The school nurse notices that a 14-year old who used to be an excellent student and very active in sports is losing weight, acting very nervous and wide bulging eyes. The teen was recently checked by the primary care provider (PCP), who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition?

Hypothyroidism

Juvenile autoimmune thyroiditis

Hashimoto thyroid disease

Graves Disease

Answer and Explanation

The Correct Answer is D

A. Hypothyroidism: Hypothyroidism is characterized by symptoms such as weight gain, fatigue, dry skin, and cold intolerance. The teen's symptoms of weight loss, nervousness, and bulging eyes are not typical of hypothyroidism.

B. Juvenile autoimmune thyroiditis: Juvenile autoimmune thyroiditis is typically associated with hypothyroidism and does not present with symptoms like weight loss, nervousness, or bulging eyes. It is more often characterized by fatigue, cold intolerance, and weight gain.

C. Hashimoto thyroid disease: Hashimoto's disease is an autoimmune disorder that often leads to hypothyroidism. The symptoms described (weight loss, nervousness, bulging eyes) do not align with Hashimoto's disease, which is generally linked to an underactive thyroid.

D. Graves' Disease: Graves' disease is a type of hyperthyroidism often characterized by weight loss, nervousness, bulging eyes (exophthalmos). The symptoms align with the presentation of this teen, and the low TSH level further supports the diagnosis.

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Correct Answer is B

Explanation

A. Decreased free thyroxine index: In Graves' disease, there is an overproduction of thyroid hormones, including thyroxine (T4), leading to an increase in the free thyroxine index, not a decrease. Elevated T4 levels are typical in hyperthyroidism associated with Graves' disease.

B. Decreased thyroid stimulating hormone (TSH): In Graves' disease, the body produces excess thyroid hormones, which suppresses the pituitary gland’s production of TSH. As a result, TSH levels are typically low in Graves' disease.

C. Decreased triiodothyronine (T3): Graves' disease usually results in increased levels of T3 and T4 due to the overactive thyroid. A decrease in T3 would be inconsistent with the hyperthyroid state seen in this disorder.

D. Decreased thyrotropin receptor antibodies: In Graves' disease, there is an increase in thyrotropin receptor antibodies, which stimulate the thyroid to produce excess thyroid hormones. These antibodies are often elevated, not decreased.

A. The nurse will monitor the client's blood glucose levels four (4) times a day. B. The client will demonstrate appropriate insulin injection techniques C. The client will maintain normal kidney function with 30-ml/hr urine output. D. The client will have a blood glucose level between 60-110 mg/dl at 1600.

Correct Answer is D

Explanation

A. The nurse will monitor the client's blood glucose levels four (4) times a day: This is important, but it is an intervention rather than a goal. A goal should be measurable and focused on the client's outcome, such as maintaining specific glucose levels.

B. The client will demonstrate appropriate insulin injection techniques: This is a good educational goal, but it does not directly address the immediate concern. The problem states noncompliance, implying the client knows how to inject but isn't doing it consistently.

C. The client will maintain normal kidney function with 30-ml/hr urine output: While monitoring kidney function is important in diabetes, this goal does not address the immediate risk of hyperglycemia. Urine output is not the primary indicator of hyperglycemia.

D. The client will have a blood glucose level between 60-110 mg/dl at 1600: This short-term goal is specific, measurable, and time-bound. It addresses the desired outcome of maintaining blood glucose within a normal range, which addresses hyperglycemia due to noncompliance.

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Naxlex Comprehensive Predictor Exams

A nurse is in a provider's office is reviewing the health record of a client who is being evaluated for Grave's disease. Which of the following is an expected laboratory finding for this client?

Correct Answer is B

Explanation

The nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperglycemia related to noncompliance with the medication regimen." Which statement is an appropriate short-term goal for the client?

Correct Answer is D

Explanation

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