Chapter 46 Medical Surgical Nursing Preparation For Practice 2nd Edition

Chapter 46  Medical Surgical Nursing Preparation For Practice 2nd Edition

Complete Chapter Questions And Answers
 

Sample Questions

Question 1
Type: MCSA
During the assessment of a patient with thyroid dysfunction, the nurse notes hair loss and warm, moist skin. Which question is most important for the nurse to ask this patient?
1. “Have you experienced any recent weight loss?”
2. “Have you been feeling constipated?”
3. “Have you noticed increased bruising?”
4. “Have you noticed that you do not tolerate cold as well as you once did?”
Correct Answer: 1
Rationale 1: Hair loss and warm, moist skin are both findings associated with hyperthyroidism. Weight loss is another finding that would support a diagnosis of hyperthyroidism.
Rationale 2: Constipation is a symptom of hypothyroidism. People with hypothyroidism have dry skin and cold extremities, so the patient’s findings do not support a diagnosis of hypothyroidism.
Rationale 3: Bruising and delayed wound healing support a diagnosis of hypothyroidism. People with hypothyroidism have dry skin and cold extremities, so the patient’s findings do not support a diagnosis of hypothyroidism.
Rationale 4: Cold intolerance is a finding associated with hypothyroidism. People with hypothyroidism have dry skin and cold extremities, so the patient’s findings do not support a diagnosis of hypothyroidism.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 46-2

Question 2
Type: MCSA
Which instruction would be most important for the nurse to give to a patient who is scheduled to have a subtotal thyroidectomy?
1. Report sensations of tingling in toes, fingers, or lips.
2. Report headache immediately.
3. Herbal remedies are appropriate for use postoperatively.
4. Avoid exposure to crowds for several weeks after surgery.
Correct Answer: 1
Rationale 1: Hypoparathyroidism may result from the manipulation of the parathyroid glands during a subtotal thyroidectomy. The lack of circulating PTH causes hypocalcemia. Neuromuscular manifestations include numbness and tingling around the mouth and in the fingertips.
Rationale 2: Headache is not an emergent sign of any complication of this surgery.
Rationale 3: Herbal therapies should be used with extreme caution and only after consultation with the patient’s health care provider.
Rationale 4: There is no indication that the patient should avoid crowds any more than with any other surgical procedure.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 46-3

Question 3
Type: MCSA
The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new prescription for methimazole (Tapazole). Which patient statement indicates understanding of instructions about this medication?
1. “This medication will increase my metabolism.”
2. “As long as I take this medication daily, the time of the dose is not important.”
3. “This medication will cure my thyroid problem.”
4. “I will need regular blood tests while taking this medication.”
Correct Answer: 4
Rationale 1: Hyperthyroidism is treated by administering methimazole or PTU, medications that reduce TH production, thereby decreasing metabolism.
Rationale 2: Consistency of dosing time is important with methimazole.
Rationale 3: Antithyroid medications are not cures, but rather serve to balance thyroid hormones.
Rationale 4: The patient’s white blood cell counts and liver function should be monitored while taking this medication.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 46-3

Question 4
Type: MCSA
The nurse is caring for a patient with elevated serum thyroid hormones and new-onset exophthalmos. The nurse establishes which nursing diagnosis?
1. Disturbed Body Image
2. Risk for Infection
3. Imbalanced Nutrition: More than Body Requirements
4. Fluid Volume Excess
Correct Answer: 1
Rationale 1: The bulging of the eyes characteristic of exophthalmos affects body image.
Rationale 2: The presence of exophthalmos may increase the risk of eye infection to some degree, but this diagnosis is not as likely to be a priority as another.
Rationale 3: A diagnosis of imbalanced nutrition is not related to exophthalmos.
Rationale 4: A diagnosis of excess fluid is not related to exophthalmos.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: 46-3