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HESI MedSurge Version 2

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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 yourillness."4. "Your behavior is caused by the stress of trying to...

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  • August 28, 2023
  • 51
  • 2023/2024
  • Exam (elaborations)
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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.

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.

3. Oligomenorrhea.

4. Menorrhagia.

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.

4. 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.

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.”

6. 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.”

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.

8. 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.”

9. 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.

10. 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.

4. Increase the body's ability to excrete thyroxine.

11. The nurse is administering a saturated solution of potassium iodide (SSKI). The

11. The nurse is administering a saturated solution of potassium iodide (SSKI). The

nurse should:

1. Pour the solution over ice chips.

2. Mix the solution with an antacid.

3. Dilute the solution with water, milk, or fruit juice and have the client drink it

with a straw.

4. Disguise the solution in a pureed fruit or vegetable.

12. Following a subtotal thyroidectomy, the nurse asks the client to speak

immediately upon regaining consciousness. The nurse does this to monitor for signs of

which of the following?

1. Internal hemorrhage.

2. Decreasing level of consciousness.

3. Laryngeal nerve damage.

4. Upper airway obstruction.

, 13. A client who has undergone a subtotal thyroidectomy is subject to

complications in the first 48 hours after surgery. The nurse should obtain and keep at the

bedside equipment to:

1. Begin total parenteral nutrition.

2. Start a cutdown infusion.

3. Administer tube feedings.

4. Perform a tracheotomy.

14. One day following a subtotal thyroidectomy, a client begins to have tingling in

the fingers and toes. The nurse should first:

1. Encourage the client to flex and extend the fingers and toes.

2. Notify the physician.

3. Assess the client for thrombophlebitis.

4. Ask the client to speak.

15. Which of the following medications should be available to provide emergency

treatment if a client develops tetany after a subtotal thyroidectomy?

1. Sodium phosphate.

2. Calcium gluconate.

3. Echothiophate iodide.

4. Sodium bicarbonate.

16. A 60-year-old female is diagnosed with hypothyroidism. The nurse should

assess the client for which of the following?

1. Tachycardia.

2. Weight gain.

3. Diarrhea.

4. Nausea.

17. The nurse should assess a client with hypothyroidism for which of the

following?

1. Corneal abrasion due to inability to close the eyelids.

2. Weight loss due to hypermetabolism.

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