NURSING LICENSURE
PNR 408 FINAL EXAM (FOCUS ON CH 54, 56, 59, 61, 63 OF MED-SURG
NURSING (LEWIS) AND MIX OF SOME PREV QUESTIONS FROM THE TEST 1
AND TEST 2 SETS.) | QUESTIONS AND ANSWERS | SOLVED 100% CORRECT!!
**2026/2027**
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Endocrine Problems (Lewis Ch 54)
Breast Disorders (Lewis Ch 56)
Male Reproductive Problems (Lewis Ch 59)
Acute Intracranial Problems (Lewis Ch 61)
Chronic Neurologic Problems (Lewis Ch 63)
STUVIAACTUALEXAM
,
, PNR 408 FINAL EXAM | Lewis Ch 54, 56, 59, 61, 63 | 2026/2027 SOLVED 100% CORRECT
SECTION 1: ENDOCRINE PROBLEMS (LEWIS CH 54)
Q1.
A 42-year-old patient is admitted with severe headache, visual field cuts, and galactorrhea. MRI reveals a pituitary
macroadenoma. Serum prolactin is markedly elevated. The nurse anticipates that the initial collaborative management
priority will focus on which intervention?
A. Immediate transsphenoidal resection to prevent further optic-nerve compression.
B. Initiation of a dopamine agonist such as cabergoline to suppress prolactin secretion and potentially shrink the tumor.
C. High-dose glucocorticoid replacement before any other therapy is considered.
D. Radiation therapy as first-line treatment because medical therapy is rarely effective for macroadenomas.
Correct Answer: B
Rationale:
Prolactin-secreting macroadenomas are usually treated first with dopamine agonists, which often reduce tumor size and prolactin
levels, frequently improving visual symptoms without immediate surgery. Surgery is reserved for intolerance, resistance, or acute
visual compromise unresponsive to medication. Glucocorticoids are not the primary therapy for prolactinoma.
Q2.
A patient with known primary hypothyroidism is brought to the emergency department with hypothermia, bradycardia,
hypotension, and decreased level of consciousness. Family reports the patient stopped taking levothyroxine three
weeks ago after running out of refills. Which nursing action takes precedence?
A. Administer oral levothyroxine immediately and warm the patient with blankets only.
B. Establish intravenous access, prepare for possible intubation, and anticipate intravenous levothyroxine and supportive
care for myxedema coma.
C. Obtain a full set of thyroid function tests before any treatment is started.
D. Give a rapid fluid bolus of normal saline and observe for improvement before involving the provider.
Correct Answer: B
Rationale:
Myxedema coma is a life-threatening decompensation of hypothyroidism requiring airway protection, cardiovascular support, and
prompt intravenous thyroid hormone replacement. Waiting for laboratory confirmation or relying solely on oral replacement delays
critical therapy.
Q3.
A patient recovering from total thyroidectomy develops tingling around the mouth and in the fingertips four hours after
surgery. Chvostek sign is positive. The nurse recognizes this as early evidence of which complication and prepares
which intervention?
A. Hypocalcemia from parathyroid gland injury; prepare intravenous calcium gluconate.
B. Hyperkalemia from tissue trauma; prepare intravenous insulin and glucose.
C. Thyroid storm; prepare propylthiouracil and beta-blockade.
D. Hematoma formation at the incision; prepare for immediate surgical re-exploration.
Correct Answer: A
Rationale:
Accidental removal or ischemia of the parathyroid glands can produce acute hypocalcemia, manifested by perioral and distal
paresthesias and a positive Chvostek sign. Intravenous calcium is the immediate treatment while serum calcium is confirmed.
Thyroid storm and hematoma present with different clinical pictures.
PNR 408 FINAL EXAM (FOCUS ON CH 54, 56, 59, 61, 63 OF MED-SURG
NURSING (LEWIS) AND MIX OF SOME PREV QUESTIONS FROM THE TEST 1
AND TEST 2 SETS.) | QUESTIONS AND ANSWERS | SOLVED 100% CORRECT!!
**2026/2027**
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Endocrine Problems (Lewis Ch 54)
Breast Disorders (Lewis Ch 56)
Male Reproductive Problems (Lewis Ch 59)
Acute Intracranial Problems (Lewis Ch 61)
Chronic Neurologic Problems (Lewis Ch 63)
STUVIAACTUALEXAM
,
, PNR 408 FINAL EXAM | Lewis Ch 54, 56, 59, 61, 63 | 2026/2027 SOLVED 100% CORRECT
SECTION 1: ENDOCRINE PROBLEMS (LEWIS CH 54)
Q1.
A 42-year-old patient is admitted with severe headache, visual field cuts, and galactorrhea. MRI reveals a pituitary
macroadenoma. Serum prolactin is markedly elevated. The nurse anticipates that the initial collaborative management
priority will focus on which intervention?
A. Immediate transsphenoidal resection to prevent further optic-nerve compression.
B. Initiation of a dopamine agonist such as cabergoline to suppress prolactin secretion and potentially shrink the tumor.
C. High-dose glucocorticoid replacement before any other therapy is considered.
D. Radiation therapy as first-line treatment because medical therapy is rarely effective for macroadenomas.
Correct Answer: B
Rationale:
Prolactin-secreting macroadenomas are usually treated first with dopamine agonists, which often reduce tumor size and prolactin
levels, frequently improving visual symptoms without immediate surgery. Surgery is reserved for intolerance, resistance, or acute
visual compromise unresponsive to medication. Glucocorticoids are not the primary therapy for prolactinoma.
Q2.
A patient with known primary hypothyroidism is brought to the emergency department with hypothermia, bradycardia,
hypotension, and decreased level of consciousness. Family reports the patient stopped taking levothyroxine three
weeks ago after running out of refills. Which nursing action takes precedence?
A. Administer oral levothyroxine immediately and warm the patient with blankets only.
B. Establish intravenous access, prepare for possible intubation, and anticipate intravenous levothyroxine and supportive
care for myxedema coma.
C. Obtain a full set of thyroid function tests before any treatment is started.
D. Give a rapid fluid bolus of normal saline and observe for improvement before involving the provider.
Correct Answer: B
Rationale:
Myxedema coma is a life-threatening decompensation of hypothyroidism requiring airway protection, cardiovascular support, and
prompt intravenous thyroid hormone replacement. Waiting for laboratory confirmation or relying solely on oral replacement delays
critical therapy.
Q3.
A patient recovering from total thyroidectomy develops tingling around the mouth and in the fingertips four hours after
surgery. Chvostek sign is positive. The nurse recognizes this as early evidence of which complication and prepares
which intervention?
A. Hypocalcemia from parathyroid gland injury; prepare intravenous calcium gluconate.
B. Hyperkalemia from tissue trauma; prepare intravenous insulin and glucose.
C. Thyroid storm; prepare propylthiouracil and beta-blockade.
D. Hematoma formation at the incision; prepare for immediate surgical re-exploration.
Correct Answer: A
Rationale:
Accidental removal or ischemia of the parathyroid glands can produce acute hypocalcemia, manifested by perioral and distal
paresthesias and a positive Chvostek sign. Intravenous calcium is the immediate treatment while serum calcium is confirmed.
Thyroid storm and hematoma present with different clinical pictures.
