MED SURG II HESI EXAM GUIDE QUESTIONS AND
ANSWERS SURE A+
✔✔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. - ✔✔3. Wearing dark-colored
glasses.
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 moisture to
the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the
retrobulbar connective tissues and extraocular muscle volume are expanded because of
fluid retention. The pressure is also increased.
CN: Reduction of risk potential; CL: Synthesize
✔✔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." -
✔✔4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer
produced."
Sodium iodide 131I destroys the thyroid follicular cells, and thyroid hormones are no
longer produced. RAI is commonly recommended for clients with Graves'
disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine.
The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of thyroid hormones with RAI.
CN: Pharmacological and parenteral therapies; CL: Synthesize
,✔✔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. -
✔✔3. Take thyroxine replacement for the remainder of the client's life.
The client needs to be educated about the need for lifelong thyroid hormone
replacement. Permanent hypothyroidism is the major complication of RAI 131I
treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client
needs to
monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1
week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not
hypothyroidism.
CN: Pharmacological and parenteral therapies; CL: Synthesize
✔✔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. - ✔✔2. Reduce the vascularity of the
thyroid gland.
SSKI is frequently administered before a thyroidectomy because it helps decrease the
vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a
condition that presents a hazard during surgery. Preparation of the client for surgery
includes depleting the gland of thyroid hormone and decreasing vascularity.
SSKI does not decrease the progression of exophthalmos, and it does not decrease the
body's ability to store thyroxine or increase the body's ability to excrete thyroxine.
CN: Pharmacological and parenteral therapies; CL: Apply
✔✔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. - ✔✔3. Dilute the solution with
water, milk, or fruit juice and have the client drink it with a straw.
SSKI should be diluted well in milk, water, juice, or a carbonated beverage before
administration to help disguise the strong, bitter taste. Also, this drug is irritating
to mucosa if taken undiluted. The client should sip the diluted preparation through a
drinking straw to help prevent staining of the teeth. Pouring the solution over ice chips
will not sufficiently dilute the SSKI or cover the taste. Antacids are not used to dilute or
cover the taste of SSKI. Mixing in a puree would put the SSKI in contact with the teeth.
CN: Pharmacological and parenteral therapies; CL: Apply
✔✔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. - ✔✔3. Laryngeal nerve damage.
Laryngeal nerve damage is a potential complication of thyroid surgery because of the
proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the
client to speak helps assess for signs of laryngeal nerve damage. Persistent or
worsening hoarseness and weak voice are signs of laryngeal nerve damage and should
be reported to the physician immediately. Internal hemorrhage is detected by changes
in vital signs. The client's level of consciousness can be partially assessed by asking
her to speak, but that is not the primary reason for doing so in this situation. Upper
airway obstruction is detected by color and respiratory rate and pattern.
CN: Reduction of risk potential; CL: Analyze
✔✔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. - ✔✔4. Perform a tracheotomy
✔✔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.
ANSWERS SURE A+
✔✔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. - ✔✔3. Wearing dark-colored
glasses.
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 moisture to
the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the
retrobulbar connective tissues and extraocular muscle volume are expanded because of
fluid retention. The pressure is also increased.
CN: Reduction of risk potential; CL: Synthesize
✔✔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." -
✔✔4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer
produced."
Sodium iodide 131I destroys the thyroid follicular cells, and thyroid hormones are no
longer produced. RAI is commonly recommended for clients with Graves'
disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine.
The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of thyroid hormones with RAI.
CN: Pharmacological and parenteral therapies; CL: Synthesize
,✔✔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. -
✔✔3. Take thyroxine replacement for the remainder of the client's life.
The client needs to be educated about the need for lifelong thyroid hormone
replacement. Permanent hypothyroidism is the major complication of RAI 131I
treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client
needs to
monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1
week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not
hypothyroidism.
CN: Pharmacological and parenteral therapies; CL: Synthesize
✔✔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. - ✔✔2. Reduce the vascularity of the
thyroid gland.
SSKI is frequently administered before a thyroidectomy because it helps decrease the
vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a
condition that presents a hazard during surgery. Preparation of the client for surgery
includes depleting the gland of thyroid hormone and decreasing vascularity.
SSKI does not decrease the progression of exophthalmos, and it does not decrease the
body's ability to store thyroxine or increase the body's ability to excrete thyroxine.
CN: Pharmacological and parenteral therapies; CL: Apply
✔✔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. - ✔✔3. Dilute the solution with
water, milk, or fruit juice and have the client drink it with a straw.
SSKI should be diluted well in milk, water, juice, or a carbonated beverage before
administration to help disguise the strong, bitter taste. Also, this drug is irritating
to mucosa if taken undiluted. The client should sip the diluted preparation through a
drinking straw to help prevent staining of the teeth. Pouring the solution over ice chips
will not sufficiently dilute the SSKI or cover the taste. Antacids are not used to dilute or
cover the taste of SSKI. Mixing in a puree would put the SSKI in contact with the teeth.
CN: Pharmacological and parenteral therapies; CL: Apply
✔✔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. - ✔✔3. Laryngeal nerve damage.
Laryngeal nerve damage is a potential complication of thyroid surgery because of the
proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the
client to speak helps assess for signs of laryngeal nerve damage. Persistent or
worsening hoarseness and weak voice are signs of laryngeal nerve damage and should
be reported to the physician immediately. Internal hemorrhage is detected by changes
in vital signs. The client's level of consciousness can be partially assessed by asking
her to speak, but that is not the primary reason for doing so in this situation. Upper
airway obstruction is detected by color and respiratory rate and pattern.
CN: Reduction of risk potential; CL: Analyze
✔✔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. - ✔✔4. Perform a tracheotomy
✔✔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.
