B. Increased urine output

C. Decreased sense of smell

D. Difficulty remembering to take the drug

A

Rationale: Difficulty sleeping is a symptom of overmedication and hyperthyroidism. It may indicate that the dosage is too high and needs to be adjusted.

Which client will the nurse consider to be at highest risk for development of Graves disease?

A. 25-year-old who has been taking thyroid hormone replacement therapy for 9 years

B. 35-year-old woman who has type 1 diabetes mellitus

C. 45-year-old man who eats a vegan diet that includes seaweed

D. 55-year-old who lives near a uranium-processing plant

B

Rationale: Graves disease is an autoimmune disorder, and it is most often seen in people who have other autoimmune diseases like type 1 diabetes.

Which assessment findings that are unique to Graves disease will the nurse expect in a client who has hyperthyroidism?

Select all that apply.

A. Goiter

B. Fine tremors

C. Elevated body temperature

D. Dry, waxy swelling on shins

E. Multiple nodules in the thyroid gland

A, C, E

Rationale: Goiter, elevated temperature, and multiple thyroid nodules are common in Graves disease. Tremors and waxy shins (pretibial myxedema) may occur in hyperthyroidism in general but are not exclusive to Graves.

In collaboration with the registered dietitian nutritionist, which dietary modifications will the nurse suggest to a client with hyperthyroidism?

Select all that apply.

A. Increased salt water fish or seafood

B. Increased overall calories

C. Elimination of fatty food

D. Increased carbohydrates

E. Increased protein

F. Fluid restriction

B, D, E

Rationale: Clients with hyperthyroidism are hypermetabolic and need more calories, protein, and carbs to prevent weight loss and muscle wasting. Fat and fluid restrictions are not indicated.

Which assessment technique will the nurse avoid during the examination of a client with hyperthyroidism to prevent harm?

A. Using an oral thermometer for temperature assessment

B. Checking hydration status by pinching up the skin

C. Measuring blood pressure with an external cuff

D. Palpating the thyroid gland

D

Rationale: Palpating the thyroid gland can stimulate a sudden release of thyroid hormones, potentially leading to a thyroid storm, which is life-threatening. It should be avoided in clients with hyperthyroidism.

Which new-onset problem is most important for the nurse to instruct a client, starting on propylthiouracil as therapy for hyperthyroidism, to notify the primary health care provider immediately?

A. Insomnia

B. Ringing in the ears

C. Heat intolerance

D. Dark-colored urine

D

Rationale: Dark-colored urine is a sign of liver toxicity, which is a severe side effect of propylthiouracil (PTU) and should be reported immediately.

Which statement by a client undergoing radioactive iodine (RAI) therapy demonstrates to the nurse that the client has correct understanding of postprocedure precautions?

A. "I will wear a wig until my hair grows back in."

B. "I will be sure to use only one toilet and not let others use it for 2 weeks."

C. "I will avoid crowds and other people who are ill to reduce the risk for an infection."

D. "I will avoid having a manicure or pedicure during the first month after treatment."

B

Rationale: After RAI therapy, clients must take radiation precautions, including using a separate toilet if possible, because their urine contains radioactive iodine that could be harmful to others.

Which assessment finding of a client 10 hours after a subtotal thyroidectomy indicates to the nurse possible airway obstruction?

A. Client is drooling.

B. Oxygen saturation is 97%.

C. Dressing has a moderate amount of serosanguineous drainage.

D. Client responds to questions correctly but does not open the eyes while talking.

A

Rationale: Drooling is a sign of difficulty swallowing or airway obstruction, often due to swelling, bleeding, or nerve damage after thyroid surgery. This requires immediate intervention.

Which actions will the nurse take to help prevent strain on the suture line for a client who had a total thyroidectomy for thyroid cancer yesterday?

Select all that apply.

A. Keeping the client on total bedrest

B. Placing a small pillow under the client's head

C. Maintaining the head of the bed in the flat position

D. Instructing the client to avoid deep-breathing exercises

E. Applying an elastic wrap around the neck over the dressing

F. Instructing the client to place both hands on the back of the neck while moving

B, F

Rationale: Placing a small pillow and having the client support the neck with hands while moving help prevent tension on the suture line. Total bedrest and avoiding deep breathing are not appropriate, and elastic wraps can restrict breathing.

Which complication does the nurse suspect when a client who had a thyroidectomy 1 day ago now has a weak voice and hoarseness?

A. Impending hemorrhage

B. Laryngeal nerve damage

C. Partial airway obstruction

D. Irritation from the endotracheal tube

B

Rationale: Hoarseness and weak voice after thyroidectomy suggest possible damage to the laryngeal nerve, which controls vocal cord function.

Which client does the nurse consider to be at highest risk for a change in thyroid function from thyroiditis?

A. 25-year-old woman who received a tetanus vaccination yesterday

B. 38-year-old woman taking thyroid hormone replacement therapy

C. 50-year-old man who sustained a neck injury in a car crash

D. 61-year-old man who had influenza 3 weeks ago

D

Rationale: Thyroiditis, an inflammation of the thyroid gland, often follows a viral infection such as influenza, especially a few weeks later.

Which laboratory value indicates to the nurse that a client who had a subtotal thyroidectomy for thyroid cancer several months ago may now have a recurrence of the disorder?

A. Thyrotropin receptor antibody level of 0%

B. Thyroglobulin level of 120 ng/mL

C. Serum calcium level of 10.0 mg/dL (2.37 mmol/L)

D. Serum triiodothyronine (T3) 70 ng/dL (3.4 nmol/L)

B

Rationale: A high thyroglobulin level suggests recurrence of thyroid cancer in clients who had a subtotal thyroidectomy. It is a tumor marker for thyroid tissue activity.

For which laboratory value will the nurse immediately assess the reflexes of a client who has hypoparathyroidism?

A. Sodium 131 mEq/L (mmol/L)

B. Potassium 5.1 mEq/L (mmol/L)

C. Calcium 7.8 mg/dL (1.76 mmol/L)

D. pH 7.33

C

Rationale: A low calcium level (normal is 8.5-10.5 mg/dL) is a critical finding in hypoparathyroidism and can lead to neuromuscular irritability and seizures. Reflexes should be checked immediately to assess severity and risk.

Which substances does the nurse expect to be prescribed for a client who has hypoparathyroidism to manage the symptoms?

Select all that apply.

A. Sodium supplement

B. Calcium supplement

C. Potassium supplement

D. Phosphorus supplement

E. Vitamin C

F. Vitamin D

B, F

Rationale: Clients with hypoparathyroidism often have calcium deficiency, so calcium supplements and vitamin D (which helps calcium absorption) are prescribed. Phosphorus supplements are avoided because calcium and phosphorus have an inverse relationship in the body.

Which instruction will the nurse give to an assistive personnel (AP) who is preparing to move a client with severe hypoparathyroidism to prevent harm?

A. Apply a warming blanket.

B. Offer oral fluids every 2 hours.

C. Provide the client with a soft-bristled toothbrush.

D. Use a lift sheet when moving the client in bed.

D

Rationale: Clients with hypoparathyroidism often have brittle bones due to calcium loss, which increases their risk for fractures. Using a lift sheet helps move them gently and safely.

With which client will the nurse be aware of an increased risk for hyperparathyroidism?

A. 28-year-old woman with pregnancy

B. 45-year-old man receiving dialysis for end-stage kidney disease

C. 55-year-old man with moderate heart failure after myocardial infarction last year

D. 60-year-old woman on home oxygen therapy for chronic obstructive pulmonary disease

B

Rationale: Clients with chronic kidney disease (CKD) or those on dialysis are at risk for secondary hyperparathyroidism due to altered calcium-phosphorus balance and reduced vitamin D activation by the kidneys.

Which additional health problems will the nurse expect the client with chronic hyperparathyroidism to be at risk for if management is not effective?

Select all that apply.

A. Psychosis

B. Kidney stones

C. Thyroid cancer

D. Bone fractures

E. Chronic diarrhea

F. Peptic ulcer disease

A, B, D, F

Rationale:

• Excess parathyroid hormone (PTH) causes bone resorption, leading to fractures.

• Calcium loss from bones increases serum calcium, which can result in psychosis and peptic ulcers due to increased gastric acid.

• Kidney stones are also common from hypercalcemia.

• Thyroid cancer and chronic diarrhea are not associated with hyperparathyroidism.