ADVANTAGE FOR PEDIATRIC NURSING CRITICAL COMPONENTS OF NURSING
CARE STUDY GUIDE 2026 LATEST UPDATE
The nurse is completing a health assessment of a 42-year-old female with suspected
Graves' Disease. The nurse should assess this client for:
1. anorexia
2. tachycardia
3. weight gain
4. cold skin - ANSWER-2. tachycardia
Graves' disease, the most common type of thyrotoxicosis, is a state of
hypermetabolism. The increased metabolic rate generates heat and produces
tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss
of weight, despite a good appetite and adequate caloric intake, is a common feature of
hyperthyroidism. Cold skin is associated with hypothyroidism.
CN: Physiological adaptation; CL: Analyze
When conducting a health history with a female client with thyrotoxicosis, the nurse
should ask about which of the following changes in the menstrual cycle?
1. dysmenorrhea
2. metrorrhagia
3. oligomenorrhea
4. menorrhagia - ANSWER-3. oligomenorrhea
A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even
the absence of menstruation (amenorrhea) may result from the hormonal imbalances of
thyrotoxicosis. Oligomenorrhea in women and decreased libido and impotence in men
are common features of thyrotoxicosis. Dysmenorrhea is painful menstruation.
Metrorrhagia, blood loss between menstrual periods, is a symptom of hypothyroidism.
Menorrhagia, excessive bleeding during menstrual periods, is a symptom of
hypothyroidism.
CN: Physiological adaptation; CL: Analyze
A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the
client for which of the following? (Select all that apply.)
1. rapid pulse
2. decreased energy and fatigue
3. weight gain of 10 lbs (4.5 kg)
4. fine, thin hair with hair loss
5. constipation
,6. menorrhagia. - ANSWER-2. decreased energy and fatigue, 3. weight gain of 10 lbs
(4.5 kg), 5. constipation, 6. menorrhagia
Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone.
Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse
hair, constipation, and menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should
teach the client to immediately report which of the following?
1. sore throat
2. painful, excessive menstruation
3. constipation
4. increased urine output - ANSWER-1. sore throat
The most serious adverse effects of PTU are leukopenia and agranulocytosis, which
usually occur within the first 3 months of treatment. The client should be taught to
promptly report to the health care provider signs and symptoms of infection, such as a
sore throat and fever. Clients having a sore throat and fever should have an immediate
white blood cell count and differential performed, and the drug must be withheld until
the results are obtained. Painful menstruation, constipation, and increased urine output
are not associated with PTU therapy.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having
problems at work because I lose my temper very easily." Which of the following
responses by the nurse would give the client the most accurate explanation of her
behavior?
1. "Your behavior is caused by temporary confusion brought on by your illness."
2. "Your behavior is caused by the excess thyroid hormone in your system."
3. "Your behavior is caused by your worrying about the seriousness of your illness."
4. "Your behavior is caused by the stress of trying to manage a career and cope with
illness." - ANSWER-2. "Your behavior is caused by the excess thyroid hormone in your
system."
A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating
thyroid hormones in the body. This symptom decreases as the client responds to
therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her
illness, and stress may influence her mood; however, irritability is a common symptom
of thyrotoxicosis and the client should be informed of that fact rather than blamed.
,CN: Psychosocial integrity; CL: Synthesize
The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy.
Which of the following statements from the client indicates the desired outcome of the
drug?
1. "I have excess energy throughout the day."
2. "I am able to sleep and rest at night."
3. "I have lost weight since taking this medication."
4. "I do perspire throughout the entire day." - ANSWER-2. "I am able to sleep and rest
at night."
PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid
hormones and peripheral conversion of T4 to the more active T3. A client taking this
antithyroid drug should be able to sleep and rest well at night since the level of thyroid
hormones is reduced in the blood. Excess energy throughout the day, loss of weight
and perspiring through the day are symptoms of hyperthyroidism indicating the drug has
not produced its outcome.
CN: Pharmacological and parenteral therapies; CL: Evaluate.
The nurse should teach the client with Graves' disease to prevent corneal
irritation from mild exophthalmos by:
1. Massaging the eyes at regular intervals.
2. Instilling an ophthalmic anesthetic as prescribed.
3. Wearing dark-colored glasses.
4. Covering both eyes with moistened gauze pads. - ANSWER-3. Wearing dark-colored
glasses.
Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes
measures such as wearing sunglasses to protect the eyes from corneal irritation.
Treatment of ophthalmopathy should be performed in consultation with an
ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic
anesthetic is used to examine and possibly treat a painful eye, not protect the cornea.
Covering the eyes with moist gauze pads is not a satisfactory nursing measure to
protect
the eyes of a client with exophthalmos because treatment is not focused on moisture to
the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the
retrobulbar connective tissues and extraocular muscle volume are expanded because of
fluid retention. The pressure is also increased.
CN: Reduction of risk potential; CL: Synthesize
A client with Graves' disease is treated with radioactive iodine (RAI) in the
, form of sodium iodide 131I. Which of the following statements by the nurse will explain
to the client how the drug works?
1. "The RAI stabilizes the thyroid hormone levels before a thyroidectomy."
2. "The RAI reduces uptake of thyroxine and thereby improves your condition."
3. "The RAI lowers the levels of thyroid hormones by slowing your body's
production of them."
4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer produced." -
ANSWER-4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer
produced."
Sodium iodide 131I destroys the thyroid follicular cells, and thyroid hormones are no
longer produced. RAI is commonly recommended for clients with Graves'
disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine.
The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of thyroid hormones with RAI.
CN: Pharmacological and parenteral therapies; CL: Synthesize
After treatment with radioactive iodine (RAI) in the form of sodium iodide 131I, the nurse
teaches the client to:
1. Monitor for signs and symptoms of hyperthyroidism.
2. Rest for 1 week to prevent complications of the medication.
3. Take thyroxine replacement for the remainder of the client's life.
4. Assess for hypertension and tachycardia resulting from altered thyroid activity. -
ANSWER-3. Take thyroxine replacement for the remainder of the client's life.
The client needs to be educated about the need for lifelong thyroid hormone
replacement. Permanent hypothyroidism is the major complication of RAI 131I
treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client
needs to
monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1
week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not
hypothyroidism.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with a large goiter is scheduled for a subtotal thyroidectomy to treat
thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed
preoperatively for the client. The expected outcome of using this drug is that it helps:
1. Slow progression of exophthalmos.
2. Reduce the vascularity of the thyroid gland.
3. Decrease the body's ability to store thyroxine.
CARE STUDY GUIDE 2026 LATEST UPDATE
The nurse is completing a health assessment of a 42-year-old female with suspected
Graves' Disease. The nurse should assess this client for:
1. anorexia
2. tachycardia
3. weight gain
4. cold skin - ANSWER-2. tachycardia
Graves' disease, the most common type of thyrotoxicosis, is a state of
hypermetabolism. The increased metabolic rate generates heat and produces
tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss
of weight, despite a good appetite and adequate caloric intake, is a common feature of
hyperthyroidism. Cold skin is associated with hypothyroidism.
CN: Physiological adaptation; CL: Analyze
When conducting a health history with a female client with thyrotoxicosis, the nurse
should ask about which of the following changes in the menstrual cycle?
1. dysmenorrhea
2. metrorrhagia
3. oligomenorrhea
4. menorrhagia - ANSWER-3. oligomenorrhea
A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even
the absence of menstruation (amenorrhea) may result from the hormonal imbalances of
thyrotoxicosis. Oligomenorrhea in women and decreased libido and impotence in men
are common features of thyrotoxicosis. Dysmenorrhea is painful menstruation.
Metrorrhagia, blood loss between menstrual periods, is a symptom of hypothyroidism.
Menorrhagia, excessive bleeding during menstrual periods, is a symptom of
hypothyroidism.
CN: Physiological adaptation; CL: Analyze
A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the
client for which of the following? (Select all that apply.)
1. rapid pulse
2. decreased energy and fatigue
3. weight gain of 10 lbs (4.5 kg)
4. fine, thin hair with hair loss
5. constipation
,6. menorrhagia. - ANSWER-2. decreased energy and fatigue, 3. weight gain of 10 lbs
(4.5 kg), 5. constipation, 6. menorrhagia
Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone.
Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse
hair, constipation, and menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should
teach the client to immediately report which of the following?
1. sore throat
2. painful, excessive menstruation
3. constipation
4. increased urine output - ANSWER-1. sore throat
The most serious adverse effects of PTU are leukopenia and agranulocytosis, which
usually occur within the first 3 months of treatment. The client should be taught to
promptly report to the health care provider signs and symptoms of infection, such as a
sore throat and fever. Clients having a sore throat and fever should have an immediate
white blood cell count and differential performed, and the drug must be withheld until
the results are obtained. Painful menstruation, constipation, and increased urine output
are not associated with PTU therapy.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having
problems at work because I lose my temper very easily." Which of the following
responses by the nurse would give the client the most accurate explanation of her
behavior?
1. "Your behavior is caused by temporary confusion brought on by your illness."
2. "Your behavior is caused by the excess thyroid hormone in your system."
3. "Your behavior is caused by your worrying about the seriousness of your illness."
4. "Your behavior is caused by the stress of trying to manage a career and cope with
illness." - ANSWER-2. "Your behavior is caused by the excess thyroid hormone in your
system."
A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating
thyroid hormones in the body. This symptom decreases as the client responds to
therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her
illness, and stress may influence her mood; however, irritability is a common symptom
of thyrotoxicosis and the client should be informed of that fact rather than blamed.
,CN: Psychosocial integrity; CL: Synthesize
The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy.
Which of the following statements from the client indicates the desired outcome of the
drug?
1. "I have excess energy throughout the day."
2. "I am able to sleep and rest at night."
3. "I have lost weight since taking this medication."
4. "I do perspire throughout the entire day." - ANSWER-2. "I am able to sleep and rest
at night."
PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid
hormones and peripheral conversion of T4 to the more active T3. A client taking this
antithyroid drug should be able to sleep and rest well at night since the level of thyroid
hormones is reduced in the blood. Excess energy throughout the day, loss of weight
and perspiring through the day are symptoms of hyperthyroidism indicating the drug has
not produced its outcome.
CN: Pharmacological and parenteral therapies; CL: Evaluate.
The nurse should teach the client with Graves' disease to prevent corneal
irritation from mild exophthalmos by:
1. Massaging the eyes at regular intervals.
2. Instilling an ophthalmic anesthetic as prescribed.
3. Wearing dark-colored glasses.
4. Covering both eyes with moistened gauze pads. - ANSWER-3. Wearing dark-colored
glasses.
Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes
measures such as wearing sunglasses to protect the eyes from corneal irritation.
Treatment of ophthalmopathy should be performed in consultation with an
ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic
anesthetic is used to examine and possibly treat a painful eye, not protect the cornea.
Covering the eyes with moist gauze pads is not a satisfactory nursing measure to
protect
the eyes of a client with exophthalmos because treatment is not focused on moisture to
the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the
retrobulbar connective tissues and extraocular muscle volume are expanded because of
fluid retention. The pressure is also increased.
CN: Reduction of risk potential; CL: Synthesize
A client with Graves' disease is treated with radioactive iodine (RAI) in the
, form of sodium iodide 131I. Which of the following statements by the nurse will explain
to the client how the drug works?
1. "The RAI stabilizes the thyroid hormone levels before a thyroidectomy."
2. "The RAI reduces uptake of thyroxine and thereby improves your condition."
3. "The RAI lowers the levels of thyroid hormones by slowing your body's
production of them."
4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer produced." -
ANSWER-4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer
produced."
Sodium iodide 131I destroys the thyroid follicular cells, and thyroid hormones are no
longer produced. RAI is commonly recommended for clients with Graves'
disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine.
The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of thyroid hormones with RAI.
CN: Pharmacological and parenteral therapies; CL: Synthesize
After treatment with radioactive iodine (RAI) in the form of sodium iodide 131I, the nurse
teaches the client to:
1. Monitor for signs and symptoms of hyperthyroidism.
2. Rest for 1 week to prevent complications of the medication.
3. Take thyroxine replacement for the remainder of the client's life.
4. Assess for hypertension and tachycardia resulting from altered thyroid activity. -
ANSWER-3. Take thyroxine replacement for the remainder of the client's life.
The client needs to be educated about the need for lifelong thyroid hormone
replacement. Permanent hypothyroidism is the major complication of RAI 131I
treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client
needs to
monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1
week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not
hypothyroidism.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with a large goiter is scheduled for a subtotal thyroidectomy to treat
thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed
preoperatively for the client. The expected outcome of using this drug is that it helps:
1. Slow progression of exophthalmos.
2. Reduce the vascularity of the thyroid gland.
3. Decrease the body's ability to store thyroxine.
