Question

A nurse assessed a client immediately after thyroidectomy and asked the client to say "hello." The client moves the lips but is not able to speak the word. What should the nurse do next?

Answer 1

Correct Answers:

Notify the surgeon

Rationale :

🟥 Inability to speak following a thyroidectomy is a potential sign of laryngeal nerve injury, particularly to the recurrent laryngeal nerve, which can impair vocal cord function.

🟥 This is a serious postoperative complication that can lead to airway obstruction or long-term voice loss, requiring immediate medical evaluation.

🟥 The nurse should not delay by giving fluids or encouraging coughing, as this could risk aspiration if vocal cord function is impaired.

🟥 Promptly notifying the surgeon allows for immediate assessment and intervention to protect the airway and evaluate for nerve damage.

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Answer 2

Correct Answers:

Fatigue

Rationale :

🟦 Fatigue is one of the most common and early symptoms of hypothyroidism, resulting from a slowed metabolic rate due to insufficient thyroid hormone.

🟦 Clients may report persistent tiredness, sluggishness, and difficulty concentrating, even after adequate rest.

🟦 Other signs of hypothyroidism include cold intolerance, dry skin, weight gain, constipation, and bradycardia.

🟦 Recognizing fatigue helps the nurse tailor care to energy conservation, support activity levels, and anticipate treatment needs such as levothyroxine therapy.

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Answer 3

Correct Answers:

Daily weights.

Rationale :

🟩 Hyperthyroidism increases the body's metabolic rate, which can lead to rapid weight loss despite normal or increased appetite.

🟩 Monitoring daily weights allows the nurse to track nutritional status, evaluate response to therapy, and detect worsening catabolism or fluid shifts.

🟩 Weight changes are a key indicator of metabolic balance in clients with thyroid disorders.

🟩 This intervention supports early identification of complications like thyrotoxic crisis or worsening disease.

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Answer 4

Correct Answers:

Tingling of the extremities

Rationale :

🟣 Hypocalcemia is common after a total thyroidectomy due to possible removal or damage to the parathyroid glands, which regulate calcium levels.

🟣 A calcium level of 7.6 mg/dL is below normal (normal: 8.5–10.5 mg/dL) and indicates moderate hypocalcemia.

🟣 Tingling or numbness in the fingers, toes, or around the mouth is an early neuromuscular sign of low calcium.

🟣 Additional symptoms can include muscle cramps, tetany, or positive Chvostek’s and Trousseau’s signs.

🟣 The nurse should report findings immediately and anticipate IV calcium gluconate administration if symptoms worsen.

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Answer 5

Correct Answers:

Diabetes

Rationale :

🔷 Diabetes mellitus is a major risk factor for pyelonephritis due to impaired immune response and poor glycemic control, which create an environment conducive to bacterial growth.

🔷 Hyperglycemia promotes bacterial colonization in the urinary tract and reduces the ability of neutrophils to fight infections effectively.

🔷 Diabetic clients often have autonomic neuropathy, which may impair bladder emptying, leading to urinary stasis, a key contributor to upper urinary tract infections like pyelonephritis.

🔷 Pyelonephritis is a bacterial infection of the renal pelvis and kidney, often ascending from lower urinary tract infections, which are more common in diabetics.

🔷 Management requires antibiotic therapy, close monitoring, and glycemic control to prevent recurrence and renal complications.

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Answer 6

Correct Answers:

can go 8 to I0 hours without emptying my bladder."

Rationale :

🔶 Infrequent voiding (such as going 8–10 hours without urinating) promotes urinary stasis, which allows bacteria to multiply, increasing the risk for cystitis (bladder infection).

🔶 Regular voiding helps to flush bacteria from the urinary tract, preventing their ascent into the bladder or urethra.

🔶 Stagnant urine becomes a favorable environment for pathogens like E. coli, the most common causative agent of recurrent urinary tract infections (UTIs) in women.

🔶 Female clients are more prone to cystitis due to a shorter urethra, and behavioral habits such as delayed voiding significantly raise the risk of recurrence.

🔶 Nurses should educate clients to urinate every 2–4 hours, especially after sexual activity and upon feeling the urge, to prevent urinary infections.

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Answer 7

Correct Answers:

Drink 3 liters of fluid every day

Rationale :

🔷 High fluid intake is the most effective strategy for preventing recurring kidney stones, as it helps to dilute urine and reduce the concentration of stone-forming substances.

🔷 A daily fluid intake of at least 3 liters promotes a urine output of more than 2.5 liters, which is associated with a lower risk of stone formation.

🔷 Adequate hydration flushes the urinary tract, minimizing crystal aggregation and preventing the buildup of calcium oxalate, uric acid, or other stone-forming materials.

🔷 Clients should be encouraged to drink water throughout the day, including at night if possible, especially in warm climates or during physical activity.

🔷 Teaching should also include urine color monitoring—urine should be pale yellow to clear as a sign of good hydration.

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Answer 8

Correct Answers:

Drink liberal amounts of fluids

Rationale :

🔸 Increasing fluid intake is a key preventive measure for recurrent urinary tract infections (UTIs) as it helps to flush bacteria out of the urinary tract before they can multiply.

🔸 Drinking liberal amounts of fluids, especially water, increases urine output, reducing urinary stasis and the risk of bacterial colonization in the bladder.

🔸 Clients should be encouraged to drink enough to produce pale yellow or clear urine, a sign of proper hydration and effective urinary cleansing.

🔸 This practice, in combination with proper perineal hygiene and voiding after sexual intercourse, can significantly reduce the risk of recurring UTIs.

🔸 Nurses should also educate female clients to avoid irritants like bubble baths and to wipe front to back after voiding or defecation.

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Answer 9

Correct Answers:

Check the client's history for allergy to iodine.

Rationale :

🔶 An intravenous pyelogram (IVP) involves the injection of iodinated contrast dye, which can trigger severe allergic reactions in clients with iodine or shellfish allergies.

🔶 Identifying a history of iodine allergy is crucial before the procedure to prevent life-threatening reactions such as anaphylaxis, bronchospasm, or hypotension.

🔶 If an allergy is identified, the provider may order premedication (e.g., corticosteroids or antihistamines) or opt for an alternative imaging study.

🔶 This step is prioritized over hydration or bowel prep, as a contrast reaction poses an immediate and critical safety risk.

🔶 Ensuring allergy history is known and documented is a standard safety protocol for any procedure involving contrast dye.

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Answer 10

Correct Answers:

Notify the healthcare provider if vomiting blood.

Rationale :

🔴 NSAIDs (e.g., ibuprofen, naproxen) are known to irritate the gastric mucosa and increase the risk of GI bleeding, ulcers, and gastritis, especially with long-term use.

🔴 Vomiting blood (hematemesis) is a serious sign of upper GI bleeding, which can result from NSAID-induced gastric ulceration or erosion of the stomach lining.

🔴 The nurse must instruct the client to report any signs of GI bleeding, such as bloody vomit, black tarry stools, or abdominal pain.

🔴 Taking NSAIDs with food or milk (not on an empty stomach) is recommended to reduce gastric irritation.

🔴 Tapering is not required for NSAIDs, and they are not typically applied topically unless in a specific topical form like diclofenac gel.

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N3661 spring 2025 Final Exam

No.

1 :
A nurse assessed a client immediately after thyroidectomy and asked the client to say "hello." The client moves the lips but is not able to speak the word. What should the nurse do next?

2 :
A client is being evaluated for hypothyroidism. To plan care, the nurse should ask the client which sign or symptom?

3 :
The nurse is caring for a client with hyperthyroidism. The nurse should include the following in the plan of care :

4 :
A nurse is caring for a client who had a total thyroidectomy and a serum calcium level of 7.6 mg/dL. (range 8.5-10.5) Which of the following findings should the nurse expect?

5 :
A client has been diagnosed with pyelonephritis. Based on the client's medical history, which disorder is a risk factor for developing pyelonephritis

6 :
Which statement by a female client would indicate that she is at the highest risk for a recurrence of cystitis

7 :
A nurse provides dietary teaching to a client with a history of recurring kidney stones. Which of the following instructions should the nurse include in the teaching?

8 :
A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client?

9 :
The client is scheduled for an intravenous pyelogram (IVP). The contrast will be needed to determine the location of the renal calculi. Which action would be the most important for the nurse to include in pre-test preparation?

10 :
The client diagnosed with osteoarthritis (OA) is prescribed a nonsteroidal anti-inflammatory drug (NSAID) by mouth. Which instruction should the nurse teach the client?

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N3661 spring 2025 Final Exam

No.

1 : A nurse assessed a client immediately after thyroidectomy and asked the client to say "hello." The client moves the lips but is not able to speak the word. What should the nurse do next?

2 : A client is being evaluated for hypothyroidism. To plan care, the nurse should ask the client which sign or symptom?

3 : The nurse is caring for a client with hyperthyroidism. The nurse should include the following in the plan of care :

4 : A nurse is caring for a client who had a total thyroidectomy and a serum calcium level of 7.6 mg/dL. (range 8.5-10.5) Which of the following findings should the nurse expect?

5 : A client has been diagnosed with pyelonephritis. Based on the client's medical history, which disorder is a risk factor for developing pyelonephritis

6 : Which statement by a female client would indicate that she is at the highest risk for a recurrence of cystitis

7 : A nurse provides dietary teaching to a client with a history of recurring kidney stones. Which of the following instructions should the nurse include in the teaching?

8 : A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client?

9 : The client is scheduled for an intravenous pyelogram (IVP). The contrast will be needed to determine the location of the renal calculi. Which action would be the most important for the nurse to include in pre-test preparation?

10 : The client diagnosed with osteoarthritis (OA) is prescribed a nonsteroidal anti-inflammatory drug (NSAID) by mouth. Which instruction should the nurse teach the client?

1 :
A nurse assessed a client immediately after thyroidectomy and asked the client to say "hello." The client moves the lips but is not able to speak the word. What should the nurse do next?

2 :
A client is being evaluated for hypothyroidism. To plan care, the nurse should ask the client which sign or symptom?

3 :
The nurse is caring for a client with hyperthyroidism. The nurse should include the following in the plan of care :

4 :
A nurse is caring for a client who had a total thyroidectomy and a serum calcium level of 7.6 mg/dL. (range 8.5-10.5) Which of the following findings should the nurse expect?

5 :
A client has been diagnosed with pyelonephritis. Based on the client's medical history, which disorder is a risk factor for developing pyelonephritis

6 :
Which statement by a female client would indicate that she is at the highest risk for a recurrence of cystitis

7 :
A nurse provides dietary teaching to a client with a history of recurring kidney stones. Which of the following instructions should the nurse include in the teaching?

8 :
A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client?

9 :
The client is scheduled for an intravenous pyelogram (IVP). The contrast will be needed to determine the location of the renal calculi. Which action would be the most important for the nurse to include in pre-test preparation?

10 :
The client diagnosed with osteoarthritis (OA) is prescribed a nonsteroidal anti-inflammatory drug (NSAID) by mouth. Which instruction should the nurse teach the client?