MED-SURG II HESI EXAM - SET ONE
WITH ELABORATED QUESTIONS AND
ANSWERS
The nurse is completing a health assessment of a 42-year-old female with suspected Graves' Disease.
The nurse should assess this client for:
1. anorexia
2. tachycardia
3. weight gain
4. cold skin - ANSWER-2. tachycardia
Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased
metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated
with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common
feature of hyperthyroidism. Cold skin is associated with hypothyroidism.
CN: Physiological adaptation; CL: Analyze
When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about
which of the following changes in the menstrual cycle?
1. dysmenorrhea
2. metrorrhagia
3. oligomenorrhea
4. menorrhagia - ANSWER-3. oligomenorrhea
,A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the absence of
menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis.
Oligomenorrhea in women and decreased libido and impotence in men are common features of
thyrotoxicosis. Dysmenorrhea is painful menstruation. Metrorrhagia, blood loss between menstrual
periods, is a symptom of hypothyroidism. Menorrhagia, excessive bleeding during menstrual periods, is
a symptom of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of
the following? (Select all that apply.)
1. rapid pulse
2. decreased energy and fatigue
3. weight gain of 10 lbs (4.5 kg)
4. fine, thin hair with hair loss
5. constipation
6. menorrhagia. - ANSWER-2. decreased energy and fatigue, 3. weight gain of 10 lbs (4.5 kg), 5.
constipation, 6. menorrhagia
Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia,
decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and
menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to
immediately report which of the following?
,1. sore throat
2. painful, excessive menstruation
3. constipation
4. increased urine output - ANSWER-1. sore throat
The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within
the first 3 months of treatment. The client should be taught to promptly report to the health care
provider signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat
and fever should have an immediate white blood cell count and differential performed, and the drug
must be withheld until
the results are obtained. Painful menstruation, constipation, and increased urine output are not
associated with PTU therapy.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having
problems at work because I lose my temper very easily." Which of the following responses by the nurse
would give the client the most accurate explanation of her behavior?
1. "Your behavior is caused by temporary confusion brought on by your illness."
2. "Your behavior is caused by the excess thyroid hormone in your system."
3. "Your behavior is caused by your worrying about the seriousness of your illness."
4. "Your behavior is caused by the stress of trying to manage a career and cope with illness." - ANSWER-
2. "Your behavior is caused by the excess thyroid hormone in your system."
A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid hormones in
the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause
confusion. The client may be worried about her illness, and stress may influence her mood; however,
, irritability is a common symptom of thyrotoxicosis and the client should be informed of that fact rather
than blamed.
CN: Psychosocial integrity; CL: Synthesize
The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which of the
following statements from the client indicates the desired outcome of the
drug?
1. "I have excess energy throughout the day."
2. "I am able to sleep and rest at night."
3. "I have lost weight since taking this medication."
4. "I do perspire throughout the entire day." - ANSWER-2. "I am able to sleep and rest at night."
PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormones and
peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to
sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy
throughout the day, loss of weight and perspiring through the day are symptoms of hyperthyroidism
indicating the drug has not produced its outcome.
CN: Pharmacological and parenteral therapies; CL: Evaluate.
The nurse should teach the client with Graves' disease to prevent corneal
irritation from mild exophthalmos by:
1. Massaging the eyes at regular intervals.
2. Instilling an ophthalmic anesthetic as prescribed.
WITH ELABORATED QUESTIONS AND
ANSWERS
The nurse is completing a health assessment of a 42-year-old female with suspected Graves' Disease.
The nurse should assess this client for:
1. anorexia
2. tachycardia
3. weight gain
4. cold skin - ANSWER-2. tachycardia
Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased
metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated
with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common
feature of hyperthyroidism. Cold skin is associated with hypothyroidism.
CN: Physiological adaptation; CL: Analyze
When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about
which of the following changes in the menstrual cycle?
1. dysmenorrhea
2. metrorrhagia
3. oligomenorrhea
4. menorrhagia - ANSWER-3. oligomenorrhea
,A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the absence of
menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis.
Oligomenorrhea in women and decreased libido and impotence in men are common features of
thyrotoxicosis. Dysmenorrhea is painful menstruation. Metrorrhagia, blood loss between menstrual
periods, is a symptom of hypothyroidism. Menorrhagia, excessive bleeding during menstrual periods, is
a symptom of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of
the following? (Select all that apply.)
1. rapid pulse
2. decreased energy and fatigue
3. weight gain of 10 lbs (4.5 kg)
4. fine, thin hair with hair loss
5. constipation
6. menorrhagia. - ANSWER-2. decreased energy and fatigue, 3. weight gain of 10 lbs (4.5 kg), 5.
constipation, 6. menorrhagia
Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia,
decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and
menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
Propylthiouracil (PTU) is prescribed for a client with Graves' disease. The nurse should teach the client to
immediately report which of the following?
,1. sore throat
2. painful, excessive menstruation
3. constipation
4. increased urine output - ANSWER-1. sore throat
The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within
the first 3 months of treatment. The client should be taught to promptly report to the health care
provider signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat
and fever should have an immediate white blood cell count and differential performed, and the drug
must be withheld until
the results are obtained. Painful menstruation, constipation, and increased urine output are not
associated with PTU therapy.
CN: Pharmacological and parenteral therapies; CL: Synthesize
A client with thyrotoxicosis says to the nurse, "I am so irritable. I am having
problems at work because I lose my temper very easily." Which of the following responses by the nurse
would give the client the most accurate explanation of her behavior?
1. "Your behavior is caused by temporary confusion brought on by your illness."
2. "Your behavior is caused by the excess thyroid hormone in your system."
3. "Your behavior is caused by your worrying about the seriousness of your illness."
4. "Your behavior is caused by the stress of trying to manage a career and cope with illness." - ANSWER-
2. "Your behavior is caused by the excess thyroid hormone in your system."
A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid hormones in
the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause
confusion. The client may be worried about her illness, and stress may influence her mood; however,
, irritability is a common symptom of thyrotoxicosis and the client should be informed of that fact rather
than blamed.
CN: Psychosocial integrity; CL: Synthesize
The nurse is evaluating a client with hyperthyroidism who is taking
Propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which of the
following statements from the client indicates the desired outcome of the
drug?
1. "I have excess energy throughout the day."
2. "I am able to sleep and rest at night."
3. "I have lost weight since taking this medication."
4. "I do perspire throughout the entire day." - ANSWER-2. "I am able to sleep and rest at night."
PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormones and
peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to
sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy
throughout the day, loss of weight and perspiring through the day are symptoms of hyperthyroidism
indicating the drug has not produced its outcome.
CN: Pharmacological and parenteral therapies; CL: Evaluate.
The nurse should teach the client with Graves' disease to prevent corneal
irritation from mild exophthalmos by:
1. Massaging the eyes at regular intervals.
2. Instilling an ophthalmic anesthetic as prescribed.
