LEWIS MEDICAL SURGICAL NURSING 2026
ADULT HEALTHCARE ASSESSMENT TEST PAPER
QUESTIONS SOLUTIONS GRADED A+
◉ A few hours after returning to the surgical nursing unit, a patient
who has undergone a subtotal thyroidectomy develops laryngeal
stridor and a cramp in the right hand. Which action will the nurse
anticipate taking next?
a. Infuse IV calcium gluconate.
b. Suction the patient's airway.
c. Prepare for endotracheal intubation.
d. Assist with emergency tracheostomy.
Answer: Answer: a. Infuse IV calcium gluconate.
The patients clinical manifestations of stridor and cramping are
consistent with tetany caused by hypocalcemia resulting from
damage to the parathyroid glands during surgery. Endotracheal
intubation or tracheostomy may be needed if the calcium does not
resolve the stridor. Suctioning will not correct the stridor.
◉ A patient with Graves disease has exophthalmos. Which nursing
action will be included in the plan of care?
,a. Apply eye patches to protect the cornea from irritation.
b. Place cold packs on the eyes to relieve pain and swelling.
c. Elevate the head of the patient's bed to reduce periorbital fluid.
d. Teach the patient to blink every few seconds to lubricate the
cornea.
Answer: Answer: c. Elevate the head of the patient's bed to reduce
periorbital fluid.
The patient should sit upright as much as possible to promote fluid
drainage from the periorbital area. With exophthalmos the patient is
unable to close the eyes completely. Lubrication of the eyes, rather
than eye patches, will protect the eyes from developing corneal
scarring. The swelling of the eye is not caused by excessive blood
flow to the eye, so cold packs will not be helpful.
◉ A patient with hyperthyroidism is treated with radioactive iodine
(RAI) at a clinic. Before the patient is discharged, the nurse instructs
the patient:
a. that symptoms of hyperthyroidism should be relieved in about a
week.
b. that symptoms of hypothyroidism may occur as the RAI therapy
takes effect.
, c. to discontinue the antithyroid medications taken before the
radioactive therapy.
d. about radioactive precautions to take with urine, stool, and other
body secretions.
Answer: Answer: b. that symptoms of hypothyroidism may occur as
the RAI therapy takes effect.
There is a high incidence of postradiation hypothyroidism after RAI,
and the patient should be monitored for symptoms of
hypothyroidism. RAI has a delayed response, with the maximum
effect not seen for 2 to 3 months, and the patient will continue to
take antithyroid medications during this time. The therapeutic dose
of radioactive iodine is low enough that no radiation safety
precautions are needed.
◉ A 72-year-old patient is diagnosed with hypothyroidism and
levothyroxine (Synthroid) is prescribed. Which assessment is most
important for the nurse to make during initiation of thyroid
replacement?
a. Apical pulse rate.
b. Nutritional intake.
c. Intake and output.
d. Orientation and alertness.
Answer: Answer: a. Apical pulse rate.
ADULT HEALTHCARE ASSESSMENT TEST PAPER
QUESTIONS SOLUTIONS GRADED A+
◉ A few hours after returning to the surgical nursing unit, a patient
who has undergone a subtotal thyroidectomy develops laryngeal
stridor and a cramp in the right hand. Which action will the nurse
anticipate taking next?
a. Infuse IV calcium gluconate.
b. Suction the patient's airway.
c. Prepare for endotracheal intubation.
d. Assist with emergency tracheostomy.
Answer: Answer: a. Infuse IV calcium gluconate.
The patients clinical manifestations of stridor and cramping are
consistent with tetany caused by hypocalcemia resulting from
damage to the parathyroid glands during surgery. Endotracheal
intubation or tracheostomy may be needed if the calcium does not
resolve the stridor. Suctioning will not correct the stridor.
◉ A patient with Graves disease has exophthalmos. Which nursing
action will be included in the plan of care?
,a. Apply eye patches to protect the cornea from irritation.
b. Place cold packs on the eyes to relieve pain and swelling.
c. Elevate the head of the patient's bed to reduce periorbital fluid.
d. Teach the patient to blink every few seconds to lubricate the
cornea.
Answer: Answer: c. Elevate the head of the patient's bed to reduce
periorbital fluid.
The patient should sit upright as much as possible to promote fluid
drainage from the periorbital area. With exophthalmos the patient is
unable to close the eyes completely. Lubrication of the eyes, rather
than eye patches, will protect the eyes from developing corneal
scarring. The swelling of the eye is not caused by excessive blood
flow to the eye, so cold packs will not be helpful.
◉ A patient with hyperthyroidism is treated with radioactive iodine
(RAI) at a clinic. Before the patient is discharged, the nurse instructs
the patient:
a. that symptoms of hyperthyroidism should be relieved in about a
week.
b. that symptoms of hypothyroidism may occur as the RAI therapy
takes effect.
, c. to discontinue the antithyroid medications taken before the
radioactive therapy.
d. about radioactive precautions to take with urine, stool, and other
body secretions.
Answer: Answer: b. that symptoms of hypothyroidism may occur as
the RAI therapy takes effect.
There is a high incidence of postradiation hypothyroidism after RAI,
and the patient should be monitored for symptoms of
hypothyroidism. RAI has a delayed response, with the maximum
effect not seen for 2 to 3 months, and the patient will continue to
take antithyroid medications during this time. The therapeutic dose
of radioactive iodine is low enough that no radiation safety
precautions are needed.
◉ A 72-year-old patient is diagnosed with hypothyroidism and
levothyroxine (Synthroid) is prescribed. Which assessment is most
important for the nurse to make during initiation of thyroid
replacement?
a. Apical pulse rate.
b. Nutritional intake.
c. Intake and output.
d. Orientation and alertness.
Answer: Answer: a. Apical pulse rate.
