Mark Klimek NCLEX Study Guide 2026: Complete
Lecture Notes, Blue Book Review & Practice
Questions
Question 1
A nurse is providing discharge teaching to a client who had a subtotal
thyroidectomy. Which statement by the client indicates a need for further teaching?
A. "I will need to take thyroid hormone replacement for the rest of my life."
B. "I should watch for signs of infection like a fever, as this could indicate thyroid
storm."
C. "It's important to take my PTU medication exactly as prescribed."
D. "If I feel numbness and tingling in my fingers, I will call my doctor immediately."
Correct Answer: A
Rationale: The notes specify that a subtotal thyroidectomy ("subs get storm") leaves
a portion of the thyroid gland, so the client should retain some hormone production
and not automatically require lifelong hormone replacement. This is a key difference
from a total thyroidectomy ("totals get tetany, need lifelong hormone replacement").
Option B is correct because infection can trigger thyroid storm after a subtotal.
Option C is correct as PTU (Propylthiouracil) is a medication used to manage
hyperthyroidism pre- and post-operatively. Option D is correct because, although
more common in total thyroidectomies, any neck surgery can risk damage to the
parathyroid glands, leading to hypocalcemia, with numbness and tingling
(paresthesia) as an early sign.
Question 2
The nurse receives a phone call from a client who had a total thyroidectomy 2 days
ago. The client reports a tingling sensation around the lips and in the fingers. What
should the nurse instruct the client to do first?
,A. "Take your prescribed calcium supplement immediately."
B. "Come to the emergency department right away."
C. "Place a paper bag over your mouth and breathe slowly."
D. "Try to relax and see if the sensation goes away in an hour."
Correct Answer: B
Rationale: After a total thyroidectomy ("totals get tetany"), the client is at high risk
for hypocalcemia due to accidental removal or damage to the parathyroid glands.
Numbness and tingling (paresthesia) around the mouth and in the fingers is the first
sign of hypocalcemia, which can rapidly progress to life-threatening tetany and
laryngospasm. This is an emergency requiring immediate medical evaluation. While a
calcium supplement may be prescribed, the client needs IV calcium and assessment
in a controlled setting. Option C is a treatment for hyperventilation, not
hypocalcemia. Option D is unsafe due to the risk of rapid progression.
Question 3
The nurse is caring for a client 4 hours post-operative following a thyroidectomy. The
client's voice is hoarse, and they complain of a tingling sensation in their hands.
Which PRN prescription should the nurse administer first?
A. IV push morphine sulfate for pain.
B. Oral acetaminophen for temperature.
C. IV push calcium gluconate.
D. Oral levothyroxine.
Correct Answer: C
Rationale: The client is exhibiting signs of hypocalcemia (tetany, paresthesia), a
known complication after thyroidectomy, especially a total one. This is a medical
emergency. Calcium gluconate is the immediate treatment to correct the electrolyte
imbalance and prevent life-threatening complications like laryngospasm or seizures.
Pain (Option A) and fever (Option B) are secondary concerns at this moment.
Levothyroxine (Option D) is for long-term hormone replacement and will not address
the acute symptoms.
Question 4
,A client with hyperthyroidism is being treated with radioactive iodine. What is the
most important point for the nurse to include in the discharge teaching?
A. "You will need to be on lifelong thyroid hormone replacement."
B. "You will need to take this medication for the rest of your life."
C. "You may experience a sore throat for a few days."
D. "You should see symptom improvement within 24-48 hours."
Correct Answer: A
Rationale: Radioactive iodine destroys the thyroid tissue, essentially creating a state
of hypothyroidism. Therefore, the client will eventually need to take lifelong thyroid
hormone replacement (levothyroxine) to maintain a normal metabolic state. Option B
is incorrect because radioactive iodine is usually a one-time treatment. Option C is
not a common side effect. Option D is incorrect; symptom improvement is gradual,
taking weeks to months.
Question 5
The nurse is assessing a client with Cushing's syndrome. Which of the following
findings would the nurse most expect to see?
A. Bronze skin pigmentation and hypotension.
B. Weight loss and heat intolerance.
C. Moon face and hyperglycemia.
D. Tetany and paresthesia.
Correct Answer: C
Rationale: The notes associate Cushing's syndrome (too much steroid) with "moon
face" and "high blood sugar" (hyperglycemia). These are classic signs of excess
cortisol. Option A describes Addison's disease (bronze/tan skin and risk of
shock/hypotension). Option B describes hyperthyroidism/Grave's disease. Option D
describes hypocalcemia, a risk after thyroidectomy.
Question 6
A client with Addison's disease is admitted to the medical unit. Which nursing
intervention is the highest priority?
, A. Implementing fall precautions due to muscle weakness.
B. Assessing for hyperpigmentation of the skin.
C. Monitoring for signs of infection.
D. Assessing blood pressure frequently.
Correct Answer: D
Rationale: The notes emphasize that clients with Addison's disease "go into shock
very easily." This is because they lack cortisol and aldosterone, leading to an inability
to handle stress and maintain blood pressure and fluid volume (addisonian crisis).
Frequent blood pressure monitoring is the priority to detect early signs of
hypotension and impending shock. While the other options are relevant to Addison's
disease, they are not the immediate, life-saving priority.
Question 7
A client returns to the unit after a unilateral adrenalectomy for Cushing's syndrome.
Post-operatively, the nurse should prioritize monitoring for which complication?
A. Hypokalemia
B. Hyperglycemia
C. Adrenal crisis
D. Moon face
Correct Answer: C
Rationale: The client has been living with excess cortisol from Cushing's syndrome,
which has suppressed the function of the remaining adrenal gland and the pituitary's
ACTH production. Suddenly removing the source of excess cortisol (the tumor/gland)
can lead to a sharp drop in cortisol levels, resulting in adrenal insufficiency (adrenal
crisis/hypotension/shock). The nurse must monitor for hypotension and administer
stress-dose steroids as prescribed. Hypokalemia (A) and hyperglycemia (B) are signs
of Cushing's syndrome pre-operatively. Moon face (D) is a chronic sign that will
resolve slowly, not an acute post-op complication.
Question 8
Lecture Notes, Blue Book Review & Practice
Questions
Question 1
A nurse is providing discharge teaching to a client who had a subtotal
thyroidectomy. Which statement by the client indicates a need for further teaching?
A. "I will need to take thyroid hormone replacement for the rest of my life."
B. "I should watch for signs of infection like a fever, as this could indicate thyroid
storm."
C. "It's important to take my PTU medication exactly as prescribed."
D. "If I feel numbness and tingling in my fingers, I will call my doctor immediately."
Correct Answer: A
Rationale: The notes specify that a subtotal thyroidectomy ("subs get storm") leaves
a portion of the thyroid gland, so the client should retain some hormone production
and not automatically require lifelong hormone replacement. This is a key difference
from a total thyroidectomy ("totals get tetany, need lifelong hormone replacement").
Option B is correct because infection can trigger thyroid storm after a subtotal.
Option C is correct as PTU (Propylthiouracil) is a medication used to manage
hyperthyroidism pre- and post-operatively. Option D is correct because, although
more common in total thyroidectomies, any neck surgery can risk damage to the
parathyroid glands, leading to hypocalcemia, with numbness and tingling
(paresthesia) as an early sign.
Question 2
The nurse receives a phone call from a client who had a total thyroidectomy 2 days
ago. The client reports a tingling sensation around the lips and in the fingers. What
should the nurse instruct the client to do first?
,A. "Take your prescribed calcium supplement immediately."
B. "Come to the emergency department right away."
C. "Place a paper bag over your mouth and breathe slowly."
D. "Try to relax and see if the sensation goes away in an hour."
Correct Answer: B
Rationale: After a total thyroidectomy ("totals get tetany"), the client is at high risk
for hypocalcemia due to accidental removal or damage to the parathyroid glands.
Numbness and tingling (paresthesia) around the mouth and in the fingers is the first
sign of hypocalcemia, which can rapidly progress to life-threatening tetany and
laryngospasm. This is an emergency requiring immediate medical evaluation. While a
calcium supplement may be prescribed, the client needs IV calcium and assessment
in a controlled setting. Option C is a treatment for hyperventilation, not
hypocalcemia. Option D is unsafe due to the risk of rapid progression.
Question 3
The nurse is caring for a client 4 hours post-operative following a thyroidectomy. The
client's voice is hoarse, and they complain of a tingling sensation in their hands.
Which PRN prescription should the nurse administer first?
A. IV push morphine sulfate for pain.
B. Oral acetaminophen for temperature.
C. IV push calcium gluconate.
D. Oral levothyroxine.
Correct Answer: C
Rationale: The client is exhibiting signs of hypocalcemia (tetany, paresthesia), a
known complication after thyroidectomy, especially a total one. This is a medical
emergency. Calcium gluconate is the immediate treatment to correct the electrolyte
imbalance and prevent life-threatening complications like laryngospasm or seizures.
Pain (Option A) and fever (Option B) are secondary concerns at this moment.
Levothyroxine (Option D) is for long-term hormone replacement and will not address
the acute symptoms.
Question 4
,A client with hyperthyroidism is being treated with radioactive iodine. What is the
most important point for the nurse to include in the discharge teaching?
A. "You will need to be on lifelong thyroid hormone replacement."
B. "You will need to take this medication for the rest of your life."
C. "You may experience a sore throat for a few days."
D. "You should see symptom improvement within 24-48 hours."
Correct Answer: A
Rationale: Radioactive iodine destroys the thyroid tissue, essentially creating a state
of hypothyroidism. Therefore, the client will eventually need to take lifelong thyroid
hormone replacement (levothyroxine) to maintain a normal metabolic state. Option B
is incorrect because radioactive iodine is usually a one-time treatment. Option C is
not a common side effect. Option D is incorrect; symptom improvement is gradual,
taking weeks to months.
Question 5
The nurse is assessing a client with Cushing's syndrome. Which of the following
findings would the nurse most expect to see?
A. Bronze skin pigmentation and hypotension.
B. Weight loss and heat intolerance.
C. Moon face and hyperglycemia.
D. Tetany and paresthesia.
Correct Answer: C
Rationale: The notes associate Cushing's syndrome (too much steroid) with "moon
face" and "high blood sugar" (hyperglycemia). These are classic signs of excess
cortisol. Option A describes Addison's disease (bronze/tan skin and risk of
shock/hypotension). Option B describes hyperthyroidism/Grave's disease. Option D
describes hypocalcemia, a risk after thyroidectomy.
Question 6
A client with Addison's disease is admitted to the medical unit. Which nursing
intervention is the highest priority?
, A. Implementing fall precautions due to muscle weakness.
B. Assessing for hyperpigmentation of the skin.
C. Monitoring for signs of infection.
D. Assessing blood pressure frequently.
Correct Answer: D
Rationale: The notes emphasize that clients with Addison's disease "go into shock
very easily." This is because they lack cortisol and aldosterone, leading to an inability
to handle stress and maintain blood pressure and fluid volume (addisonian crisis).
Frequent blood pressure monitoring is the priority to detect early signs of
hypotension and impending shock. While the other options are relevant to Addison's
disease, they are not the immediate, life-saving priority.
Question 7
A client returns to the unit after a unilateral adrenalectomy for Cushing's syndrome.
Post-operatively, the nurse should prioritize monitoring for which complication?
A. Hypokalemia
B. Hyperglycemia
C. Adrenal crisis
D. Moon face
Correct Answer: C
Rationale: The client has been living with excess cortisol from Cushing's syndrome,
which has suppressed the function of the remaining adrenal gland and the pituitary's
ACTH production. Suddenly removing the source of excess cortisol (the tumor/gland)
can lead to a sharp drop in cortisol levels, resulting in adrenal insufficiency (adrenal
crisis/hypotension/shock). The nurse must monitor for hypotension and administer
stress-dose steroids as prescribed. Hypokalemia (A) and hyperglycemia (B) are signs
of Cushing's syndrome pre-operatively. Moon face (D) is a chronic sign that will
resolve slowly, not an acute post-op complication.
Question 8
