Nursing Elites

1. During preoperative teaching for a female client undergoing subtotal thyroidectomy, which statement should the nurse include?

• A. The head of your bed must remain flat for 24 hours after surgery.
• B. You should avoid deep breathing and coughing after surgery.
• C. You won't be able to swallow for the first day or two.
• D. You must avoid hyperextending your neck after surgery.

Correct answer: D

Rationale: The correct answer is D. Instructing the client to avoid hyperextending the neck after thyroid surgery is crucial to prevent stress on the surgical site and reduce the risk of complications such as strain on the incision or damage to the healing tissues. Choices A, B, and C are incorrect because: A) Keeping the head of the bed flat for 24 hours is not necessary after a thyroidectomy; elevation of the head of the bed can actually help reduce swelling and improve comfort. B) Encouraging deep breathing and coughing after surgery is essential to prevent respiratory complications such as pneumonia, so this advice is incorrect. C) Difficulty swallowing after thyroid surgery is not a typical outcome, so this statement is inaccurate and should not be included in the preoperative teaching.

2. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, Nurse Libby prepares to take emergency action to prevent the potential complication of:

• A. Thyroid storm.
• B. Cretinism.
• C. Myxedema coma.
• D. Hashimoto's thyroiditis.

Correct answer: C

Rationale: The scenario described with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area is indicative of myxedema coma, a severe and life-threatening complication of hypothyroidism. Myxedema coma requires immediate emergency treatment to prevent further deterioration. Choice A, thyroid storm, is a complication of hyperthyroidism characterized by an increase in body temperature, heart rate, and blood pressure. Choice B, cretinism, refers to untreated congenital hypothyroidism leading to mental and physical growth retardation. Choice D, Hashimoto's thyroiditis, is an autoimmune condition leading to hypothyroidism but does not present with the acute, life-threatening symptoms described in the scenario.

3. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with his ability to go outdoors. Based on these assessment findings, Nurse Richard would suspect which of the following disorders?

• A. Diabetes mellitus
• B. Diabetes insipidus
• C. Hypoparathyroidism
• D. Hyperparathyroidism

Correct answer: D

Rationale: The symptoms described in the scenario, such as bone pain, increased urination, anorexia, and weakness, are indicative of hyperparathyroidism. In hyperparathyroidism, there is an excess of parathyroid hormone leading to increased calcium levels, which can result in bone pain and various systemic effects. Choices A, B, and C are incorrect because they do not align with the symptoms presented by the client. Diabetes mellitus primarily presents with polyuria, polydipsia, and hyperglycemia. Diabetes insipidus manifests as polyuria and polydipsia with dilute urine. Hypoparathyroidism usually presents with hypocalcemia, causing symptoms like muscle cramps, tingling sensations, and seizures.

4. A client with DM is taking regular and NPH insulin every morning. The nurse should provide which instruction to the client?

• A. Take the regular insulin first, then the NPH insulin.
• B. Take the NPH insulin first, then the regular insulin.
• C. Mix the insulins in a separate syringe.
• D. Take the regular insulin first and immediately follow it with the NPH insulin.

Correct answer: A

Rationale: The correct instruction for the client is to take the regular insulin first, then the NPH insulin. Regular insulin should be administered before NPH insulin to prevent contamination and maintain the potency of each insulin type. Choice B is incorrect because NPH insulin should not be taken before regular insulin. Mixing the insulins in a separate syringe, as suggested in choice C, is not recommended as it may alter the effectiveness of the insulins. Choice D is also incorrect as taking the regular insulin first and immediately following it with NPH insulin is not the recommended administration sequence.

5. A client with hypothyroidism is receiving levothyroxine therapy. The healthcare provider should monitor for which of the following signs of medication overdose?

• A. Bradycardia
• B. Weight gain
• C. Tachycardia
• D. Cold intolerance

Correct answer: C

Rationale: The correct answer is C: Tachycardia. Tachycardia is a sign of levothyroxine overdose, indicating that the dose may need to be adjusted. Bradycardia (Choice A) is a sign of hypothyroidism, not an overdose of levothyroxine. Weight gain (Choice B) and cold intolerance (Choice D) are also symptoms of hypothyroidism, not medication overdose.

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