Excelsior NUR 212 Practice Exam

1. A nurse is assessing a client who is experiencing a thyroid storm. Which of the following findings should the nurse anticipate?

• A. Tachycardia
• B. Coma
• C. Hypothermia
• D. Fruity smelling breath

Answer: A and B. Thyroid storm causes a hypermetabolic state with tachycardia, hyperthermia (not hypothermia), agitation, and, in severe or untreated cases, progression to coma; fruity-smelling breath is instead associated with diabetic ketoacidosis.

2. Classify each finding as consistent with Graves' Disease or Myxedema:

• Nonpitting edema with thinning hair → Myxedema
• 10 lb weight loss in a month with a fine hand tremor → Graves' Disease
• Anxious, irritable, skin moist and warm → Graves' Disease
• Heart rate 54, constipation, poor appetite → Myxedema

Why: Graves' disease (hyperthyroidism) produces a hypermetabolic picture — weight loss, tremor, anxiety, warm/moist skin, tachycardia — while myxedema (severe hypothyroidism) produces the opposite: nonpitting edema, hair thinning, bradycardia, constipation, and poor appetite.

3. A client with hypothyroidism is prescribed levothyroxine. Which instruction should the nurse include?

• A. "Take this medication with high-protein foods."
• B. "Take this medication during your morning meal."
• C. "Take this medication with a full glass of water or fruit juice."
• D. "Take this medication before a meal or several hours after a meal."

Answer: D. Levothyroxine is best absorbed on an empty stomach, so it should be taken before a meal or several hours after eating; taking it with food (especially high-protein or calcium-rich foods) can interfere with absorption.

4. A nurse is reviewing labs for a client who has acute pancreatitis. The nurse should expect elevation of which value?

• A. Magnesium
• B. Amylase
• C. Calcium
• D. RBC count

Answer: B. Elevated serum amylase (along with lipase) is a hallmark laboratory finding in acute pancreatitis, reflecting pancreatic inflammation and enzyme release.

5. Following surgical removal of the thyroid and parathyroid gland, which 2 findings require immediate follow-up?

• A. Hand tremors
• B. Foot cramps
• C. Increased appetite
• D. Dizziness

Answer: A and B. Hand tremors and foot cramps are signs of hypocalcemia/tetany, a known complication after parathyroid removal or injury during thyroid surgery, and require immediate follow-up; increased appetite and dizziness are less specific and less urgent in this context.

6. A client is 1 day post-op from a subtotal thyroidectomy and reports tingling in the hands, soles of the feet, and around the lips. For which finding should the nurse assess?

• A. Chvostek's sign
• B. Babinski's sign
• C. Kernig's sign
• D. Brudzinski's sign

Answer: A. Perioral and extremity tingling after thyroid surgery suggests hypocalcemia from parathyroid gland disturbance; Chvostek's sign (facial twitching upon tapping the facial nerve) is the classic assessment for hypocalcemia/tetany in this context.