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Nursing Practice Questions: Thyroid, Pancreatitis, Osteomyelitis, Rheumatoid Arthritis, Study notes of Medicine

Indiana University KokomoMedicine

A series of multiple-choice questions and answers related to various nursing practices, focusing on conditions like thyroid disorders, pancreatitis, osteomyelitis, and rheumatoid arthritis. It provides insights into the assessment, diagnosis, and management of these conditions, offering valuable learning opportunities for nursing students and professionals.

Typology: Study notes

2022/2023

Uploaded on 10/30/2024

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Med Surg 2 Exam
1. You are the nurse on the medical surgical floor, and you are caring for a 49-year-old male client
with elevated T4 & T3levels. The patient also has a low thyroid stimulating hormone level (TSH).
Which actions should you take? Select all that apply.
- Administer Synthroid
- Administer Lithium
- Obtain baseline vital signs.
- Obtain an order for telemetry monitoring to assess for dysrhythmias.
- Assess for Chvostek’s sign.
2. You are caring for a patient who had a thyroidectomy earlier in the day because of her Graves
diagnosis. The patient develops laryngeal stridor, circumoral area tingling, and cramping of the
hands upon return to the surgical nursing unit. Which collaborative action will you anticipate
next?
- Provide Prn pain medication as ordered.
- Administer IV calcium gluconate.
- Prepare to suction the patient’s airway.
- Obtain a prn order for Ativan.
3. You are working night shift and your co worker has admitted a 42-year-old female patient with
graves disease who has severe exophthalmos. Which action below should be included in the
patient’s plan of care?
- Apply alternating eye patches to protect the cornea from irritation.
- Elevate the head of the bed to reduce periorbital edema.
- Educate the patient to blink every few seconds to lubricate the cornea.
- Assess both eyes every shift for signs of infection.
4. You are admitting a patient on the med surg floor with a diagnosis of Cushing’s syndrome. Which
finding should you expect during your assessment?
- Bronzed appearance of the skin
- Decreased axillary and pubic hair.
- Purplish streaks on the abdomen
- Chronically low blood pressure
5. A 56-year-old female client to the emergency department in thyroid storm. Which medication
should the nurse expect will have rapid effects on this client?
- Iodine
- Propanol
- PTU
6. A 42-year-old male client is being seen by an internal medicine specialist and is diagnosed with
hypothyroidism. The nurse should assess the client for which of the following? (Select all that
apply)
- Constipation
- Decreased energy and fatigue
- Bilateral pedal edema
- Migraines
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Med Surg 2 Exam

  1. You are the nurse on the medical surgical floor, and you are caring for a 49-year-old male client with elevated T4 & T3levels. The patient also has a low thyroid stimulating hormone level (TSH). Which actions should you take? Select all that apply.
    • Administer Synthroid
    • Administer Lithium
    • Obtain baseline vital signs.
    • Obtain an order for telemetry monitoring to assess for dysrhythmias.
    • Assess for Chvostek’s sign.
  2. You are caring for a patient who had a thyroidectomy earlier in the day because of her Graves diagnosis. The patient develops laryngeal stridor, circumoral area tingling, and cramping of the hands upon return to the surgical nursing unit. Which collaborative action will you anticipate next?
    • Provide Prn pain medication as ordered.
    • Administer IV calcium gluconate.
    • Prepare to suction the patient’s airway.
    • Obtain a prn order for Ativan.
  3. You are working night shift and your co worker has admitted a 42-year-old female patient with graves disease who has severe exophthalmos. Which action below should be included in the patient’s plan of care?
    • Apply alternating eye patches to protect the cornea from irritation.
    • Elevate the head of the bed to reduce periorbital edema.
    • Educate the patient to blink every few seconds to lubricate the cornea.
    • Assess both eyes every shift for signs of infection.
  4. You are admitting a patient on the med surg floor with a diagnosis of Cushing’s syndrome. Which finding should you expect during your assessment?
    • Bronzed appearance of the skin
    • Decreased axillary and pubic hair.
    • Purplish streaks on the abdomen
    • Chronically low blood pressure
  5. A 56-year-old female client to the emergency department in thyroid storm. Which medication should the nurse expect will have rapid effects on this client?
    • Iodine
    • Propanol
    • PTU
  6. A 42-year-old male client is being seen by an internal medicine specialist and is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? (Select all that apply)
    • Constipation
    • Decreased energy and fatigue
    • Bilateral pedal edema
    • Migraines
  1. A female patient is admitted to the intensive care unit with the diagnosis of myxedema coma. You are the nurse caring for her. Which of the following collaborative actions would you anticipate? Select all that apply.
    • IV fluids use 0.9% sodium chloride.
    • Administer levothyroxine IV bolus.
    • Place in cooling blanket
    • Cardiac monitor for dysrhythmias
    • Rule out and treat infections.
  2. A nurse in the surgical intensive care unit is caring for a patient who had a total thyroidectomy and parathyroidectomy. While assessing the patient, the nurse notices a positive trousseau’s sign. Which laboratory result does the nurse correlate with this condition?
    • Serem sodium of 124
    • Serem magnesium of 2.
    • Serem potassium of 3.
    • Serem calcium 7.
  3. A nurse is assessing a client who has been admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12lbs) the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis?
    • Administer aspirin as prescribed for any sign of hyperthermia.
    • Keeping the client NPO
    • Provide a quiet low stimulating environment.
    • Observe the client carefully for signs of hypocalcemia.
  4. The ambulance delivers a 35-year-old client into the ER. Upon assessment the client is confused delirious and complaining of nausea/vomiting and abdominal pain. The family states the client had minor surgery last week. The client has the following EKG strip and has a temperature of 38.4 C. You review the chart and note the client is taking the following medications Methimazole and propranolol. You prepare for interventions related to which diagnosis.
    • Acute thyrotoxicosis
    • Addison’s crisis
    • Myxedema coma
  5. You are the nurse on the progressive care unit, and you have just admitted a patient with pyelonephritis. You are completing her shift assessment and understand that which of the below is most important finding to report to the health care provider?
    • Cloudy and foul-smelling urine Flank tenderness to palpation
    • Blood pressure of 90/
    • Temperature of 100.2 F
  6. You are caring for a 52-year-old male patient who was admitted yesterday evening with renal calculi. Your assessment shows the patient to have gross hematuria and severe colicky right flank pain which nursing action is the highest priority for this patient.
    • Give Zofran as needed for nausea.
    • Encourage increased oral fluid intake.
    • Monitors temp every 4 hours.
    • The administrator prescribed analgesic.
  • Hypocalcemia
  1. The nurse is completing a health history on a new patient in an outpatient health clinic. What information indicates to the nurse that the patient should be screened for hep C.
  • The pt experienced with IV drugs about 20 years ago.
  • The patient eats frequently in fast food restaurants.
  • The patient had a blood transfusion in 2003.
  • The patient recently traveled to a country with poor sanitation.
  1. As a student nurse, you understand which of the following goals is most appropriate for the client that has been diagnosed with viral hepatitis.
  • Increase activity levels gradually.
  • Experience relief from edema
  • Decreased presence of Cullen’s sign
  • Achieve control of Hgb A1C
  1. The nurse is working on the medical surgical floor and is caring for 64-year-old male that been diagnosed with pancreatitis due to his alcoholism. Which lab values indicate that the client is experiencing acute pancreatitis?
  • WBC of 10000
  • Amylase of 982 units
  • Amylase of 29 units
  • ALT of 31
  1. A seasoned nurse is teaching her orientee about the differences between acute and chronic pancreatitis. Which of the following are found more frequently in chronic versus acute pancreatitis.
  • Require a high carb high protein low fat diet
  • Needs to abstain from NSAIDS
  • Experience acute abdominal pain
  • Malabsorption and diabetes mellitus
  1. A nurse is caring for a 46 year old male client with acute pancreatitis and is creating a care plan for him. Which intervention should the nurse include to reduce his discomfort.
  • Maintain client’s NPO and administer intravenous fluids
  • Place the client in a dorsal recumbent position with the head of bed elevated
  • Administer morphine sulfate by mouth every 4 hours as needed
  • Provide small frequent feedings with no concentrated sweets
  1. A nurse is caring for a 46 year old female client in the emergency department who has been diagnosed with acute pancreatitis due to cholelithiasis. After treating the client pain, which of the following should the nurse address as the priority intervention?
  • Monitor the client’s respiratory status
  • Provide oral hygiene
  • Assist the client to a side lying position
  • Withhold oral fluids and food
  1. A nurse is completing an admission assessment on a 45 year old female client who has been diagnosed and pancreatitis. Which of the below findings should the nurse expect
  • Report of pain being worse when sitting upright
  • Epigastric pain radiating to the left shoulder
  • Pain in right upper quadrant radiating to the right shoulder
  • Pain is worse when patient assumes a side lying position with knees bent.
  1. The nurse manager prepares to discharge a 50 year old male client with chronic pancreatitis. Which nursing intervention has the priority when preparing to discharge the patient?
  • Discuss the need to avoid spicy foods
  • Instruct patient on consuming a high carb low fat diet
  • Refer the patient to AA
  • Explain the importance of alcohol abstinence
  1. A nurse is assessing a male client who has recently been diagnosed with acute pancreatitis which of the following actions should be taken to assess this client for the presence of Cullen’s sign
  • Tap lightly at the vertebral margin on the clients back
  • Inspect the skin around the umbilicus
  • Auscultation the area below the scapula
  • Inspect the skin on the flank area
  1. A nurse is caring for a hospitalized client who has hep B and a 10 year history of IV drug use. Which of the following interventions is the priority for the nurse to include in the client’s plan of care
  • High protein diet
  • Bedrest with bathroom privileges
  • Hourly oral intake
  • Acetaminophen every 6 hrs prn pain
  1. H You are the nurse on a medical floor and have a 42 year old male patient with acute osteomyelitis of the right femur. He is hospitalized for twice daily irrigation with Gentamacyin (Gentak) Which intervention will the nurse include in the initial plan of care a. Assisted weight bearing ambulation b. Positioning of the right leg in flexion c. Immobilization of the right leg d. Activity as tolerated
  2. Before administering medication, the nurse is reviewing results of laboratory tests ordered for a patient diagnosed with RA. Which data is most important to communicate to the health care provider for this patient who is taking Rheumatrex? a. the erythrocyte sedimentation rate is elevated b. the white blood cell count is 1500 c. the rheumatoid factor is positive d. the blood glucose is 90
  3. A nurse is caring for a client who has newly diagnosed rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease?
  • ANA titer
  • BUN and creatinine
  • C-reactive protein (CRP)
  1. Your client has a diagnosis of hypothyroidism. You are preparing to administer levothyroxine. The order reads levothyroxine 0.175 mg by mouth once a day. The amount available is 88mcg/tablet. How many tablets will the nurse administer per dose.
  1. A nurse is preparing to administer cefazolin 1 gram by intermittent IV bolus over 30 minutes to a patient admitted with urosepsis. Available is cefazolin 1 gram in 100 mL dextrose 5% in water (D5W). Due to covid, the hospital is out of IV pumps. The drop factor of the manual IV tubing is 10gtt/ML. The nurse should set the manual IV infusion to deliver how many gtt/min. Round to the nearest whole number
  1. The medication is preparing to administer 250 mg ceftriaxone IM for a severe UTI. Available is 3 g/5mL. How many mL should the nurse administer per dose.
  1. Your client has been diagnosed with acute pyelonephritis. You are preparing to administer vancomycin 15 mg/kg/day. Equally every 12 hours. Your client weighs 198 lbs. How many mg should you administer with each dose.

42.Nurse notes: 1000 Debbie Smith presented to her HCP with fatigue, being cold all the time, depression feeling as if she cannot straight and constipation. Her fatigue began about 6 months ago and is worsening. Recently her family realized there had to be something wrong with her when she was wearing a sweater and it was 85 degrees out. Vital signs Temp: 97.0 Pulse 52, RR 24, BP 100/41 02 100% on Room air height 5’4 weight 145 up 15 lbs in past 6 months NKA Past Medical History: Two C-sections, menopause symptoms began 1 year ago Current meds: Black cohosh for menopausal symptoms Results of the nurses assessment are: Skin dry, color pink, cap refill < 3 seconds. No nausea/vomiting/diarrhea. No jugular vein distension. Alert,, slow to respond monotone voice/ flat affect oriented x4, heart tones s1 and s2 heard, lungs clear, abdomen soft, non- distended , bowel sounds (+)x 4 quads + 1 peripheral edema, liver not palpable. Of these 6 client findings select the top 3 findings that would indicate follow up: - Fatigue - Live not palpable - BP 118/ - Slow to respond

- RR 24

  • Cold
  1. The following labs were ordered CBC, BMP, ANA, T3, T Results are Na (135-150) 140 K (3.5-5.0) Cl 95-105: 100 CO2 23-33: 30 BUN 5-20: 10 8CR 0.6-1.2: 0. BG 70-100: 90 CA 9-11: 10 RBC 3.8-5.2: 4 WBC 6-17: 10 HGB 11.5-14.5: 12 HCT 35-42: 36 The client is at most risk for having:
  • Hypothyroidism
  • Hyperthyroidism
  • Thyroiditis
  • Goiter
  1. Levothyroxine Synthyroid
  • purpose
  • Patient education
  1. Propylthiouracil
  • purpose
  • used to decrease inflammation
  • used to protect thyroid gland from radioactive iodine
  1. Prednisone Purpose:
    • Used to protect thyroid gland from radioactive iodine
    • Used to decrease inflammation
    • Used to lower the amount of thyroid hormone produced
    • Used to treat an underactive thyroid
    • Used with other drugs for treatment of thyrotoxicosis Patient Education:
    • Take on empty stomach, same time daily
    • Medication takes full effect within 2-3 weeks
    • Take on empty stomach, same time daily
    • Could cause immunosuppression
  2. A 27year old female client is been seen by her primary health care provider in the outpatient clinic for unintentional weight loss, heat intolerance, and intermittent hand tremors. Client states she is adopted and unsure if she has a family history of thyroid problems. Her possible diagnosis by her health care provider is hyperthyroidism. The primary health care provider plans to order la tests to confirm this diagnose. What additional physical assessment findings would the nurse expect to be present in this client?
  • Diaphoresis
  • Insomnia
  • Hypotension
  • Irritability
  • Sinus Bradycardia -Constipation
  1. Which serum lab test results support the clients propable diagnosis?
  • Increased calcium
  • Decreased total thyroxine
  • Increased total thyroxine
  • Increased anti-thyroglobulin
  • Decreased thyroid thyroid stimulating hormone
  • Decreased calcium -increased thyroid stimulating hormone
  1. A 42 year old man had a total thyroidectomy for thyroid cancer, after chemotherapy was unsuccessful treating the cancer. Upon discharge the nurse is preparing to teach the client about his thyroid replacement medication (levothyroxine). Which health teaching will the nurse include about the drug?
  • You will only need to take this medication until your TSH level is therapeutic.
  • Let your primary health care provider if you experience regular bowel movements
  • Different medications may increase or decrease the absorption of this medication
  • There are very few side effects of levothyroxine -It will be necessary to get repeated laboratory tests to monitor your thyroid hormone levels.
  • Check with your primary health care provider if you take any other OTC and supplements
  • Don’t take less of the drug than ordered to prevent hypothyroidism symptoms