2 PMOC · 0084 GSN
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Examination 2
E N D O C R I N E · B U R N S · P E D I AT R I CS · L A B VA LU E S · P H A R M ACO LO G Y · C R I T I C A L C A R E
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Examination 2 TOTAL QUESTIONS 85 Questions
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans endocrine disorders, burns, pediatrics, lab values, pharmacology, and critical care.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical values and guidelines reflect current evidence-based practice standards.
, SECTION I — THYROID & PARATHYROID DISORDERS Questions 1 – 12
1. A patient presents with heat intolerance, tachycardia, weight loss, increased systolic
blood pressure, and a visible goiter. The nurse suspects hyperthyroidism. Which are the
primary causes?
A. Autoimmune disease and medications
B. Graves disease and thyroiditis
C. Chronic kidney failure and vitamin D deficiency
D. Neck surgery and cancer radiation
CORRECT ANSWER B — Graves disease and thyroiditis
RATIONALE Hyperthyroidism is most commonly caused by Graves disease (autoimmune —
stimulating TSH receptor antibodies) and thyroiditis (inflammation releasing
stored thyroid hormone). Classic symptoms include heat intolerance, tachycardia,
weight loss despite increased appetite, increased systolic BP, and goiter.
Treatment options: PTU, methimazole (preferred in pregnancy after first
trimester), radioactive iodine therapy, and thyroidectomy. Autoimmune disease
and medications cause hypothyroidism. Neck surgery and radiation cause
hypoparathyroidism.
,2. The nurse is caring for a patient immediately following a thyroidectomy. What equipment
must be kept at the bedside and why?
A. Cardiac monitor — risk of atrial fibrillation
B. Tracheostomy tray — risk of stridor and laryngeal spasms
C. Defibrillator — risk of ventricular tachycardia
D. NG tube — risk of gastric distention
CORRECT ANSWER B — Tracheostomy tray — risk of stridor and laryngeal spasms
RATIONALE After thyroidectomy, a tracheostomy tray must be kept at the bedside because of
the risk of laryngeal edema, stridor, and laryngeal spasms that can cause acute
airway obstruction. The parathyroid glands may also be inadvertently removed or
damaged, causing hypocalcemia — calcium gluconate must be at the bedside.
The nurse should monitor for Chvostek's and Trousseau's signs. Hemorrhage with
tracheal compression is another emergency complication requiring immediate
intervention.
3. A post-thyroidectomy patient develops muscle cramps, tingling around the mouth, and a
positive Chvostek's sign. What complication does the nurse suspect?
A. Thyroid storm
B. Hypocalcemia due to parathyroid disruption
C. Myxedema coma
D. Recurrent laryngeal nerve damage
CORRECT ANSWER B — Hypocalcemia due to parathyroid disruption
RATIONALE Post-thyroidectomy hypocalcemia results from inadvertent removal of or damage
to the parathyroid glands, which regulate calcium. Signs include circumoral
tingling, muscle cramps, positive Chvostek's sign (facial muscle contraction when
facial nerve is tapped), and positive Trousseau's sign (carpopedal spasm with BP
cuff inflation). Calcium gluconate must be at the bedside for emergency IV
administration. This is distinct from thyroid storm (fever, tachycardia,
hypertension) and myxedema coma (hypothermia, hypotension,
hypothyroidism).
, 4. A patient with hyperthyroidism develops a temperature that is 1 degree elevated above
baseline, along with severe tachycardia and systolic hypertension. The nurse recognizes
this as which condition?
A. Myxedema coma
B. Addisonian crisis
C. Thyroid storm
D. Cushing syndrome
CORRECT ANSWER C — Thyroid storm
RATIONALE Thyroid storm is a life-threatening exacerbation of hyperthyroidism. A
temperature elevation of even 1 degree is an emergency. Classic triad: fever,
tachycardia, and systolic hypertension. Treatment includes PTU and methimazole
(to block thyroid hormone synthesis), hydrocortisone, prednisone, and cooling
blankets. This is a medical emergency with high mortality if untreated.
Precipitating factors include infection, trauma, surgery, and non-compliance with
antithyroid medications. Myxedema coma is the opposite — severe
hypothyroidism with hypothermia and hypotension.
5. A patient with hypothyroidism asks about medication management. The nurse correctly
explains that levothyroxine (Synthroid) should be taken:
A. At bedtime with a high-fiber snack
B. In the morning, 30 minutes before meals, and avoid taking with fiber
C. With the largest meal of the day to enhance absorption
D. Only when symptoms of fatigue and cold intolerance are present
CORRECT ANSWER B — In the morning, 30 minutes before meals, and avoid taking with fiber
RATIONALE Levothyroxine (Synthroid) must be taken in the morning, 30 minutes before
meals, on an empty stomach for optimal absorption. Fiber, calcium, iron, and
antacids interfere with absorption and must be avoided within 4 hours. Therapy
should be initiated "low and slow" (start at a low dose and titrate gradually). The
nurse should teach the patient to monitor for signs of hyperthyroidism (chest
pain, tachycardia, palpitations) which indicate excessive dosing. Symptoms of
hypothyroidism include cold intolerance, weight gain, dry skin, brittle nails/hair,
hair loss, and constipation.
Galen College of Nursing
✚
G
★
Excellence in Nursing Education
EST. 1989
WE CHANGE THE LIFE OF ONE TO CARE FOR THE LIVES OF MANY
NSG 4800 — Comprehensive Examination 2
E N D O C R I N E · B U R N S · P E D I AT R I CS · L A B VA LU E S · P H A R M ACO LO G Y · C R I T I C A L C A R E
INSTITUTION Galen College of Nursing COURSE CODE NSG 4800
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
(BSN)
EXAM TITLE Comprehensive Examination 2 TOTAL QUESTIONS 85 Questions
COURSE TITLE Comprehensive Nursing Synthesis FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans endocrine disorders, burns, pediatrics, lab values, pharmacology, and critical care.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical values and guidelines reflect current evidence-based practice standards.
, SECTION I — THYROID & PARATHYROID DISORDERS Questions 1 – 12
1. A patient presents with heat intolerance, tachycardia, weight loss, increased systolic
blood pressure, and a visible goiter. The nurse suspects hyperthyroidism. Which are the
primary causes?
A. Autoimmune disease and medications
B. Graves disease and thyroiditis
C. Chronic kidney failure and vitamin D deficiency
D. Neck surgery and cancer radiation
CORRECT ANSWER B — Graves disease and thyroiditis
RATIONALE Hyperthyroidism is most commonly caused by Graves disease (autoimmune —
stimulating TSH receptor antibodies) and thyroiditis (inflammation releasing
stored thyroid hormone). Classic symptoms include heat intolerance, tachycardia,
weight loss despite increased appetite, increased systolic BP, and goiter.
Treatment options: PTU, methimazole (preferred in pregnancy after first
trimester), radioactive iodine therapy, and thyroidectomy. Autoimmune disease
and medications cause hypothyroidism. Neck surgery and radiation cause
hypoparathyroidism.
,2. The nurse is caring for a patient immediately following a thyroidectomy. What equipment
must be kept at the bedside and why?
A. Cardiac monitor — risk of atrial fibrillation
B. Tracheostomy tray — risk of stridor and laryngeal spasms
C. Defibrillator — risk of ventricular tachycardia
D. NG tube — risk of gastric distention
CORRECT ANSWER B — Tracheostomy tray — risk of stridor and laryngeal spasms
RATIONALE After thyroidectomy, a tracheostomy tray must be kept at the bedside because of
the risk of laryngeal edema, stridor, and laryngeal spasms that can cause acute
airway obstruction. The parathyroid glands may also be inadvertently removed or
damaged, causing hypocalcemia — calcium gluconate must be at the bedside.
The nurse should monitor for Chvostek's and Trousseau's signs. Hemorrhage with
tracheal compression is another emergency complication requiring immediate
intervention.
3. A post-thyroidectomy patient develops muscle cramps, tingling around the mouth, and a
positive Chvostek's sign. What complication does the nurse suspect?
A. Thyroid storm
B. Hypocalcemia due to parathyroid disruption
C. Myxedema coma
D. Recurrent laryngeal nerve damage
CORRECT ANSWER B — Hypocalcemia due to parathyroid disruption
RATIONALE Post-thyroidectomy hypocalcemia results from inadvertent removal of or damage
to the parathyroid glands, which regulate calcium. Signs include circumoral
tingling, muscle cramps, positive Chvostek's sign (facial muscle contraction when
facial nerve is tapped), and positive Trousseau's sign (carpopedal spasm with BP
cuff inflation). Calcium gluconate must be at the bedside for emergency IV
administration. This is distinct from thyroid storm (fever, tachycardia,
hypertension) and myxedema coma (hypothermia, hypotension,
hypothyroidism).
, 4. A patient with hyperthyroidism develops a temperature that is 1 degree elevated above
baseline, along with severe tachycardia and systolic hypertension. The nurse recognizes
this as which condition?
A. Myxedema coma
B. Addisonian crisis
C. Thyroid storm
D. Cushing syndrome
CORRECT ANSWER C — Thyroid storm
RATIONALE Thyroid storm is a life-threatening exacerbation of hyperthyroidism. A
temperature elevation of even 1 degree is an emergency. Classic triad: fever,
tachycardia, and systolic hypertension. Treatment includes PTU and methimazole
(to block thyroid hormone synthesis), hydrocortisone, prednisone, and cooling
blankets. This is a medical emergency with high mortality if untreated.
Precipitating factors include infection, trauma, surgery, and non-compliance with
antithyroid medications. Myxedema coma is the opposite — severe
hypothyroidism with hypothermia and hypotension.
5. A patient with hypothyroidism asks about medication management. The nurse correctly
explains that levothyroxine (Synthroid) should be taken:
A. At bedtime with a high-fiber snack
B. In the morning, 30 minutes before meals, and avoid taking with fiber
C. With the largest meal of the day to enhance absorption
D. Only when symptoms of fatigue and cold intolerance are present
CORRECT ANSWER B — In the morning, 30 minutes before meals, and avoid taking with fiber
RATIONALE Levothyroxine (Synthroid) must be taken in the morning, 30 minutes before
meals, on an empty stomach for optimal absorption. Fiber, calcium, iron, and
antacids interfere with absorption and must be avoided within 4 hours. Therapy
should be initiated "low and slow" (start at a low dose and titrate gradually). The
nurse should teach the patient to monitor for signs of hyperthyroidism (chest
pain, tachycardia, palpitations) which indicate excessive dosing. Symptoms of
hypothyroidism include cold intolerance, weight gain, dry skin, brittle nails/hair,
hair loss, and constipation.
