2026 GRADED A+ EXAM
NUR 6121 Exam 2 | Questions and
Answers | 2026 Update | 100% Correct –
WPU.
1. You are determining thyroid hormone replacement for a 35-year-old woman with
hypothyroidism. Which factors are most important for establishing a euthyroid state?
A) Age and gender only
B) Body weight, age, and overall health
C) TSH alone
D) Duration of hypothyroidism
Answer: B) Body weight, age, and overall health
Rationale: Thyroid hormone dosing is individualized based on the patient’s weight, age, and
health status, not just labs.
2. Which laboratory abnormality is most commonly associated with hypothyroidism?
A) Hyperglycemia
B) Dyslipidemia and elevated TSH
C) Low LDL
D) Low TSH and high T3
Answer: B) Dyslipidemia and elevated TSH
Rationale: Hypothyroidism slows metabolism, often causing elevated cholesterol and TSH;
dyslipidemia is usually treated after TSH is controlled.
3. What happens to TSH levels when serum-free T4 decreases?
A) TSH decreases
B) TSH rises
,2026 GRADED A+ EXAM
C) T3 decreases
D) No change
Answer: B) TSH rises
Rationale: Low T4 reduces negative feedback on the pituitary, leading to increased TSH.
4. After initiating thyroid replacement therapy, when is the best time to measure TSH?
A) 1–2 weeks
B) 6–8 weeks
C) 24 hours
D) 1 year
Answer: B) 6–8 weeks
Rationale: TSH stabilizes slowly; measuring too early may give misleading results.
5. A 75-year-old patient with hypothyroidism weighs 155 lbs. Which is an appropriate starting
dose of levothyroxine?
A) 100 mcg/day
B) 50 mcg/day or even 25 mcg/day
C) 200 mcg/day
D) 10 mcg/day
Answer: B) 50 mcg/day or even 25 mcg/day
Rationale: Older adults usually start at lower doses to avoid cardiac complications.
6. A 70-year-old woman presents with weight loss, palpitations, and constipation. Labs show TSH
0.03, T4 33. Which is your next step?
A) Start levothyroxine immediately
B) Repeat labs, thyroid scan, ultrasound, or fine needle biopsy if nodules are present
C) Start beta-blocker only
D) Wait 6 months before testing
Answer: B) Repeat labs, thyroid scan, ultrasound, or fine needle biopsy if nodules are present
Rationale: Low TSH and high T4 suggest hyperthyroidism; imaging helps identify underlying
causes.
,2026 GRADED A+ EXAM
7. Which laboratory assay is most sensitive for screening primary hypothyroidism?
A) Free T4
B) Total T3
C) TSH
D) Anti-thyroid antibodies
Answer: C) TSH
Rationale: TSH changes occur early, making it the most sensitive initial screen.
8. Bariatric surgery for weight loss is recommended for patients with:
A) BMI 30 or greater
B) BMI 35 or greater with 1+ comorbidities
C) BMI <25
D) Any patient requesting surgery
Answer: B) BMI 35 or greater with 1+ comorbidities (HTN, DM2, HF, OSA)
Rationale: Surgery is indicated for severe obesity or moderate obesity with complications.
9. Diagnostic criteria for metabolic syndrome include all except:
A) Waist circumference >40 in men, >35 in women
B) Hypertension
C) Dyslipidemia
D) Diabetes
Answer: A) Waist circumference >40 in men, >35 in women (note: correct central obesity
criteria differs)
Rationale: Metabolic syndrome includes HTN, dyslipidemia, insulin resistance; waist cutoff
depends on gender-specific thresholds.
10. True or False: Dyslipidemia in hypothyroid patients should be treated before achieving TSH
control.
Answer: False
Rationale: Lipid levels often normalize once euthyroid state is achieved; early treatment may
not be necessary.
, 2026 GRADED A+ EXAM
11. Which symptom is NOT typically associated with hypothyroidism?
A) Fatigue
B) Weight gain
C) Heat intolerance
D) Constipation
Answer: C) Heat intolerance
Rationale: Hypothyroid patients usually have cold intolerance, not heat intolerance.
12. What is a common initial presentation of hyperthyroidism in older adults?
A) Weight gain and fatigue
B) Atrial fibrillation, palpitations, or unexplained weight loss
C) Constipation and bradycardia
D) Hair loss only
Answer: B) Atrial fibrillation, palpitations, or unexplained weight loss
Rationale: Older adults may present atypically; cardiac symptoms are common.
13. Scenario: A patient presents with TSH 0.01, free T4 40. Which medication is most
appropriate?
A) Levothyroxine 50 mcg/day
B) Methimazole or radioactive iodine therapy as indicated
C) Insulin
D) Statin therapy
Answer: B) Methimazole or radioactive iodine therapy as indicated
Rationale: Suppressed TSH and elevated T4 indicate hyperthyroidism; treatment focuses on
reducing thyroid hormone levels.
14. True or False: Levothyroxine should be taken with food for better absorption.
Answer: False
Rationale: Best absorbed on an empty stomach; food interferes with absorption.
NUR 6121 Exam 2 | Questions and
Answers | 2026 Update | 100% Correct –
WPU.
1. You are determining thyroid hormone replacement for a 35-year-old woman with
hypothyroidism. Which factors are most important for establishing a euthyroid state?
A) Age and gender only
B) Body weight, age, and overall health
C) TSH alone
D) Duration of hypothyroidism
Answer: B) Body weight, age, and overall health
Rationale: Thyroid hormone dosing is individualized based on the patient’s weight, age, and
health status, not just labs.
2. Which laboratory abnormality is most commonly associated with hypothyroidism?
A) Hyperglycemia
B) Dyslipidemia and elevated TSH
C) Low LDL
D) Low TSH and high T3
Answer: B) Dyslipidemia and elevated TSH
Rationale: Hypothyroidism slows metabolism, often causing elevated cholesterol and TSH;
dyslipidemia is usually treated after TSH is controlled.
3. What happens to TSH levels when serum-free T4 decreases?
A) TSH decreases
B) TSH rises
,2026 GRADED A+ EXAM
C) T3 decreases
D) No change
Answer: B) TSH rises
Rationale: Low T4 reduces negative feedback on the pituitary, leading to increased TSH.
4. After initiating thyroid replacement therapy, when is the best time to measure TSH?
A) 1–2 weeks
B) 6–8 weeks
C) 24 hours
D) 1 year
Answer: B) 6–8 weeks
Rationale: TSH stabilizes slowly; measuring too early may give misleading results.
5. A 75-year-old patient with hypothyroidism weighs 155 lbs. Which is an appropriate starting
dose of levothyroxine?
A) 100 mcg/day
B) 50 mcg/day or even 25 mcg/day
C) 200 mcg/day
D) 10 mcg/day
Answer: B) 50 mcg/day or even 25 mcg/day
Rationale: Older adults usually start at lower doses to avoid cardiac complications.
6. A 70-year-old woman presents with weight loss, palpitations, and constipation. Labs show TSH
0.03, T4 33. Which is your next step?
A) Start levothyroxine immediately
B) Repeat labs, thyroid scan, ultrasound, or fine needle biopsy if nodules are present
C) Start beta-blocker only
D) Wait 6 months before testing
Answer: B) Repeat labs, thyroid scan, ultrasound, or fine needle biopsy if nodules are present
Rationale: Low TSH and high T4 suggest hyperthyroidism; imaging helps identify underlying
causes.
,2026 GRADED A+ EXAM
7. Which laboratory assay is most sensitive for screening primary hypothyroidism?
A) Free T4
B) Total T3
C) TSH
D) Anti-thyroid antibodies
Answer: C) TSH
Rationale: TSH changes occur early, making it the most sensitive initial screen.
8. Bariatric surgery for weight loss is recommended for patients with:
A) BMI 30 or greater
B) BMI 35 or greater with 1+ comorbidities
C) BMI <25
D) Any patient requesting surgery
Answer: B) BMI 35 or greater with 1+ comorbidities (HTN, DM2, HF, OSA)
Rationale: Surgery is indicated for severe obesity or moderate obesity with complications.
9. Diagnostic criteria for metabolic syndrome include all except:
A) Waist circumference >40 in men, >35 in women
B) Hypertension
C) Dyslipidemia
D) Diabetes
Answer: A) Waist circumference >40 in men, >35 in women (note: correct central obesity
criteria differs)
Rationale: Metabolic syndrome includes HTN, dyslipidemia, insulin resistance; waist cutoff
depends on gender-specific thresholds.
10. True or False: Dyslipidemia in hypothyroid patients should be treated before achieving TSH
control.
Answer: False
Rationale: Lipid levels often normalize once euthyroid state is achieved; early treatment may
not be necessary.
, 2026 GRADED A+ EXAM
11. Which symptom is NOT typically associated with hypothyroidism?
A) Fatigue
B) Weight gain
C) Heat intolerance
D) Constipation
Answer: C) Heat intolerance
Rationale: Hypothyroid patients usually have cold intolerance, not heat intolerance.
12. What is a common initial presentation of hyperthyroidism in older adults?
A) Weight gain and fatigue
B) Atrial fibrillation, palpitations, or unexplained weight loss
C) Constipation and bradycardia
D) Hair loss only
Answer: B) Atrial fibrillation, palpitations, or unexplained weight loss
Rationale: Older adults may present atypically; cardiac symptoms are common.
13. Scenario: A patient presents with TSH 0.01, free T4 40. Which medication is most
appropriate?
A) Levothyroxine 50 mcg/day
B) Methimazole or radioactive iodine therapy as indicated
C) Insulin
D) Statin therapy
Answer: B) Methimazole or radioactive iodine therapy as indicated
Rationale: Suppressed TSH and elevated T4 indicate hyperthyroidism; treatment focuses on
reducing thyroid hormone levels.
14. True or False: Levothyroxine should be taken with food for better absorption.
Answer: False
Rationale: Best absorbed on an empty stomach; food interferes with absorption.
