118 Finals Reviewer PDF

CHECK THE NOTES EVERY TOPIC PARA MAKA G KA SA GIST EACH TOPIC (LUV U!) A 45-year-old patient presents with severe dyspnea, tachypnea, and cyanosis after aspiration of gastric contents. Which of the following is the likely diagnosis?...

CHECK THE NOTES EVERY TOPIC PARA MAKA G KA SA GIST EACH TOPIC (LUV U!) A 45-year-old patient presents with severe dyspnea, tachypnea, and cyanosis after aspiration of gastric contents. Which of the following is the likely diagnosis? A) Chronic bronchitis B) Acute Respiratory Distress Syndrome (ARDS) C) Pulmonary embolism D) Asthma exacerbation A patient in the ICU is diagnosed with ARDS. What would you expect to see on their chest X-ray? A) Clear lung fields B) Bilateral infiltrates C) Pleural effusion D) Lung hyperinflation ACUTE RESPIRATORY During rounds, a patient with ARDS shows persistent hypoxemia despite oxygen supplementation. Which intervention is most appropriate to improve oxygenation? DISTRESS SYNDROME A) Positive end-expiratory pressure (PEEP) B) Administration of diuretics C) High-dose corticosteroids D) Bronchodilator therapy A nurse is caring for an ARDS patient on mechanical ventilation. The arterial blood gas (ABG) reveals a PaO2 of 55 mmHg and an FiO2 of 80%. What should be the next step? A) Increase FiO2 B) Increase PEEP C) Administer a beta-blocker D) Reduce tidal volume A 60-year-old with ARDS develops decreased urinary output and edema. What is the most likely cause? A) Hypovolemia B) Fluid overload C) Electrolyte imbalance D) Kidney infection A patient with ARDS has crackles on auscultation and intercostal muscle retractions. Which other sign is expected? A) Cyanosis B) Bradycardia C) Normal respiratory rate D) Decreased blood pressure A patient with ARDS is on mechanical ventilation with PEEP. What is the purpose of PEEP in this condition? A) Decrease oxygen consumption B) Prevent alveolar collapse C) Reduce heart rate D) Stabilize blood pressure Which nursing diagnosis is most appropriate for a patient with ARDS? A) Risk for infection B) Impaired gas exchange C) Acute pain D) Deficient fluid volume A patient with ARDS is receiving nutritional support. Why is this intervention important? A) To stabilize blood sugar B) To provide energy and prevent tissue breakdown C) To reduce inflammation D) To enhance oxygen transport A nurse notices that a patient with ARDS has an oxygen saturation of 88% despite high oxygen delivery. What is the priority action? A) Recheck the saturation B) Call the respiratory therapist C) Adjust PEEP settings D) Notify the physician immediately What is a critical goal of oxygen therapy in ARDS patients? A) Maintain oxygen saturation above 85% B) Use the lowest FiO2 to maintain oxygen saturation >90% C) Deliver 100% oxygen at all times D) Reduce carbon dioxide levels A patient with ARDS is receiving sedation for mechanical ventilation. Which sedative is commonly used in this scenario? A) Furosemide B) Propofol C) Metoprolol D) Morphine What is the most common physical assessment finding in a patient with ARDS? A) Clear lung sounds B) Bilateral crackles C) Hypotension D) Slow respiratory rate A nurse is monitoring a patient with ARDS for complications. Which finding suggests worsening of the condition? A) Decreased FiO2 requirements B) Persistent hypoxemia C) Stable ABG values D) Improved breath sounds An ARDS patient has high levels of positive end-expiratory pressure (PEEP). What complication should the nurse watch for? A) Pulmonary embolism B) Barotrauma C) Dehydration D) Bradycardia A patient with ARDS has a PaO2/FiO2 ratio of 100. How is their ARDS severity classified? A) Mild B) Moderate C) Severe D) Critical Which ABG finding is typical in ARDS? A) Metabolic alkalosis B) Respiratory alkalosis C) Metabolic acidosis D) Respiratory acidosis A nurse is educating a family about ARDS. Which statement accurately describes the condition? A) “ARDS is caused by chronic conditions like asthma.” B) “ARDS leads to fluid accumulation in the lungs, impairing oxygen exchange.” C) “ARDS is a temporary condition that resolves in days.”  D) “ARDS only affects elderly patients.” Which intervention is least likely to be included in ARDS management? A) Fluid restriction B) Antibiotic therapy C) Use of corticosteroids D) High-protein diet What radiographic finding is characteristic of ARDS? A) Hyperinflation of the lungs B) Bilateral infiltrates C) Unilateral effusion D) Normal lung fields A 25-year-old patient with Type 1 Diabetes presents to the ER with nausea, vomiting, and abdominal pain. Their blood glucose is 450 mg/dL. What condition should be suspected? A) Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) B) Diabetic Ketoacidosis (DKA) C) Hypoglycemia D) Lactic acidosis A patient in DKA has a blood pH of 7.1 and ketones in their urine. What is the primary treatment goal? A) Correct hyperglycemia B) Address dehydration and acidosis C) Administer antibiotics D) Stabilize potassium levels only Which clinical feature differentiates DKA from HHNS? A) Severe dehydration B) Elevated blood glucose C) Presence of ketosis D) Neurological deficits What initial fluid replacement is recommended for a patient in DKA? DIABETIC A) Dextrose 5% in water KETOACIDOSIS B) 0.9% normal saline (NAA NI SA NOTES FIRST IS 0.9 - 0.45 - D5W) C) Lactated Ringer’s D) 0.45% saline A 40-year-old patient with DKA has a potassium level of 5.5 mEq/L. What intervention is appropriate? A) Administer insulin and monitor potassium B) Give potassium supplementation C) Restrict fluids D) Initiate a high-protein diet A patient in DKA is receiving insulin therapy. What should the nurse closely monitor? A) Sodium levels B) Potassium levels C) Calcium levels D) Magnesium levels Which ABG finding is most consistent with DKA? A) pH 7.4, HCO3 24 mEq/L B) pH 7.1, HCO3 12 mEq/L C) pH 7.3, HCO3 22 mEq/L D) pH 7.5, HCO3 28 mEq/L A patient in DKA has a blood glucose level of 280 mg/dL, and IV fluids are being given. What is the next step? A) Switch to Dextrose 5% in water B) Continue normal saline C) Discontinue IV fluids D) Administer a diuretic Why is potassium supplementation often needed during DKA treatment? A) Potassium is lost through vomiting B) Insulin therapy causes potassium to shift intracellularly C) Potassium is excreted in urine due to hyperglycemia D) All of the above A patient’s DKA is resolving, and their blood glucose drops to 200 mg/dL. What adjustment should be made? A) Stop insulin infusion B) Switch IV fluids to include dextrose C) Administer glucagon D) Increase insulin dosage A nurse is monitoring urine output in a patient with DKA. Why is this important? A) To assess hydration status B) To measure glucose excretion C) To monitor for infection D) To evaluate kidney function What is the primary cause of acidosis in DKA? A) Hyperglycemia B) Ketone production C) Dehydration D) Electrolyte imbalance Which symptom is commonly associated with DKA? A) Bradycardia B) Acetone breath C) Hypertension D) Normal respiratory rate In DKA, what is the purpose of administering insulin? A) To lower blood glucose B) To stop ketone production C) To correct acidosis D) All of the above Which electrolyte imbalance is most concerning during DKA treatment? A) Hypernatremia B) Hypokalemia C) Hypercalcemia D) Hyponatremia A patient with DKA is drowsy and lethargic. What is the priority action? A) Start IV fluids B) Monitor blood pressure C) Perform a neurological assessment D) Administer pain medication What is the typical bicarbonate level in severe DKA? A) 20-30 mEq/L B) 15-20 mEq/L C) 0-15 mEq/L D) 25-30 mEq/L A patient with DKA reports rapid breathing. What is this respiratory pattern called? A) Cheyne-Stokes respiration B) Kussmaul respiration C) Apneustic breathing D) Biot’s respiration When transitioning a DKA patient to subcutaneous insulin, what is essential? A) Stop IV insulin immediately B) Overlap IV and subcutaneous insulin for 1-2 hours C) Administer glucagon simultaneously D) Monitor blood glucose hourly What is the most common precipitating factor for DKA? A) Missed insulin doses B) High-fat diet C) Stress D) Infection How does dehydration contribute to DKA? A) Reduces insulin effectiveness B) Increases glucose concentration C) Promotes ketone production D) All of the above What is the target glucose reduction rate in DKA treatment? A) 50-100 mg/dL per hour B) 20-50 mg/dL per hour C) 100-200 mg/dL per hour D) No specific target Which lab finding confirms metabolic acidosis in DKA? A) Low serum bicarbonate B) Elevated anion gap C) Low pH D) All of the above Why is it important to avoid rapid correction of blood glucose in DKA? A) It can cause hypoglycemia B) It can lead to cerebral edema C) It may increase potassium excretion D) All of the above A patient’s potassium level drops to 3.0 mEq/L during DKA treatment. What should the nurse do? A) Stop insulin therapy B) Administer IV potassium C) Reduce fluid rate D) Increase sodium intake Which factor is NOT a common cause of DKA? A) Infection B) Missed insulin doses C) Low carbohydrate intake D) Undiagnosed diabetes  What dietary advice is crucial for preventing DKA in diabetics? A) Avoid high-fat foods B) Maintain consistent carbohydrate intake C) Skip meals when not hungry D) Increase protein consumption A patient in DKA shows signs of fluid overload during treatment. What should be done? A) Stop IV fluids immediately B) Switch to diuretics C) Reduce fluid infusion rate D) Administer vasopressors Why are frequent blood glucose checks necessary during DKA treatment? A) To monitor treatment effectiveness B) To adjust insulin dosage C) To prevent hypoglycemia D) All of the above What is the primary goal of rehydration in DKA? A) To restore vascular volume B) To prevent cerebral edema C) To dilute blood glucose D) All of the above A 70-year-old patient with Type 2 Diabetes presents to the ER with confusion, profound dehydration, and a blood glucose level of 750 mg/dL. What is the most likely diagnosis? A) Diabetic Ketoacidosis (DKA) B) Hyperglycemia Hyperosmolar Nonketotic Syndrome (HHNS) C) Hypoglycemia D) Lactic acidosis Answer: B Which symptom is most characteristic of HHNS compared to DKA? A) Acetone breath B) High blood ketones C) Profound dehydration D) Severe abdominal pain Answer: C What is the primary cause of neurologic symptoms in HHNS? A) Hypoglycemia B) Cerebral dehydration C) Ketosis D) Hypokalemia Answer: B HYPERGLYCEMIC HYPEROSMOLAR A patient in HHNS has a serum osmolality of 330 mOsm/kg. What does this indicate? NONKETOTIC SYNDROME A) Normal hydration status B) Severe hyperosmolality C) Fluid overload D) Early onset HHNS Answer: B What is the initial treatment priority for a patient with HHNS? A) Insulin therapy B) Fluid replacement C) Potassium supplementation D) Antibiotic therapy Answer: B A patient in HHNS is receiving IV fluids. What type of fluid is typically given first? A) Dextrose 5% in water B) 0.9% normal saline C) Lactated Ringer’s D) 0.45% saline Answer: B A patient with HHNS has a blood glucose of 800 mg/dL and is started on IV fluids. At what glucose level should the fluid be changed to include dextrose? A) 500 mg/dL B) 300 mg/dL C) 200 mg/dL D) 100 mg/dL Answer: B Why is insulin therapy used less aggressively in HHNS than in DKA? A) HHNS patients are less dehydrated B) There is no acidosis to correct C) HHNS patients have lower blood glucose levels D) Insulin is not effective in HHNS Answer: B What electrolyte imbalance is most commonly associated with HHNS treatment? A) Hypernatremia B) Hypokalemia C) Hypercalcemia D) Hyponatremia Answer: B A nurse is monitoring a patient with HHNS for complications. Which finding suggests worsening of the condition? A) Improved urine output B) Persistent confusion C) Blood glucose below 300 mg/dL D) Stable vital signs Answer: B What is the typical blood glucose range in HHNS? A) 300-400 mg/dL B) 400-600 mg/dL C) 600-1200 mg/dL D) 100-200 mg/dL Answer: C Which patient is most at risk for developing HHNS? A) A 25-year-old with Type 1 Diabetes B) A 60-year-old with Type 2 Diabetes and recent infection C) A 45-year-old with well-controlled diabetes D) A 30-year-old with gestational diabetes Answer: B A patient with HHNS is confused and lethargic. What nursing intervention is a priority? A) Administer pain medication B) Start IV fluid therapy C) Monitor for seizures D) Perform a neurological assessment Answer: B Which clinical feature differentiates HHNS from DKA? A) Presence of acidosis B) Absence of ketosis C) Hyperglycemia D) Dehydration Answer: B Why are neurologic symptoms common in HHNS? A) Hypoglycemia B) Hyperosmolality and fluid shifts in the brain C) Electrolyte imbalances D) Acidosis Answer: B What is the primary goal of treatment for HHNS? A) Correct acidosis B) Stabilize blood glucose C) Rehydrate and restore electrolyte balance D) Prevent infection Answer: C Which lab finding is consistent with HHNS? A) Low blood glucose B) High ketones in urine C) Osmolality > 320 mOsm/kg D) Normal electrolyte levels Answer: C A patient’s HHNS is improving. What is a key indicator of recovery? A) Normal blood pressure B) Clear mental status C) Blood glucose > 600 mg/dL D) Decreased urine output Answer: B What complication should a nurse monitor for during HHNS treatment? A) Hypoglycemia B) Cerebral edema C) Pulmonary embolism D) Bradycardia Answer: B Which factor commonly precipitates HHNS? A) Insulin overdose B) Infection or illness C) High carbohydrate diet D) Excessive exercise Answer: B How does profound dehydration in HHNS affect blood osmolality? A) Decreases osmolality B) Increases osmolality C) Has no effect D) Normalizes osmolality Answer: B A patient with HHNS has a potassium level of 3.2 mEq/L. What intervention is appropriate? A) Increase IV fluid rate B) Administer potassium supplementation C) Restrict potassium intake D) Stop insulin therapy Answer: B What is the role of dextrose in the treatment of HHNS? A) Prevents hypoglycemia during glucose correction B) Increases blood glucose levels C) Reduces dehydration D) Enhances insulin sensitivity Answer: A What is the expected effect of insulin therapy in HHNS? A) Rapid glucose normalization B) Gradual decrease in blood glucose C) Immediate rehydration D) Electrolyte balance restoration Answer: B A patient with HHNS is improving, and their blood glucose is now 250 mg/dL. What adjustment should be made? A) Increase insulin infusion rate B) Switch to IV fluids with dextrose C) Discontinue IV fluids D) Stop insulin therapy Answer: B Why is potassium monitored closely in HHNS treatment? A) Insulin therapy can cause hypokalemia B) Dehydration increases potassium levels C) Potassium is unaffected in HHNS D) Hyperkalemia is the main concern Answer: A A patient with HHNS experiences seizures. What is the likely cause? A) Hypoglycemia B) Cerebral dehydration and electrolyte imbalance C) Hypernatremia D) Hyperkalemia Answer: B Which fluid imbalance is most commonly associated with HHNS? A) Fluid overload B) Profound dehydration C) Normal hydration D) Hypovolemia Answer: B A patient’s osmolality is 310 mOsm/kg, and they are diagnosed with HHNS. What is the expected intervention? A) Administer diuretics B) Initiate fluid replacement therapy C) Restrict fluid intake D) Increase insulin dosage Answer: B  Which nursing action is critical in the initial phase of HHNS treatment? A) Administer high-dose insulin B) Monitor fluid status and electrolytes C) Restrict oral intake D) Perform hourly neurologic assessments Answer: B 1. A 55-year-old patient with chronic liver disease presents with confusion, altered sleep patterns, and asterixis. Which diagnostic test is most important to confirm hepatic encephalopathy? A) Complete blood count B) Serum ammonia levels C) Liver function tests D) Abdominal ultrasound Answer: B) Serum ammonia levels HEPATIC 2. A patient with hepatic encephalopathy is prescribed lactulose. What is the primary purpose of this medication? ENCEPHALOPATHY A) Decrease serum ammonia levels B) Improve liver function C) Manage abdominal pain D) Increase bile production Answer: A) Decrease serum ammonia levels 3. During a follow-up, the caregiver of a hepatic encephalopathy patient reports frequent diarrhea after lactulose use. What is the most appropriate nursing response? A) Discontinue the medication immediately B) Reduce the lactulose dosage C) Encourage increased protein intake D) Explain that diarrhea is expected Answer: B) Reduce the lactulose dosage 4. A patient with hepatic encephalopathy demonstrates confusion and constructional apraxia. What is the best method to monitor neurologic status over time? A) Frequent liver enzyme testing B) Daily handwriting and arithmetic assessments C) Continuous EEG monitoring D) Recording serum bilirubin levels Answer: B) Daily handwriting and arithmetic assessments 5. A hepatic encephalopathy patient has a sweet fecal odor in their breath (fetor hepaticus). What does this indicate? A) High ammonia levels in the blood B) Gastrointestinal bleeding C) Bacterial overgrowth D) Portal vein obstruction Answer: A) High ammonia levels in the blood 6. Which dietary adjustment is most appropriate for a patient with hepatic encephalopathy? A) High protein intake to prevent muscle wasting B) Low protein intake to minimize ammonia production C) High-fat meals to increase energy levels D) Fluid restriction to prevent edema Answer: B) Low protein intake to minimize ammonia production 7. A patient with hepatic encephalopathy is receiving rifaximin. What is the mechanism of this medication? A) Reduces intestinal ammonia-producing bacteria B) Stimulates liver cell regeneration C) Enhances protein metabolism D) Corrects vitamin deficiencies Answer: A) Reduces intestinal ammonia-producing bacteria 8. A nurse observes a positive Babinski reflex in a patient with hepatic encephalopathy. What does this signify? A) Normal neurologic response B) Peripheral nerve damage C) Severe neurologic impairment D) Spinal cord injury Answer: C) Severe neurologic impairment 9. What is the main goal of managing hepatic encephalopathy? A) Lower bilirubin levels B) Eliminate precipitating factors and lower serum ammonia C) Increase liver enzyme production D) Enhance bile secretion Answer: B) Eliminate precipitating factors and lower serum ammonia 10. A patient with hepatic encephalopathy presents with severe confusion and agitation. What intervention should the nurse prioritize? A) Administer sedatives to calm the patient B) Start intravenous glucose to minimize protein breakdown C) Restrict all protein intake D) Perform immediate abdominal ultrasound Answer: B) Start intravenous glucose to minimize protein breakdown 11. A 45-year-old patient with liver failure experiences restlessness at night and sleeps during the day. What does this altered sleep pattern indicate? A) Impending coma B) Early stage of hepatic encephalopathy C) Chronic insomnia D) Recovery phase of liver disease Answer: B) Early stage of hepatic encephalopathy 12. A patient with hepatic encephalopathy is being monitored for motor disturbances. Which finding would the nurse expect? A) Muscle rigidity B) Asterixis (flapping tremor) C) Hypotonia D) Decerebrate posturing Answer: B) Asterixis (flapping tremor) 13. A hepatic encephalopathy patient has frequent watery stools after lactulose therapy. Which electrolyte imbalance is most concerning? A) Hypernatremia B) Hypokalemia C) Hypercalcemia D) Hypomagnesemia Answer: B) Hypokalemia 14. A patient with hepatic encephalopathy is at risk of gastrointestinal bleeding. What is the most common source of increased ammonia in such patients? A) High-protein diet B) Bleeding esophageal varices C) Pancreatic insufficiency D) Viral infection Answer: B) Bleeding esophageal varices 15. Which intervention is most appropriate for a patient with severe hepatic encephalopathy and difficulty swallowing? A) Encourage oral high-protein foods B) Administer enteral feeding C) Provide parenteral nutrition with high-fat content D) Avoid nutritional support until symptoms improve Answer: B) Administer enteral feeding 16. A nurse notes constructional apraxia in a patient with hepatic encephalopathy. What is the best test to confirm this? A) Asking the patient to repeat a sequence of numbers B) Requesting the patient to draw a simple figure C) Checking the patient's response to verbal commands D) Testing reflexes Answer: B) Requesting the patient to draw a simple figure 17. A patient with hepatic encephalopathy requires vitamin K supplementation. What is the rationale for this intervention? A) Treating hypokalemia B) Enhancing liver metabolism C) Correcting coagulation abnormalities D) Reducing ammonia levels Answer: C) Correcting coagulation abnormalities 18. Which vital sign change would indicate a worsening condition in a patient with hepatic encephalopathy? A) Tachycardia B) Hypotension C) Bradypnea D) Altered mental status Answer: D) Altered mental status 19. A nurse observes fetor hepaticus in a patient. What should this finding prompt the nurse to evaluate further? A) Serum creatinine levels B) Ammonia levels C) Albumin levels D) Blood glucose levels Answer: B) Ammonia levels 20. In hepatic encephalopathy, why is lactulose administered two to three times per day? A) To enhance protein metabolism B) To expel ammonia through feces C) To maintain electrolyte balance D) To increase serum glucose levels Answer: B) To expel ammonia through feces 21. A patient with hepatic encephalopathy has protein intolerance. Which alternative source of nitrogen should the nurse provide? A) Branched-chain amino acid supplements B) Soy-based protein drinks C) Animal protein meals D) High-fat ketogenic diet Answer: A) Branched-chain amino acid supplements 22. What assessment finding in hepatic encephalopathy indicates a late-stage condition? A) Restlessness at night B) Disorientation and seizures C) Mild confusion D) Positive Babinski reflex Answer: B) Disorientation and seizures 23. A patient with hepatic encephalopathy has elevated serum ammonia. What is the immediate nursing action? A) Administer diuretics B) Initiate lactulose therapy C) Provide high-protein diet D) Perform an abdominal CT scan Answer: B) Initiate lactulose therapy 24. Which diagnostic test would reveal slowing of brain waves in hepatic encephalopathy? A) Electrocardiogram (ECG) B) Electroencephalogram (EEG) C) Magnetic resonance imaging (MRI) D) Liver biopsy Answer: B) Electroencephalogram (EEG) 25. A nurse is teaching the family of a patient with hepatic encephalopathy about avoiding protein restriction. What is the reason for this? A) Preventing hypoglycemia B) Avoiding loss of muscle mass C) Reducing ammonia production D) Enhancing liver regeneration Answer: B) Avoiding loss of muscle mass 26. Why is frequent neurologic assessment critical in patients with hepatic encephalopathy? A) To monitor liver function improvement B) To detect progression to coma C) To evaluate response to antibiotics D) To prevent bleeding complications Answer: B) To detect progression to coma 27. Which complication should the nurse monitor for in a patient with hepatic encephalopathy who has frequent bowel movements? A) Dehydration B) Hypernatremia C) Hyperkalemia D) Respiratory alkalosis Answer: A) Dehydration 28. A patient with hepatic encephalopathy develops bleeding tendencies. What is the most likely cause?  A) Vitamin K deficiency B) Decreased protein synthesis C) Elevated ammonia levels D) Portal vein thrombosis Answer: A) Vitamin K deficiency 29. A patient with hepatic encephalopathy is prescribed neomycin. What should the nurse monitor during therapy? A) Renal function B) Cardiac output C) Liver enzyme levels D) Serum glucose levels Answer: A) Renal function 30. Which meal plan is best suited for a patient with hepatic encephalopathy? A) Large protein-rich meals three times a day B) Small, frequent meals with snacks before bedtime C) Intermittent fasting with high-calorie drinks D) High-fat meals with limited fluids Answer: B) Small, frequent meals with snacks before bedtime 1. A patient with hyperthyroidism presents with a high fever (39°C), tachycardia, and confusion. What is the most likely diagnosis? A) Myxedema coma B) Thyroid storm C) Adrenal insufficiency D) Sepsis Answer: B) Thyroid storm 2. Which clinical manifestation differentiates thyroid storm from uncomplicated hyperthyroidism? A) Increased appetite B) Weight loss C) Altered mental status D) Fatigue Answer: C) Altered mental status 3. A nurse is managing a patient with thyroid storm. Which is the highest priority intervention? A) Administering acetaminophen for fever THYROID STORM B) Providing humidified oxygen C) Initiating IV fluids with dextrose D) Administering antithyroid medications Answer: B) Providing humidified oxygen 4. A patient in thyroid storm has a heart rate of 150 bpm. What is the best medication to manage this symptom? A) Digoxin B) Propranolol C) Atropine D) Metoprolol Answer: B) Propranolol 5. What is the primary cause of thyroid storm in patients with untreated hyperthyroidism? A) Pregnancy B) Stress or infection C) Vitamin deficiency D) Protein malnutrition Answer: B) Stress or infection 6. Which laboratory finding is most consistent with thyroid storm? A) Low T3 and T4 levels B) Elevated TSH C) Elevated T3 and T4 levels with suppressed TSH D) Normal thyroid function tests Answer: C) Elevated T3 and T4 levels with suppressed TSH 7. During thyroid storm management, why is acetaminophen preferred over aspirin to control fever? A) Acetaminophen has anti-inflammatory properties B) Aspirin increases free thyroid hormone levels C) Acetaminophen enhances thyroid hormone metabolism D) Aspirin causes vasoconstriction Answer: B) Aspirin increases free thyroid hormone levels 8. A patient with thyroid storm is started on propylthiouracil (PTU). What is the primary reason for this medication? A) Block thyroid hormone release B) Decrease peripheral conversion of T4 to T3 C) Manage tachycardia D) Correct electrolyte imbalances Answer: B) Decrease peripheral conversion of T4 to T3 9. What intervention is used to reduce thyroid hormone synthesis during thyroid storm? A) IV calcium infusion B) Administration of iodine solution C) Low-protein diet D) Corticosteroid therapy Answer: B) Administration of iodine solution 10. Which clinical sign in thyroid storm suggests severe cardiovascular compromise? A) Bradycardia B) Hypotension C) Widened pulse pressure D) Engorged neck veins Answer: B) Hypotension 11. In thyroid storm, why are IV fluids with dextrose often administered? A) Correct dehydration and restore liver glycogen B) Reduce thyroid hormone production C) Decrease insulin resistance D) Control hyperglycemia Answer: A) Correct dehydration and restore liver glycogen 12. A thyroid storm patient receives hydrocortisone. What is the expected benefit of this therapy? A) Inhibits TSH secretion B) Supports adrenal function and reduces inflammation C) Stimulates thyroid hormone excretion D) Corrects electrolyte imbalances Answer: B) Supports adrenal function and reduces inflammation 13. Which neurological symptom may indicate progression to severe thyroid storm? A) Headache B) Restlessness C) Seizures D) Insomnia Answer: C) Seizures 14. After iodine administration in thyroid storm, why is it delayed for at least 1 hour after starting antithyroid drugs? A) To avoid over-suppression of the thyroid gland B) To prevent exacerbation of hyperthyroidism C) To block further thyroid hormone synthesis D) To ensure maximal drug absorption Answer: C) To block further thyroid hormone synthesis 15. Which of the following is a common complication of untreated thyroid storm? A) Hepatic failure B) Heart failure C) Kidney failure D) Pancreatic insufficiency Answer: B) Heart failure 16. A patient with thyroid storm complains of chest pain and dyspnea. What should the nurse suspect? A) Myocardial ischemia B) Pulmonary embolism C) Atrial fibrillation D) Cardiogenic shock Answer: C) Atrial fibrillation 17. In thyroid storm, which antithyroid drug has the fastest onset of action? A) Methimazole B) Levothyroxine C) Propylthiouracil (PTU) D) Dexamethasone Answer: C) Propylthiouracil (PTU) 18. A nurse is preparing to administer iodine solution to a thyroid storm patient. How does iodine help? A) Increases TSH secretion B) Suppresses release of stored thyroid hormones C) Promotes thyroid hormone metabolism D) Enhances liver function Answer: B) Suppresses release of stored thyroid hormones 19. A thyroid storm patient presents with severe agitation and fever. Which medication can help control these symptoms? A) Aspirin B) Diazepam C) Propranolol D) Hydrocortisone Answer: D) Hydrocortisone 20. Which cardiovascular symptom is most alarming in a patient with thyroid storm? A) Sinus tachycardia B) Ventricular fibrillation C) Hypertension D) Bradycardia Answer: B) Ventricular fibrillation 21. A thyroid storm patient develops altered neurologic status. Which diagnostic tool is most appropriate? A) EEG B) CT scan of the head C) Serum electrolyte panel D) Arterial blood gases Answer: A) EEG 22. A nurse administers propranolol to a thyroid storm patient. What is the expected outcome? A) Reduced thyroid hormone synthesis B) Controlled tachycardia and palpitations C) Improved renal perfusion D) Decreased fever Answer: B) Controlled tachycardia and palpitations 23. Which condition increases the risk of thyroid storm in pregnant patients? A) Abrupt withdrawal of antithyroid medication B) Gestational diabetes C) Hyperemesis gravidarum D) Placental insufficiency Answer: A) Abrupt withdrawal of antithyroid medication 24. Why is cooling therapy used cautiously in thyroid storm patients? A) To avoid rebound hyperthermia B) To prevent dehydration C) To reduce blood pressure fluctuations D) To enhance peripheral blood flow Answer: A) To avoid rebound hyperthermia 25. What is the primary role of corticosteroids in thyroid storm management? A) Suppress TSH secretion B) Support adrenal function and reduce T4 to T3 conversion C) Enhance iodine absorption D) Correct dehydration Answer: B) Support adrenal function and reduce T4 to T3 conversion 26. A patient recovering from thyroid storm is being discharged. What is the most important education topic? A) Importance of a high-calorie diet B) Regular monitoring of thyroid hormone levels C) Avoiding physical activity D) Increasing iodine intake Answer: B) Regular monitoring of thyroid hormone levels 27. A thyroid storm patient with severe fever and tachycardia is not responding to initial treatment. What is the next step? A) Increase iodine dosage B) Initiate dialysis C) Consider thyroidectomy D) Administer diuretics Answer: C) Consider thyroidectomy 28. Which symptom indicates that a thyroid storm is resolving? A) Persistent tachycardia B) Decreasing fever and improved mental status C) Continued muscle weakness D) Ongoing palpitations Answer: B) Decreasing fever and improved mental status 29. Why is oxygen therapy important in thyroid storm? A) Improves arterial oxygenation in metabolic demand B) Prevents airway collapse C) Supports hormone metabolism D) Reduces oxidative stress Answer: A) Improves arterial oxygenation in metabolic demand 30. A thyroid storm patient develops jaundice. What is the likely cause? A) Hepatic dysfunction due to high metabolic demand B) Adverse reaction to antithyroid medication C) Portal hypertension D) Vitamin deficiency Answer: A) Hepatic dysfunction due to high metabolic demand TRIAGE