Choice A: Thyroxine (T4) level. This is incorrect because T4 is one of the thyroid hormones that is increased in hyperthyroidism. T4 is produced by the thyroid gland and converted to T3 in the tissues. A high level of T4 indicates overactivity of the thyroid gland.1

Choice B: Triiodothyronine (T3) level. This is incorrect because T3 is another thyroid hormone that is increased in hyperthyroidism. T3 is the more active form of thyroid hormone and regulates the metabolism of cells. A high level of T3 indicates overactivity of the thyroid gland.1

Choice C: Thyroid stimulating hormone (TSH) level. This is correct because TSH is a hormone that stimulates the thyroid gland to produce T4 and T3. TSH is produced by the pituitary gland and regulated by a feedback mechanism. When the levels of T4 and T3 are high, the pituitary gland reduces the secretion of TSH to inhibit further production of thyroid hormones. Therefore, a low level of TSH indicates hyperthyroidism.1

Choice D: Glucose level. This is incorrect because glucose level is not directly related to thyroid function. However, hyperthyroidism can affect glucose metabolism and cause increased blood sugar levels due to increased breakdown of glycogen and glucose uptake by cells. Therefore, glucose level may be elevated in some cases of hyperthyroidism, but it is not a specific indicator.

Choice A: “I will feel shaky.” This is a correct statement, as shakiness is a common manifestation of hypoglycemia, which is a low blood glucose level. Hypoglycemia can cause the sympathetic nervous system to release adrenaline, which can cause tremors, nervousness, and anxiety.

Choice B: “My skin will be warm and moist.” This is an incorrect statement, as warm and moist skin is not a typical manifestation of hypoglycemia. Warm and moist skin can be a sign of hyperglycemia, which is a high blood glucose level. Hyperglycemia can cause dehydration, which can lead to sweating and flushing.

Choice C: “I will be more thirsty than usual.” This is an incorrect statement, as thirst is not a typical manifestation of hypoglycemia. Thirst can be a sign of hyperglycemia, which can cause dehydration, as the body tries to flush out excess glucose through urine.

Choice D: “My appetite will be decreased.” This is an incorrect statement, as decreased appetite is not a typical manifestation of hypoglycemia. Decreased appetite can be a sign of other conditions, such as nausea, infection, or depression. Hypoglycemia can cause increased hunger, as the body needs more glucose to function properly.

Choice A: Negative Chvostek’s sign is the absence of facial twitching when the facial nerve is tapped. This is a normal finding and does not indicate hypoparathyroidism. A positive Chvostek’s sign is a sign of hypocalcemia, which can occur in hypoparathyroidism.

Choice B: Flaccid muscles are weak and limp muscles that lack tone and resistance. This is not a typical finding of hypoparathyroidism, as low levels of parathyroid hormone can cause muscle spasms, cramps, and tetany.

Choice C: Numbness of the hands is a common finding of hypoparathyroidism, as low levels of parathyroid hormone can cause hypocalcemia, which affects the nerve function and sensation. Numbness can also occur in the feet, lips, and tongue.

Choice D: Hypercalcemia is a high level of calcium in the blood. This is not a finding of hypoparathyroidism, as low levels of parathyroid hormone can cause hypocalcemia, which is a low level of calcium in the blood. Hypercalcemia can be a sign of hyperparathyroidism, which is the opposite condition of hypoparathyroidism.

Choice A: Blurred vision is not a typical finding of hypothyroidism. It can be caused by other conditions, such as diabetes, glaucoma, or eye strain.

Choice B: Bradycardia is a slow heart rate, usually below 60 beats per minute. This is a common finding of hypothyroidism, as the thyroid hormone regulates the metabolic rate and affects the cardiovascular system. Low levels of thyroid hormone can cause the heart to beat slower and weaker.

Choice C: Insomnia is difficulty falling or staying asleep. This is not a common finding of hypothyroidism, as low thyroid hormone levels can cause fatigue, lethargy, and excessive sleepiness.

Choice D: Moist skin is not a common finding of hypothyroidism, as low thyroid hormone levels can cause dry skin, hair loss, and britle nails. Moist skin can be a sign of hyperthyroidism, which is the opposite condition of hypothyroidism.

Choice A reason: Insulin injected into the thigh is not the most rapidly absorbed. The abdomen is the preferred site for insulin injection, as it has the fastest and most consistent absorption rate. The thigh, arm, and butock have slower and more variable absorption rates12.

Choice B reason: The botle of insulin should not be shaken before withdrawing the medication. Shaking can damage the insulin molecules and affect their potency and effectiveness. Instead, the botle should be gently rolled between the palms to mix the insulin evenly13.

Choice C reason: Lantus insulin should not be used immediately before each meal. Lantus is a long-acting insulin that provides a steady basal level of insulin for 24 hours. It should be taken once a day at the same time every day, regardless of meals. Humalog is a rapid-acting insulin that can be used immediately before each meal to cover the postprandial glucose spikes14.

Choice D reason: Unopened vials of insulin should be kept in the refrigerator until needed. This can help preserve their quality and potency until their expiration date. Opened vials of insulin can be kept at room temperature for up to 28 days, depending on the type and brand

Choice A reason: Roast chicken with white rice is a low-fiber, easy-to-digest meal that is suitable for a client who has recovered from the acute phase of diverticulitis. A low-fiber diet can help reduce the stress on the colon and allow it to heal. White rice is a refined grain that has less fiber than whole grains, such as brown rice or quinoa12.

Choice B reason: A poached egg with sliced tomatoes is not a good choice for a client who has recovered from the acute phase of diverticulitis. Although eggs are a good source of protein and do not contain fiber, tomatoes are high in fiber and may irritate the colon. Tomatoes also have seeds, which were previously thought to cause problems for people with diverticular disease, but there is no evidence to support this. However, some people may still find them uncomfortable to eat13.

Choice C reason: Bean soup with steamed broccoli is not a good choice for a client who has recovered from the acute phase of diverticulitis. Beans and broccoli are both high in fiber and may cause gas, bloating, and cramping in the colon. A high-fiber diet is recommended for people with diverticulosis (the presence of pouches without inflammation) to prevent constipation and diverticulitis, but it should be avoided during or shortly after an episode of diverticulitis12.

Choice D reason: Ham sandwich on white bread is not a good choice for a client who has recovered from the acute phase of diverticulitis. Although white bread is low in fiber, ham is a processed meat that may increase the risk of developing diverticular disease. Research suggests that a diet high in red meat and processed meat may contribute to inflammation and infection of the pouches in the colon.

Choice A reason: A fruity odor in the breath is a symptom of hyperglycemia, especially when it is severe and causes ketoacidosis. Ketoacidosis is a condition where the body produces ketones, which are acidic substances that result from the breakdown of fat for energy when there is not enough insulin or glucose available. Ketones can make the breath smell fruity or like nail polish remover.

Choice B reason: A decreased appetite is not a symptom of hyperglycemia. On the contrary, an increased appetite or hunger is a symptom of hyperglycemia, as the body tries to compensate for the lack of glucose in the cells by stimulating the hunger center in the brain.

Choice C reason: An increased thirst is a symptom of hyperglycemia, as the body tries to flush out the excess glucose and ketones in the blood through urine. This leads to dehydration and thirst signals in the brain.

Choice D reason: A blurry vision at times is a symptom of hyperglycemia, as high blood glucose levels can cause swelling and damage to the lens of the eye, affecting its ability to focus light properly. This can lead to temporary or permanent vision problems.

Choice A reason: Wearing closed-toed shoes daily is a good practice for people with diabetes, as it can protect the feet from injuries and infections. However, it is not the most important action for preventing long-term complications of retinopathy and neuropathy. These complications are mainly caused by high blood glucose levels that damage the blood vessels and nerves in the eyes and feet.

Choice B reason: Maintaining stable blood glucose levels is the most important action for preventing long-term complications of retinopathy and neuropathy. High blood glucose levels can cause oxidative stress, inflammation, and endothelial dysfunction, which impair the blood flow and oxygen delivery to the eyes and feet. This can lead to nerve damage (neuropathy) and vision loss (retinopathy) over time. Keeping blood glucose levels within the target range can reduce the risk of these complications and slow down their progression if they already exist.

Choice C reason: Planning to have an eye examination once per year is a recommended action for people with diabetes, as it can help detect and treat retinopathy before it causes irreversible damage to the retina. However, it is not the most important action for preventing long-term complications of retinopathy and neuropathy. Eye examinations cannot prevent retinopathy from occurring or worsening; they can only monitor its status and provide appropriate interventions.

Choice D reason: Examining your feet carefully every day is another recommended action for people with diabetes, as it can help identify and treat any signs of neuropathy, such as numbness, tingling, pain, or ulcers. However, it is not the most important action for preventing long-term complications of retinopathy and neuropathy. Foot examinations cannot prevent neuropathy from occurring or worsening; they can only monitor its status and provide appropriate care.

Choice A reason: This test does not detect antithyroid antibodies in your blood. Antithyroid antibodies are proteins that atack the thyroid gland and can cause autoimmune thyroid diseases, such as Hashimoto’s thyroiditis or Graves’ disease. To detect antithyroid antibodies, you need a different blood test called the thyroid peroxidase (TPO) antibody test.

Choice B reason: This test does not measure the amount of thyroid hormone that ataches to a protein in your blood. Thyroid hormone can exist in two forms in the blood: free or bound. Free thyroid hormone is not atached to any protein and can enter the cells and tissues where it is needed. Bound thyroid hormone is atached to a protein called thyroxine-binding globulin (TBG) and cannot enter the cells and tissues. To measure the amount of thyroid hormone that ataches to TBG, you need a different blood test called the total thyroxine (T4) test.

Choice C reason: This test determines whether your thyroid gland is overactive, appropriately active, or underactive. TSH is a hormone produced by the pituitary gland that stimulates the thyroid gland to make and release thyroid hormones, such as thyroxine (T4) and triiodothyronine (T3). These hormones regulate many body functions, such as metabolism, growth, and development. The TSH test measures the amount of TSH in the blood and reflects how well the thyroid gland is working. If the TSH level is high, it means that the thyroid gland is underactive (hypothyroidism) and not making enough thyroid hormones. If the TSH level is low, it means that the thyroid gland is overactive (hyperthyroidism) and making too much thyroid hormones.

Choice D reason: This test does not measure the absorption of iodine and how it relates to the thyroid gland. Iodine is a mineral that is essential for the production of thyroid hormones. The thyroid gland absorbs iodine from the food and water we consume and uses it to make T4 and T3. To measure the absorption of iodine by the thyroid gland, you need a different test called the radioactive iodine uptake (RAIU) test.

Choice A reason: Injecting insulin into a muscle that is going to be exercised can increase the absorption of insulin and lower the blood glucose level, leading to hypoglycemia. Therefore, it is advisable to avoid injecting insulin into the same body part that will be involved in the exercise.

Choice B reason: Carrying a complex carbohydrate snack with you when you exercise is not a good idea. Complex carbohydrates take longer to digest and raise the blood glucose level slowly. They are not suitable for treating or preventing hypoglycemia during or after exercise. A simple carbohydrate snack, such as glucose tablets, juice or candy, is more appropriate for this purpose.

Choice C reason: Exercising first thing in the morning before eating breakfast is not recommended for people with type 1 diabetes. This can cause a drop in blood glucose level and increase the risk of hypoglycemia. It is beter to have a balanced breakfast that includes some carbohydrates and adjust the insulin dose accordingly before exercising.

Choice D reason: Increasing the intensity of your exercise routine if your urine is positive for ketones is a dangerous practice. Ketones are produced when the body breaks down fat for energy due to lack of insulin or glucose. High levels of ketones can lead to diabetic ketoacidosis, a life-threatening condition that requires urgent medical atention. Intense exercise can raise the blood glucose level further and worsen the situation. If your urine is positive for ketones, you should avoid vigorous activity and check your blood glucose and ketone levels frequently.