Medical Surgical Questions
From Lippincott's_Review_for_NCLEX
Nursing Care of Clients with Disorders of
the Pituitary Gland
After suffering head trauma, a client develops signs and
symptoms of diabetes insipidus.
1. Which characteristic symptom of the client’s disorder
would the nurse expect to fi nd during an assessment?
[ ] 1. Polyphagia
[ ] 2. Polyuria
[ ] 3. Glycosuria
[ ] 4. Hyperglycemia
2. How does the nurse expect the urine that is collected
for a routine urinalysis to appear?
[ ] 1. Tea-colored
[ ] 2. Pale yellow
[ ] 3. Colorless
[ ] 4. Light pink
3. Which nursing intervention is essential for monitoring
the client’s condition?
[ ] 1. Measuring intake and output
[ ] 2. Analyzing blood glucose levels
[ ] 3. Inserting a Foley catheter
[ ] 4. Sending urine samples to the laboratory
The nursing care plan indicates that the client must be
weighed each day.
4. When directing the nursing assistant to weigh the
client, which instruction is most important for obtaining
accurate data?
[ ] 1. Have the client stand on a bedside scale.
[ ] 2. Weigh the client at the same time each day.
[ ] 3. Ask that slippers be removed when being weighed.
[ ] 4. Ask about the client’s pre-disease weight.
The client is treated with intranasal lypressin (Diapid),
2 sprays q.i.d. and as needed.
5. The nurse observes the client self-administering the
medication. Which action indicates that the client is using
the medication correctly?
[ ] 1. The client shakes the medication vigorously
[ ] 2. The client’s head is tilted to the side.
[ ] 3. The client inverts the drug container.
[ ] 4. The client inhales with each spray.
6. Before the client is discharged, the physician orders
lypressin (Diapid) to be administered p.r.n. When instructing
the client about how to take this drug at home, the
nurse tells the client to administer the drug when experiencing
which sign or symptom?
[ ] 1. Increased thirst
[ ] 2. Onset of a headache
[ ] 3. Dark yellow urine
[ ] 4. A runny nose
The nurse is assessing a client who is experiencing signs
and symptoms related to a diagnosis of acromegaly.
7. During the physical assessment of this client, which
fi nding is the nurse most likely to observe?
[ ] 1. Shortened height
[ ] 2. Enlarged hands
[ ] 3. Gonadal atrophy
[ ] 4. Loss of teeth
8. Which nursing diagnosis should the nursing team
consider when developing this client’s care plan?
[ ] 1. Activity intolerance
[ ] 2. Self-care deficit
[ ] 3. Ineffective breathing
[ ] 4. Impaired swallowing
Because medical treatment was unsuccessful, the client
with acromegaly is scheduled for a trans-sphenoidalhypophysectomy.
The night before surgery, the nurse provides
the client with information about what to expect during the
postoperative period.
9. Which statement by the client indicates a misunderstanding
of the expected surgical outcome?
[ ] 1. “My appearance will gradually become normal.”
[ ] 2. “I’ll need to take replacement hormones.”
[ ] 3. “I’ll need to see my physician regularly.”
[ ] 4. “The surgical incision will be inconspicuous.”
10. Immediately after surgery, the nurse assesses the
client for bleeding. Where is the best location to assess for
bleeding?
[ ] 1. The skull
[ ] 2. The nose
[ ] 3. The ear canal
[ ] 4. The tongue
Nursing Care of Clients with Disorders of
the Thyroid Gland
A 35-year-old seeks medical attention to determine the
reason menstruation has ceased. The physician orders a
radioactive iodine uptake test.
11. After the test, the nurse provides the client with
instructions. Which statement of the nurse is most
accurate?
[ ] 1. “You must remain isolated until the radiation level
decreases sufficiently.”
[ ] 2. “You’re free to go without further precautionary
instructions.”
[ ] 3. “You must follow special precautions for a short
period of time.”
[ ] 4. “You’ll be given an antidote to reduce the radioactivity
level.”
The results of the diagnostic tests confirm that the client
has myxedema.
12. In addition to amenorrhea, which other signs of myxedema
is the nurse likely to observe in this client? Select
all that apply.
[ ] 1. Hoarse, raspy voice
[ ] 2. Oily skin with large pores
[ ] 3. Thin trunk and extremities
[ ] 4. Extreme restlessness
[ ] 5. Low body temperature
[ ] 6. Decreased blood pressure
13. When the nurse conducts an admission history, which
subjective symptom is the client likely to describe?
[ ] 1. Difficulty urinating
[ ] 2. Intolerance to cold
[ ] 3. Profuse perspiration
[ ] 4. Excessive appetite
The client with myxedema is treated with levothyroxine
(Synthroid), one tablet P.O. every day.
14. Which statement provides the best evidence that the
client understands the prescribed drug therapy?
[ ] 1. “I must take this drug after meals.”
[ ] 2. “I should avoid driving when sleepy.”
[ ] 3. “I’ll need to take this drug life-long.”
[ ] 4. “I can skip a dose if I’m nauseated.”
15. Because the client is receiving levothyroxine (Synthroid)
for the fi rst time, the nurse recognizes the need to
observe the client for adverse effects related to thyroid
replacement therapy. For which signs and symptoms
should the nurse assess? Select all that apply.
[ ] 1. Dyspnea
[ ] 2. Palpitations
[ ] 3. Excessive bruising
[ ] 4. Raised, red rash
[ ] 5. Hyperactivity
[ ] 6. Insomnia
A client seeks medical attention after noticing fullness in
the neck. After several diagnostic tests, a large endemic
goiter is diagnosed.
16. As the nurse provides care for the client newly diagnosed
with a large goiter, which interventions should be
implemented? Select all that apply.
[ ] 1. Observe the client’s respiratory status
[ ] 2. Elevate the head of the client’s bed
[ ] 3. Provide a diet high in iodized salt
[ ] 4. Obtain an order for a soft diet
[ ] 5. Assess for high fever
[ ] 6. Administer prescribed antibiotics
A client is undergoing treatment for Graves’ disease.
17. Which characteristic facial feature would the nurse
expect to note during a physical examination of this client?
[ ] 1. Bulging eyes
[ ] 2. Bulbous nose
[ ] 3. Thick lips
[ ] 4. Large tongue
The physician prescribes propylthiouracil (Propyl-Thyracil)
to treat the client’s condition.
18. Before administering this medication, what is essential
for the nurse to ask the client?
[ ] 1. “Do you have trouble swallowing?”
[ ] 2. “Do you prefer a liquid form of medication?”
[ ] 3. “Have you had digestive disorders in the past?”
[ ] 4. “Is there a possibility you could be pregnant?”
19. Because propylthiouracil (Propyl-Thyracil) can cause
agranulocytosis, the nurse advises the client to notify the
physician if which problem occurs?
[ ] 1. Persistent sore throat
[ ] 2. Occasional heart palpitations
[ ] 3. Fatigue on exertion
[ ] 4. Prolonged bleeding with trauma
After diagnostic testing, a client with Graves’ disease
is informed that it is necessary to undergo a subtotal
thyroidectomy. The physician prescribes potassium iodide
(Lugol’s solution) 4 gtt P.O. to be taken for 10 days before
the scheduled surgery.
20. When the nurse teaches the client how to self-administer
potassium iodide (Lugol’s solution), which instruction
is most appropriate?
[ ] 1. Swallow the drug quickly.
[ ] 2. Take the drug before meals.
[ ] 3. Dilute the drug in fruit juice.
[ ] 4. Chill the drug before taking it.
The client asks the nurse to explain the purpose of the
preoperative drug therapy.
21. Which response by the nurse about potassium iodide
(Lugol’s solution) is correct?
[ ] 1. It fi rms the gland so it is easily removed.
[ ] 2. It decreases the postoperative recovery time.
[ ] 3. It decreases the risk of postoperative bleeding.
[ ] 4. It eliminates the need for hormone replacement.
22. Preoperatively, which information is most important
to teach the client before the subtotal thyroidectomy?
[ ] 1. Techniques for changing positions
[ ] 2. Reasons for performing leg exercises
[ ] 3. The necessity for daily dressing changes
[ ] 4. Postoperative use of the incentive spirometer
23. To prepare for potential postoperative complications
related to the thyroidectomy, which item is necessary to
keep at the client’s bedside?
[ ] 1. Dressing change kit
[ ] 2. Tracheostomy tray
[ ] 3. Ampule of epinephrine
[ ] 4. Mechanical ventilator
After surgery, the client is returned to the nursing unit in
stable condition.
24. In which position should the client be maintained
after the subtotal thyroidectomy?
[ ] 1. Supine
[ ] 2. Sims’
[ ] 3. Semi-Fowler’s
[ ] 4. Recumbent
25. Postoperatively, the nurse should consult the physician
before encouraging the client who has undergone a
subtotal thyroidectomy to perform which activity?
[ ] 1. Forced coughing
[ ] 2. Deep breathing
[ ] 3. Ambulating
[ ] 4. Dangling legs
26. Which intervention is most appropriate to add to the
client’s care plan when monitoring for incisional bleeding
after a subtotal thyroidectomy?
[ ] 1. Observe for signs of hypovolemic shock.
[ ] 2. Assess for dampness at the back of the client’s neck.
[ ] 3. Remove the dressing to directly inspect the wound.
[ ] 4. Weigh all gauze dressings before and after changing.
27. Which assessment technique is most appropriate
when checking for laryngeal nerve damage in a client who
has had a thyroidectomy?
[ ] 1. Turning the client’s head from side to side
[ ] 2. Observing the client swallowing
[ ] 3. Looking for tracheal deviation
[ ] 4. Asking the client to say “Ah”
28. The nurse should assess for hypocalcemia based on
which client statements after a subtotal thyroidectomy?
Select all that apply.
[ ] 1. “I feel like I could vomit.”
[ ] 2. “My lips feel numb and tingly.”
[ ] 3. “Light seems to bother my eyes.”
[ ] 4. “I feel weak when I walk.”
[ ] 5. “I have cramps in my legs.”
[ ] 6. “I feel like my throat is constricting.”
Because the client is exhibiting signs and symptoms
of hypocalcemia after surgery, the nurse assesses for
Chvostek’s sign.
29. Place an X in the area of the head that the nurse
should assess to determine a positive or negative
Chvostek’s sign.
A day after a client undergoes subtotal thyroidectomy, the
nurse suspects that the client is developing clinical manifestations
related to thyroid crisis.
30. Which signs and symptoms related to thyroid crisis
require immediate notification of the physician? Select all
that apply.
[ ] 1. High fever
[ ] 2. Falling blood pressure
[ ] 3. Regular noisy respirations
[ ] 4. Hand spasms
[ ] 5. Heart palpitations
[ ] 6. Decreased urine output
Based on the client’s clinical presentation, a diagnosis of
thyroid crisis is made.
31. Which nursing interventions are most appropriate at
this time? Select all that apply.
[ ] 1. Take the client’s vital signs at least every hour.
[ ] 2. Assess Trousseau’s sign every shift.
[ ] 3. Limit the client’s activity.
[ ] 4. Administer antipyretics per order.
[ ] 5. Encourage a diet high in iodized salt.
[ ] 6. Make sure I.V. calcium gluconate is available.
32. At the beginning of thyroid replacement therapy after
a thyroidectomy, the nurse must monitor the client closely
for side effects. Which fi ndings would the nurse expect
to detect if the client is receiving more thyroid hormone
replacement than required? Select all that apply.
[ ] 1. Hyperglycemia
[ ] 2. Tachycardia
[ ] 3. Insomnia
[ ] 4. Hirsutism
[ ] 5. Tremors
[ ] 6. Hypertension
Nursing Care of Clients with Disorders of
the Parathyroid Glands
A client who develops a benign parathyroid tumor manifests
signs of hyperparathyroidism.
33. When the nurse reviews the client’s history, which
assessment fi nding is closely associated with the client’s
diagnosis?
[ ] 1. Nightly leg cramps
[ ] 2. Recurrent kidney stones
[ ] 3. Loose bowel movements
[ ] 4. Excessive energy level
The nursing assistant assigned to this client asks why the
care plan indicates that the client is at risk for falls and
injury.
34. Which is the best explanation by the nurse concerning
an effect of hyperparathyroidism?
[ ] 1. The inability to maintain balance
[ ] 2. The risk of developing seizures
[ ] 3. Fainting when changing positions
[ ] 4. Pathologic bone fractures
The client has three of the four lobes of the parathyroid
gland surgically removed.
35. After the client returns from surgery and resumes
eating, the nurse should encourage the client to eat foods
from which food group?
[ ] 1. Bread and cereals
[ ] 2. Milk and cheese
[ ] 3. Meat and seafood
[ ] 4. Fruit and vegetables
A client diagnosed with hypoparathyroidism develops tetany
and comes to the emergency department for treatment.
36. Which I.V. medication can the nurse expect the physician
to order to treat the client’s condition?
[ ] 1. Calcium gluconate
[ ] 2. Ferrous sulfate
[ ] 3. Potassium chloride
[ ] 4. Sodium bicarbonate
Nursing Care of Clients with Disorders of
the Adrenal Glands
The nurse is caring for a client with a disorder of the
adrenal glands.
37. Place an X where the adrenal glands are located in the
diagram below.
The nurse cares for a client with Addison’s disease.
38. Which characteristic fi ndings would the nurse expect to
assess in a client with Addison’s disease? Select all that apply.
[ ] 1. Salt craving
[ ] 2. Skin blemishes
[ ] 3. Moon-shaped face
[ ] 4. Bronzed skin
[ ] 5. Hypoglycemia
[ ] 6. Weight loss
39. Which nursing assessment is most helpful in evaluating
the status of a client with Addison’s disease?
[ ] 1. Blood pressure
[ ] 2. Bowel sounds
[ ] 3. Breath sounds
[ ] 4. Heart sounds
The client’s care plan indicates that the nurse should
assist the client in selecting foods that are good sources of
sodium as part of the treatment for Addison’s disease.
40. If the following foods are available, which one should
the nurse recommend?
[ ] 1. Graham crackers
[ ] 2. Cheddar cheese
[ ] 3. Raw carrots
[ ] 4. Canned fruit
The nurse documents that the client has recurrent episodes
of hypoglycemia.
41. If a regular diet is ordered, which between-meal
snack should the nurse offer to help regulate the client’s
blood glucose level?
[ ] 1. Lemonade and peanuts
[ ] 2. Cola and potato chips
[ ] 3. Coffee and a muffi n
[ ] 4. Milk and crackers
42. Because this client is at risk for developing addisonian
crisis, which is also known as acute adrenal insuffi
ciencyand adrenal crisis, a life-threatening condition,
what should the nurse instruct the client to avoid?
[ ] 1. Stress-producing situations
[ ] 2. Consuming alcoholic beverages
[ ] 3. Eating complex carbohydrates
[ ] 4. Getting too little sleep
43. A client with Addison’s disease is admitted to the
hospital with a history of nausea and vomiting for the past
3 days. The registered nurse (RN) administers methylprednisolone
(Solu-Medrol), a glucocorticoid, intravenously.
Which nursing action is most important for the licensed
practical nurse (LPN) to implement in the client’s plan of
care?
[ ] 1. Glucometer measurements
[ ] 2. Intake and output volumes
[ ] 3. Daily weights
[ ] 4. Frequent oral care
A 38-year-old client is hospitalized after developing symptoms
that resemble those of Cushing’s syndrome. The nurse
completes admission documentation.
44. Based on the client’s condition, which fi ndings will
the nurse most likely document after completing the initial
physical assessment? Select all that apply.
[ ] 1. The client has very thin legs.
[ ] 2. The client looks emaciated.
[ ] 3. The client has bulging eyes.
[ ] 4. The client’s skin is pale.
[ ] 5. The client has bruising.
[ ] 6. The client’s scalp hair is thin.
The nurse develops the care plan and documents an
expected outcome that states, “The client will be free of
infection during the hospital stay.”
45. Based on the nurse’s understanding of this disease
process, for what reasons is the expected outcome justifi
ed? Select all that apply.
[ ] 1. The client is at risk for skin breakdown related to
thinning of the skin and edema.
[ ] 2. Wound healing is prolonged in clients with this
disorder.
[ ] 3. The immunosuppressive effects of the disorder
mask symptoms of infection.
[ ] 4. The client is at risk for aspiration pneumonia
related to laryngeal nerve damage.
[ ] 5. The client’s admission white blood cell count is
elevated.
[ ] 6. The client’s admission temperature is within
normal limits.
The physician orders a 24-hour urine collection to aid in
the diagnosis of Cushing’s syndrome.
46. The nurse is most accurate in telling the client that the
urine collection will begin when?
[ ] 1. With the client’s next voiding
[ ] 2. After the client’s next voiding
[ ] 3. After drinking a pitcher of water
[ ] 4. With the fi rst voiding in the morning
47. Which statement is correct concerning the collection
of urine for a 24-hour specimen?
[ ] 1. The volume of each voiding is measured and
recorded.
[ ] 2. The urine is placed in a container of preservative.
[ ] 3. Each voiding is taken immediately to the laboratory.
[ ] 4. The client voids directly into the specimen container.
After the health care team meets to discuss the client’s
nursing needs, the nursing diagnosis “Disturbed body
image” is added to the care plan.
48. The best rationale for adding this nursing diagnosis
to the care plan in the case of a female is that females with
Cushing’s syndrome typically experience which physiologic
effect?
[ ] 1. Masculine characteristics
[ ] 2. Heavy menstrual flow
[ ] 3. Extreme weight loss
[ ] 4. Large, pendulous breasts
Diagnostic tests confirm that the client’s adrenal glands are
producing excessive amounts of adrenocortical hormones.
49. When the nurse explains the disorder to the client’s
spouse, it is accurate to stress that the client is also likely
to experience which effect?
[ ] 1. Anxiety and occasional panic attacks
[ ] 2. Depression and suicidal tendencies
[ ] 3. Impulsiveness and poor self-control
[ ]4. Forgetfulness and memory changes
The physician orders a low-sodium diet to help treat the
client’s Cushing’s syndrome.
50. Which action by the nurse provides the best data for
monitoring the client’s therapeutic response to sodium
restriction?
[ ] 1. Monitoring sodium intake
[ ] 2. Measuring pedal edema
[ ] 3. Assessing skin turgor
[ ] 4. Weighing the client
51. Which nursing interventions are most appropriate
for managing the basic needs of a client with Cushing’s
syndrome? Select all that apply.
[ ] 1. Have the client sleep on a convoluted (egg-crate)
foam mattress.
[ ] 2. Ambulate the client at frequent intervals.
[ ] 3. Advise the client to ask for assistance when
getting up.
[ ] 4. Offer high-carbohydrate nourishment.
[ ] 5. Check the client frequently for suicidal ideation.
[ ] 6. Instruct the client to wear loose-fi tting clothing.
Eventually, the client undergoes a bilateral adrenalectomy
to correct Cushing’s syndrome.
52. To detect complications of surgery in the immediate
postoperative period, which assessment component is most
important for the nurse to monitor?
[ ] 1. Blood pressure
[ ] 2. Urine output
[ ] 3. Temperature
[ ] 4. Specifi c gravity