Nursing Elites

1. 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:

• A. Thyroid storm.
• B. Cretinism.
• C. Myxedema coma.
• D. Hashimoto's thyroiditis.

Correct answer: C

Rationale: The scenario described with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area is indicative of myxedema coma, a severe and life-threatening complication of hypothyroidism. Myxedema coma requires immediate emergency treatment to prevent further deterioration. Choice A, thyroid storm, is a complication of hyperthyroidism characterized by an increase in body temperature, heart rate, and blood pressure. Choice B, cretinism, refers to untreated congenital hypothyroidism leading to mental and physical growth retardation. Choice D, Hashimoto's thyroiditis, is an autoimmune condition leading to hypothyroidism but does not present with the acute, life-threatening symptoms described in the scenario.

2. A client with hypothyroidism is at risk for which of the following complications?

• A. Thyroid storm
• B. Myxedema coma
• C. Cushing's syndrome
• D. Diabetic ketoacidosis

Correct answer: B

Rationale: Myxedema coma is a severe, life-threatening complication that can occur in individuals with untreated or inadequately treated hypothyroidism. It is characterized by extreme hypothyroidism leading to decreased mental status, hypothermia, bradycardia, and respiratory depression. Thyroid storm (Choice A) is a severe complication of hyperthyroidism, not hypothyroidism. Cushing's syndrome (Choice C) results from prolonged exposure to high levels of cortisol, not related to hypothyroidism. Diabetic ketoacidosis (Choice D) is a complication of uncontrolled diabetes, not directly associated with hypothyroidism.

3. A client with Addison's disease is receiving corticosteroid therapy. The nurse should monitor the client for which of the following potential side effects?

• A. Hypoglycemia
• B. Hypertension
• C. Weight loss
• D. Hyperkalemia

Correct answer: B

Rationale: When a client with Addison's disease is receiving corticosteroid therapy, the nurse should monitor for hypertension as a potential side effect. Corticosteroids can lead to hypertension by causing fluid retention and increased blood volume. Hypoglycemia (Choice A) is not a common side effect of corticosteroid therapy; instead, hyperglycemia is more likely. Weight loss (Choice C) is not a typical side effect of corticosteroid therapy; in fact, weight gain is more common due to fluid retention and increased appetite. Hyperkalemia (Choice D) is a potential side effect of Addison's disease itself due to adrenal insufficiency, but it is not directly caused by corticosteroid therapy.

4. The client with DM is being instructed by the nurse about the importance of controlling blood glucose levels. The nurse should emphasize that uncontrolled blood glucose can lead to:

• A. Increased risk of heart disease and stroke.
• B. Improved wound healing.
• C. Reduced need for medication.
• D. Decreased risk of infection.

Correct answer: A

Rationale: The correct answer is A: Increased risk of heart disease and stroke. Uncontrolled blood glucose levels in clients with diabetes mellitus (DM) can lead to cardiovascular complications, such as heart disease and stroke. High blood glucose levels can damage blood vessels over time, increasing the risk of atherosclerosis and cardiovascular events. Choices B, C, and D are incorrect because uncontrolled blood glucose levels do not improve wound healing, reduce the need for medication, or decrease the risk of infection. In fact, uncontrolled blood glucose levels can impair wound healing, require more medications to manage symptoms, and increase the risk of infections due to compromised immune function.

5. 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?

• A. Primary hypothyroidism
• B. Graves' disease
• C. Thyrotoxicosis
• D. Euthyroidism

Correct answer: A

Rationale: Levothyroxine is the preferred agent for primary hypothyroidism because it provides the necessary replacement of thyroid hormone in patients with deficient thyroid function. Choice B, Graves' disease, is an autoimmune disorder that causes hyperthyroidism and is typically treated with antithyroid medications or radioactive iodine. Choice C, thyrotoxicosis, refers to the clinical state resulting from excessive thyroid hormone action and is not typically treated with levothyroxine. Choice D, euthyroidism, describes a normal thyroid function and would not require treatment with levothyroxine.

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