Nclex 350 Practice Questions

A client who underwent thyroid surgery is unable to speak and communicate. The nurse initially uses closed-ended questions to assess the client's needs. Once the client is stable, the nurse provides a small white board for the client to write and communicate to others. Which critical thinking attitude has the nurse demonstrated?

perseverance

A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery?

potassium iodide

A client has a thyroidectomy for cancer of the thyroid. When evaluating for nerve injury, what should the client be asked to do?

speak

What type of hypersensitivity reaction is the cause of systemic lupus erythematosus?

type 3

A primary healthcare provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client?

Restoration of electrolyte balance

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for which complication?

Hypotension

A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, what will the nurse emphasize?

Salt intake may have to be restricted while taking the medications.

Levothyroxine 0.125 mg by mouth is prescribed for a client with hypothyroidism. The only tablets available contain 25 mcg (25 µg) per tablet. How many tablets should the nurse administer? Record your answer using a whole number. _________

0.5

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na+ (sodium) 149 mEq/L (149 mmol/L); K + (potassium) 3.2 mEq/L (3.2 mmol/L); Hb (hemoglobin) 17 g/dL (170 mmol/L); and glucose 90 mg/dL (5 mmol/L). What should the nurse teach the client? Select all that apply.

- Avoid foods high in salt. - eat K+ foods

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply.

- Hirsutism - buffalo hump

Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply.

- diarrhea -weight loss

Fludrocortisone is prescribed for a client with adrenal insufficiency. Which responses to the medication should the nurse teach the client to report? Select all that apply.

- edema - rapid weight gain

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply.

- intolerance to cold - decreased body temperature

What clinical manifestations does a nurse expect a client with systemic lupus erythematosus (SLE) most likely to exhibit? Select all that apply.

- joint pain - facial rash - pericarditis

A client has a brain attack (stroke) that involves the right cerebral cortex and cranial nerves. Which areas of paralysis should the nurse find upon assessment? Select all that apply.

- left leg - left arm - left side of face

The nurse is assessing a client admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these are signs of Cushing disease? Select all that apply.

- round face - edema in feet and ankles - thin skin with bruising - fatty deposits on neck and back

A client is taking an antithyroid medication for hyperthyroidism. The nurse provides education about serious health problems that may develop if the medication is not effective and tachycardia continues. The nurse instructs the client to seek medical attention immediately if any of the problems occur. Which should be included in the teaching? Select all that apply.

- weight gain - pedal edema

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply.

-Hirsutism -round face - buffalo hump

A nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

-T4

A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing assessment probably reveal? Select all that apply.

-Truncal obesity -Thin extremities

A client is admitted with a diagnosis of Cushing syndrome. Which clinical manifestations should the nurse expect the client to exhibit? Select all that apply.

-weakness -HTN -Truncal obesity

A client who had a brain attack (cerebrovascular accident, CVA) has left-sided hemiparesis but is able to ambulate with assistance. When getting up from a lying position, the client reports feeling lightheaded and dizzy. The nurse explains that these clinical manifestations are a result of which condition?

Blood pooling in the lower extremities

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations?

Calcium gluconate

A nurse is caring for a client who has just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm?

Checking vital signs every two hours after they stabilize

Which drug would be effective for the treatment of pituitary Cushing's syndrome?

Cyproheptadine

Which test would the client undergo to receive a diagnosis of systemic lupus erythematosus?

Direct immunofluorescence test

A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client?

HTN

What will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate?

High levels of 17-ketosteroids in a 24-hour urine test

A nurse is caring for a client with Addison's disease. Upon assessment, which classic sign will the nurse find?

Hyperpigmentation

Bed rest is prescribed after a client's cerebrovascular accident (CVA, "brain attack") results in right hemiplegia. Which exercises should the nurse incorporate into the client's plan of care 24 hours after the brain attack?

Passive range-of-motion exercises

The nurse is caring for a client who had a brain attack (cerebrovascular accident) and who has varying moods. The moods range from anger to depression to concern about the aphasia, hemiparesis, and the gavage feedings. Which behavior best indicates the client's acceptance of physical limitations?

Performs tube feedings without assistance

A client has left hemiplegia because of a cerebrovascular accident (CVA, "brain attack"). What can the nurse do to contribute to the client's rehabilitation?

Position the client to prevent contractures.

Which important intervention should the nurse include in the plan of care for a client with Addison disease?

Protecting the client from exertion

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, what will the nurse include in the teaching?

Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone.

While hospitalized, a client has a hypertensive crisis and a brain attack (cerebrovascular accident, CVA). Initially, the nurse should place the client in which position?

Side-lying

The nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse should monitor the client for which clinical manifestation?

Signs of respiratory obstruction

A client is scheduled to have a thyroidectomy for thyroid cancer. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching?

Support the head with the hands when changing position.

Hydrocortisone is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

Supports a better response to stress

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. What concern about the client requires the nurse to notify the primary healthcare provider?

There is a decreased ability to handle stress despite steroid therapy.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client?

Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3)

A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client?

Thyroxine replacement therapy will be required indefinitely

The client is prescribed potassium iodide solution prior to surgery for a subtotal thyroidectomy. What explanation should the nurse give as to why this medication should be taken?

It will reduce the risk of hemorrhage during surgery.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response?

Less thyroid tissue is available to supply thyroid hormone after surgery.

A client with hyperthyroidism has been treated with radioactive iodine (131I) to destroy overactive thyroid gland cells. To reduce radiation exposure, the nurse's principles for providing care should be based on what?

Limiting time with and increasing distance from the client

A client with systemic lupus erythematosus is taking prednisone. The nurse anticipates that the steroid may cause hypokalemia. What food will the nurse encourage the client to eat?

broccoli

After reviewing the client's laboratory reports, the physician concludes that the client has primary hypofunction of the adrenal gland. Which clinical manifestation is likely to be observed in that client?

vitiligo

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?

Glucose level

A primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet?

"Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

Immediately after a bilateral adrenalectomy a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed?

"I am glad that I only have to take the medication once a day."

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. When teaching when to call the primary healthcare provider, what statement made by the client shows that teaching was effective?

"I should call the primary healthcare provider for dry hair and an intolerance to cold."

The nurse is teaching a client who underwent bilateral adrenalectomy about self-management after discharge. Which statements given by the client indicate effective learning? Select all that apply.

- "I will procure an influenza vaccination yearly." - "I will visit the hospital frequently for my lifelong hormonal therapy." - "I will immediately notify my primary health care provider if I have fever."

After radioactive iodine therapy, a female client becomes hypothyroid. Levothyroxine is prescribed and the client asks the nurse whether the hormone replacement therapy will interfere with the ability to become pregnant. What is the nurse's best response?

"If your thyroid function is controlled, the medicine should not interfere with your ability to become pregnant."

The blood reports of a client suggest hyperfunctioning of the adrenal glands. Which finding supports the diagnosis?

Serum potassium of 2.8 mEq/L (2.8 mmol/L)

A nurse is caring for a client with Addison disease. Which dietary instruction should the nurse teach the client to follow?

Add extra salt to food

A client who had a brain attack (cerebrovascular accident, CVA) two weeks ago is having problems communicating. The nurse shows the client a picture of a baseball and asks the client to identify it and its characteristics. The client describes its color, size, and purpose but cannot identify it as a ball. How will the nurse document this finding in the client's medical record?

Anomia

A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after surgery?

Assess the sides and back of the client's neck for evidence of bleeding.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. What action does the nurse include when providing teaching about this drug?

Decreases the size and vascularity of the thyroid gland

A client is admitted to the hospital with weakness in the right extremities, and speech that is slightly slurred. A diagnosis of brain attack (cerebrovascular accident, CVA) is suspected. During the first 24 hours after symptom onset, which action is priority?

Evaluate motor status

Initially after a brain attack (stroke, cerebrovascular accident), a client's pupils are equal and reactive to light. Four hours later the nurse identifies that one pupil reacts more slowly than the other. The client's systolic blood pressure is beginning to increase. On which condition should the nurse be prepared to focus care?

Increased intracranial pressure

Which parameter monitoring should be the nurse's priority while caring for a client with hypothyroidism?

Respiratory rate

A client is admitted to the hospital for a thyroidectomy. In which position should the nurse maintain the client after surgery?

Semi-Fowler

Which clinical manifestation occurs in a client with adrenal insufficiency?

Vitiligo

A client has undergone a subtotal thyroidectomy. The client is being transferred from the postanesthesia care unit/recovery area to the inpatient nursing unit. What emergency equipment is most important for the nurse to have available for this client?

a tracheostomy tray

Which does the nurse state is a secondary cause of adrenal insufficiency?

pituitary tumors

A client on prolonged cortisone therapy for adrenal insufficiency is being discharged. Which side effects should the nurse teach the client and family to expect? Select all that apply.

- weakness - moon face - weight gain

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply.

- lability of mood - slow wound healing

Which manifestations may indicate a client has systemic lupus erythematosus (SLE)? Select all that apply.

- pericarditis - discoid lesions - pleural effusions

On reviewing the data of a client with thyroid disorder, the primary healthcare provider prescribed atenolol. Which assessment findings would indicate the need for atenolol therapy? Select all that apply.

- tachycardia - Afib -HTN

A client who has hypofunction of the adrenal gland is prescribed oral hydrocortisone. Which clinical finding indicates the need for dosage adjustment in the client? Select all that apply.

- fluid retention - rapid gain weight -round face

What are the neurologic manifestations of hyperthyroidism? Select all that apply.

- blurred vision - exophthalmos

A nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which common responses to this disease can the nurse expect the client to exhibit? Select all that apply.

- butterfly facial rash - infla. of the joints

A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How should the nurse respond?

"The drug contains a hormone that causes male characteristics."

The client is admitted to the hospital with a large goiter, and a thyroidectomy is performed. What should the nurse do during the first four hours after the surgery? Select all that apply.

- Monitor for stridor or dyspnea - Assess the sides and back of the client's neck for evidence of bleeding

The primary health care provider prescribes fludrocortisone to a client with adrenal gland hypofunction. What does the nurse instruct the client about this medication?

"Regularly monitor blood pressure."

Levothyroxine 12.5 mcg orally each day is prescribed for a client with hypothyroidism. The pharmacy dispensed 90 tablets with each tablet containing 12.5 mcg. Six weeks later, the healthcare provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the tablets in the original prescription can be used before filling the new prescription. How many of the original tablets should the nurse instruct the client to take daily? Record your answer using a whole number. _____ tablets

2

A client is admitted with a diagnosis of chronic adrenal insufficiency. Which roommate should be avoided when assigning a room for this client?

A young adult client with pneumonia

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which should the nurse expect the health care provider to prescribe?

Calcium

A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids?

Compensate for sudden lack of these hormones following surgery

What should the nurse emphasize when providing discharge instructions for a client with the diagnosis of Addison disease?

Continue steroid replacement therapy

While assessing a client with adrenal gland hypofunction receiving drug therapy, the nurse finds that the client has a round face, rapid weight gain, and swelling in the body. Which medication change should the nurse expect the primary healthcare provider to make?

Dose adjustment of hydrocortisone

After treatment with propylthiouracil for hyperthyroidism, a client has the thyroid ablated with131I. On a visit to the endocrine clinic, the client exhibits signs and symptoms of thyrotoxic crisis (thyroid storm). What does the nurse identify as the likely cause of thyrotoxic crisis?

Excessive hormone replacement

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus?

Glucocorticoids accelerate the process of gluconeogenesis.

The parents of a young man suspected of having Cushing syndrome express anxiety about their son's condition. What should the nurse tell the parents to help them better understand the illness?

He may have mood swings or depression as a result of his illness.

A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period?

Hoarseness and airway obstruction may result from laryngeal nerve damage.

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?

Hydrocortisone succinate

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiologic responses?

Hyperplasia of the adrenal cortex

A client has a tentative diagnosis of Cushing syndrome. What physical symptoms will the client exhibit?

Hypertension and moon face

A client diagnosed with adrenal gland hypofunction is receiving fludrocortisone therapy. Which nursing intervention would help the client reduce the risk of complications?

Instruct the client to regularly monitor blood pressure

The nurse is providing education to a client with systemic lupus erythematosus. Which education will the nurse consider as high priority?

Instructing about ways to protect the skin

A client is admitted to the hospital with a possible diagnosis of Addison disease. What is an important nursing responsibility during a 24-hour urine collection for this client?

Keeping the client quiet and reducing stress

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. What is the nurse's priority action immediately postoperative?

Monitor the trachea for deviation to the right or left.

A client's laboratory report reveals decreased serum and salivary cortisol levels and increased serum potassium level from hypofunctioning of the adrenal gland. The client is prescribed fludrocortisone. Which nursing action in the follow-up visit minimizes risk of a potential side effect of medication?

Monitoring the client's blood pressure

A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time?

Observe for signs of tetany.

Which laboratory value may indicate hyperfunction of the adrenal gland in a client?

Potassium: 2.9 mEq/L

A nurse is providing postoperative care for a client who has begun taking levothyroxine after undergoing a thyroidectomy. Which findings in the client may indicate potential thyrotoxic crisis?

Rapid heartbeat and tremors

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. On what fact should the nurse base her response?

There may not be enough thyroid tissue to supply adequate thyroid hormone.

A client who is on long-term corticosteroid therapy following an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. What is the nurse's most important concern related to the client's history?

Steroid therapy will need to be increased to avert a life-threatening crisis.

A client has had a recent brain attack (cerebrovascular accident/stroke). What does the nurse anticipate will be prescribed daily to prevent straining due to constipation?

Stool softener

After stabilization of an acute adrenal insufficiency (addisonian crisis), intravenous medications are decreased gradually, and the client now is receiving hydrocortisone by mouth. What instruction should the nurse include when performing discharge teaching?

Take the medication with food

Which treatment intervention should be provided to a client diagnosed with Cushing's disease?

decrease blood glucose levels

The nurse is caring for a client with hypothyroidism. Which instruction is most important to provide to the client to help in managing their condition?

dress warmly in cold weather

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. What response should the nurse assess this client for?

hypernatremia

A nurse is caring for a client who had an adrenalectomy. What clinical response should the nurse monitor while steroid therapy is being regulated?

hypotension

A nurse is providing postoperative care for a client one hour after an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication?

hypotension

A client is admitted with systemic lupus erythematosus (SLE). The laboratory report shows the presence of neutrophils and monocytes as mediators of injury. Which type of hypersensitivity reaction most likely occurred in the client?

type 3

A client with a history of hypothyroidism reports giddiness, excessive thirst, and nausea. Which parameter assessed by the nurse confirms the diagnosis as heat stroke?

increased HR

The nurse is caring for a client diagnosed with Cushing syndrome. Which symptoms does the nurse expect the client to exhibit?

lability of mood

A client who is suspected of having Cushing syndrome is admitted to the hospital. When checking the laboratory reports, which condition should the nurse expect?

low K+

During thyroid surgery, a client's parathyroid glands have become damaged. Which condition does the nurse expect the client to develop?

tetany

What are the cardiovascular manifestations observed in a client with adrenal insufficiency?

hyponatremia

What are the primary causes of adrenal insufficiency? Select all that apply.

- TB - hemorrhage - HIV

A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply.

- tremors -heat intolerance

A client has a new diagnosis of hyperthyroidism. Which skin conditions should the nurse expect when performing a physical assessment? Select all that apply.

- warm -moist -smooth

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). Which recommendations are essential for the nurse to include? Select all that apply.

- Wear a large-brimmed hat. - Take your temperature daily." -"Balance periods of rest and activity."

A client with addisonian crisis exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies. Which responses should the nurse expect the client to exhibit? Select all that apply.

- hyperkalemia -hyponatremia -postural hypotension

After reviewing the reports of a client, the nurse suspects hypofunctioning of the adrenal gland. Which findings are consistent with hypofunctioning of the adrenal gland? Select all that apply.

- incr. Ca+ - decr. cortisol - decr. Na+

A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply.

- tachypnea - hypotension - pallor -weakness -tachycardia

A client is scheduled for an adrenalectomy. What does the nurse expect that the plan of care will include?

Parenteral corticosteroids

A nurse is assessing a client admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify?

Retention of sodium and water

A client is admitted with a brain attack (cerebrovascular accident, CVA) with left-sided paralysis. The client leans to the left when placed in a sitting position and fails to respond to stimuli in the left visual field. What should the client's plan of care include?

Teaching the client to use head movements to scan the left field of vision

A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the problem, what is the nurse's response?

Tell the client that returning to work is possible if the client takes prescribed hormone supplements.

A nurse is caring for a client who had a thyroidectomy. Which client response should the nurse assess when concerned about an accidental removal of the parathyroid glands during surgery?

Tetany

A client with a cerebrovascular accident ("brain attack") has dysarthria. What should the nurse include in the plan of care to address this problem?

effective communication