BSN 246 questions and answers with
rationales 2025\2026 update
1. 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.
ANS>> 2. 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
2. 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.
,ANS>>3. 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
3. 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 lb (4.5 kg).
4. Fine, thin hair with hair loss.
5. Constipation.
6. Menorrhagia.
ANS>>2, 3, 5, 6. 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
4. Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately
report which of the following?
,3. Constipation.
4. Increased urine output.
ANS>>1. 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
5. 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."
ANS>>2. 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
, 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."
ANS>>2. 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.
7. 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.
ANS>>3. 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
rationales 2025\2026 update
1. 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.
ANS>> 2. 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
2. 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.
,ANS>>3. 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
3. 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 lb (4.5 kg).
4. Fine, thin hair with hair loss.
5. Constipation.
6. Menorrhagia.
ANS>>2, 3, 5, 6. 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
4. Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to immediately
report which of the following?
,3. Constipation.
4. Increased urine output.
ANS>>1. 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
5. 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."
ANS>>2. 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
, 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."
ANS>>2. 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.
7. 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.
ANS>>3. 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
