MEDICAL SURGICAL HESI
EXAMINATION WITH CORRECT
ANSWERS
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. - ANSWER-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.
3. Oligomenorrhea.
4. Menorrhagia. - ANSWER-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. - ANSWER-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?
1. Sore throat.
2. Painful, excessive menstruation.
3. Constipation.
4. Increased urine output. - ANSWER-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." - ANSWER-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
6. The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance
therapy.
EXAMINATION WITH CORRECT
ANSWERS
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. - ANSWER-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.
3. Oligomenorrhea.
4. Menorrhagia. - ANSWER-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. - ANSWER-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?
1. Sore throat.
2. Painful, excessive menstruation.
3. Constipation.
4. Increased urine output. - ANSWER-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." - ANSWER-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
6. The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance
therapy.
