Nursing Elites

1. During preoperative teaching for a female client undergoing subtotal thyroidectomy, which statement should the nurse include?

• A. The head of your bed must remain flat for 24 hours after surgery.
• B. You should avoid deep breathing and coughing after surgery.
• C. You won't be able to swallow for the first day or two.
• D. You must avoid hyperextending your neck after surgery.

Correct answer: D

Rationale: The correct answer is D. Instructing the client to avoid hyperextending the neck after thyroid surgery is crucial to prevent stress on the surgical site and reduce the risk of complications such as strain on the incision or damage to the healing tissues. Choices A, B, and C are incorrect because: A) Keeping the head of the bed flat for 24 hours is not necessary after a thyroidectomy; elevation of the head of the bed can actually help reduce swelling and improve comfort. B) Encouraging deep breathing and coughing after surgery is essential to prevent respiratory complications such as pneumonia, so this advice is incorrect. C) Difficulty swallowing after thyroid surgery is not a typical outcome, so this statement is inaccurate and should not be included in the preoperative teaching.

2. The nurse is caring for a client with hypothyroidism. Which of the following clinical findings should the nurse expect?

• A. Tachycardia
• B. Weight loss
• C. Cold intolerance
• D. Diaphoresis

Correct answer: C

Rationale: Cold intolerance is a classic symptom of hypothyroidism. In hypothyroidism, the body's metabolic rate is decreased, leading to a decreased ability to regulate body temperature. This results in a feeling of being cold most of the time. Tachycardia (Choice A) is more commonly associated with hyperthyroidism, not hypothyroidism. Weight loss (Choice B) and diaphoresis (Choice D) are also more characteristic of hyperthyroidism, where there is an increased metabolic rate and excess heat production.

3. A client with hyperaldosteronism is at risk for which of the following electrolyte imbalances?

• A. Hyperkalemia
• B. Hyponatremia
• C. Hypokalemia
• D. Hypercalcemia

Correct answer: C

Rationale: In hyperaldosteronism, there is an excessive secretion of aldosterone, a hormone that promotes potassium excretion in the kidneys. This leads to low potassium levels in the blood, known as hypokalemia. Therefore, the correct answer is hypokalemia (Choice C). Hyperkalemia (Choice A) is the opposite condition, where there is high potassium levels in the blood and is not typically associated with hyperaldosteronism. Hyponatremia (Choice B) is a low sodium level, which is not directly related to aldosterone function. Hypercalcemia (Choice D) is an elevated calcium level and is not typically a direct result of hyperaldosteronism.

4. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

• A. Hypocalcemia
• B. Hypercalcemia
• C. Hypokalemia
• D. Hyperkalemia

Correct answer: A

Rationale: Chvostek's and Trousseau's signs are clinical manifestations that suggest hypocalcemia, a common complication following thyroidectomy. Chvostek's sign is elicited by tapping the facial nerve, resulting in facial muscle contraction, while Trousseau's sign is provoked by inflating a blood pressure cuff, leading to carpal spasm. Both signs are indicative of low calcium levels in the blood. Therefore, options B, C, and D are incorrect as they do not correlate with the signs specifically associated with hypocalcemia.

5. A healthcare provider caring for a client with severe malnutrition reviews the laboratory results and notes a magnesium level of 1.0 mg/dL. Which electrocardiographic change would the healthcare provider expect to note based on the magnesium level?

• A. Prominent U waves
• B. Prolonged PR interval
• C. Depressed ST segment
• D. Widened QRS complexes

Correct answer: C

Rationale: A magnesium level of 1.0 mg/dL can cause a depressed ST segment on the ECG. Magnesium deficiency commonly leads to ST segment depression on an electrocardiogram. Prominent U waves are associated with hypokalemia, prolonged PR interval is seen in conditions like first-degree heart block, and widened QRS complexes are typically related to conditions affecting the conduction system of the heart, such as bundle branch blocks.

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