NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems
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Free NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems Questions
1.
The nurse has received a change-of-shift report about these patients with COPD. Which patient would the nurse assess first?
- A A patient with peripheral edema
- B A patient who has a cough productive of thick, green mucus
- C A patient with a capillary refill greater than 3 seconds
- D A patient with a respiratory rate of 38
Explanation
Explanation
A respiratory rate of 38 indicates severe tachypnea and possible acute respiratory distress. In COPD, this could signal worsening hypoxemia, hypercapnia, or impending respiratory failure. This patient requires immediate assessment and intervention to maintain airway and breathing, as airway and oxygenation are the top priorities in the ABCs of emergency care.
Correct Answer Is:
A patient with a respiratory rate of 38
Why the other options are incorrect:
A patient with peripheral edema
Edema indicates possible right-sided heart failure (cor pulmonale) but is a chronic complication and not immediately life-threatening compared to acute respiratory distress.
A patient who has a cough productive of thick, green mucus
This suggests a respiratory infection and needs attention but does not indicate an immediate airway emergency like severe tachypnea.
A patient with a capillary refill greater than 3 seconds
Delayed capillary refill signals poor perfusion, but it is not as immediately life-threatening as signs of acute respiratory failure in COPD.
A respiratory rate of 38 indicates severe tachypnea and possible acute respiratory distress. In COPD, this could signal worsening hypoxemia, hypercapnia, or impending respiratory failure. This patient requires immediate assessment and intervention to maintain airway and breathing, as airway and oxygenation are the top priorities in the ABCs of emergency care.
Correct Answer Is:
A patient with a respiratory rate of 38
Why the other options are incorrect:
A patient with peripheral edema
Edema indicates possible right-sided heart failure (cor pulmonale) but is a chronic complication and not immediately life-threatening compared to acute respiratory distress.
A patient who has a cough productive of thick, green mucus
This suggests a respiratory infection and needs attention but does not indicate an immediate airway emergency like severe tachypnea.
A patient with a capillary refill greater than 3 seconds
Delayed capillary refill signals poor perfusion, but it is not as immediately life-threatening as signs of acute respiratory failure in COPD.
2.
Which of the following nursing actions and patient education points are appropriate regarding leukotriene receptor antagonists? Select each response as appropriate or not appropriate.
- Utilize a spacer when taking this medication
- Teach patient to rinse their mouth after taking this medication
- Use for acute asthma attacks
- Teach patient that it helps reduce inflammation
- Administer medication in the morning
- Reinforce daily use even when asymptomatic
Explanation
Explanation
Teach patient that it helps reduce inflammation – Appropriate
Leukotriene receptor antagonists block leukotrienes, which cause airway inflammation, bronchoconstriction, and mucus production.
Reinforce daily use even when asymptomatic – Appropriate
These medications are for long-term control and prevention, so they should be taken daily, even when the patient feels well, to maintain airway stability.
Correct Answer Is:
Teach patient that it helps reduce inflammation
Reinforce daily use even when asymptomatic
Why the other options are incorrect:
Utilize a spacer when taking this medication – Not Appropriate
Leukotriene receptor antagonists (e.g., montelukast) are oral medications, not inhaled, so a spacer is not needed.
Teach patient to rinse their mouth after taking this medication – Not Appropriate
Rinsing the mouth is important after inhaled corticosteroids to prevent oral thrush, but it is not required for oral leukotriene receptor antagonists.
Use for acute asthma attacks – Not Appropriate
These medications are maintenance therapy for prevention of asthma symptoms, not for relief of acute bronchospasm.
Administer medication in the morning – Not Appropriate
They are typically administered in the evening, as leukotrienes are released more during the night, and this timing improves efficacy in preventing nocturnal asthma symptoms.
Teach patient that it helps reduce inflammation – Appropriate
Leukotriene receptor antagonists block leukotrienes, which cause airway inflammation, bronchoconstriction, and mucus production.
Reinforce daily use even when asymptomatic – Appropriate
These medications are for long-term control and prevention, so they should be taken daily, even when the patient feels well, to maintain airway stability.
Correct Answer Is:
Teach patient that it helps reduce inflammation
Reinforce daily use even when asymptomatic
Why the other options are incorrect:
Utilize a spacer when taking this medication – Not Appropriate
Leukotriene receptor antagonists (e.g., montelukast) are oral medications, not inhaled, so a spacer is not needed.
Teach patient to rinse their mouth after taking this medication – Not Appropriate
Rinsing the mouth is important after inhaled corticosteroids to prevent oral thrush, but it is not required for oral leukotriene receptor antagonists.
Use for acute asthma attacks – Not Appropriate
These medications are maintenance therapy for prevention of asthma symptoms, not for relief of acute bronchospasm.
Administer medication in the morning – Not Appropriate
They are typically administered in the evening, as leukotrienes are released more during the night, and this timing improves efficacy in preventing nocturnal asthma symptoms.
3.
A nurse is caring for a patient 4 hours after a thyroidectomy. Which assessment finding requires immediate intervention?
- A Hoarseness
- B Oxygen saturation of 95%
- C Neck swelling and stridor
- D Pain at the incision site
Explanation
Explanation
Neck swelling with stridor indicates acute airway obstruction, possibly from hemorrhage or swelling compressing the trachea. This is a medical emergency that can rapidly progress to respiratory arrest. Immediate intervention, such as notifying the provider and preparing for airway management, is required.
Correct Answer Is:
Neck swelling and stridor
Why the other options are incorrect:
Hoarseness
Mild hoarseness can occur after thyroidectomy due to recurrent laryngeal nerve irritation or intubation. It should be monitored, but it is not immediately life-threatening unless accompanied by respiratory distress.
Oxygen saturation of 95%
An oxygen saturation of 95% is generally acceptable postoperatively, especially if the patient is stable and not showing other signs of distress. It requires observation but not urgent intervention.
Pain at the incision site
Mild to moderate pain is expected after surgery and can be managed with analgesics. While discomfort should be addressed, it does not indicate an immediate threat to the patient’s airway or circulation.
Neck swelling with stridor indicates acute airway obstruction, possibly from hemorrhage or swelling compressing the trachea. This is a medical emergency that can rapidly progress to respiratory arrest. Immediate intervention, such as notifying the provider and preparing for airway management, is required.
Correct Answer Is:
Neck swelling and stridor
Why the other options are incorrect:
Hoarseness
Mild hoarseness can occur after thyroidectomy due to recurrent laryngeal nerve irritation or intubation. It should be monitored, but it is not immediately life-threatening unless accompanied by respiratory distress.
Oxygen saturation of 95%
An oxygen saturation of 95% is generally acceptable postoperatively, especially if the patient is stable and not showing other signs of distress. It requires observation but not urgent intervention.
Pain at the incision site
Mild to moderate pain is expected after surgery and can be managed with analgesics. While discomfort should be addressed, it does not indicate an immediate threat to the patient’s airway or circulation.
4.
A nurse received an order to administer a tetanus vaccine to a patient who sustained a foot wound from a nail. The nurse is aware that this vaccine will cause the patient to develop which type of immunity?
- A Active natural
- B Passive natural
- C Active artificial
- D Passive artificial
Explanation
Explanation
A tetanus vaccine stimulates the body’s immune system to produce antibodies and memory cells against the tetanus toxin without causing disease. Because the immunity is acquired through intentional exposure to an antigen via vaccination, it is considered active artificial immunity. Protection develops over time and is long-lasting.
Correct Answer Is:
Active artificial
Why the other options are incorrect:
Active natural
This occurs when immunity develops after direct exposure to a pathogen through natural infection, such as chickenpox after contact with an infected person—not through vaccination.
Passive natural
This occurs when antibodies are transferred naturally from mother to child, either through the placenta (IgG) or breast milk (IgA). It does not involve vaccines.
Passive artificial
This involves giving preformed antibodies, such as immune globulin injections, for immediate but short-term protection—not stimulating the body to make its own antibodies.
A tetanus vaccine stimulates the body’s immune system to produce antibodies and memory cells against the tetanus toxin without causing disease. Because the immunity is acquired through intentional exposure to an antigen via vaccination, it is considered active artificial immunity. Protection develops over time and is long-lasting.
Correct Answer Is:
Active artificial
Why the other options are incorrect:
Active natural
This occurs when immunity develops after direct exposure to a pathogen through natural infection, such as chickenpox after contact with an infected person—not through vaccination.
Passive natural
This occurs when antibodies are transferred naturally from mother to child, either through the placenta (IgG) or breast milk (IgA). It does not involve vaccines.
Passive artificial
This involves giving preformed antibodies, such as immune globulin injections, for immediate but short-term protection—not stimulating the body to make its own antibodies.
5.
During the review of a patient’s vaccine record, the nurse identifies that the varicella vaccine was never administered. After further investigation, it was determined the patient had chickenpox as a child. This type of exposure leads to what type of immune response?
- A Innate immunity.
- B Artificial immunity.
- C Acquired immunity.
- D Passive immunity.
Explanation
Explanation
Having chickenpox as a child provided the patient with active acquired immunity. The immune system responded to the infection by producing antibodies and memory cells specific to the varicella-zoster virus. This protection is long-lasting and develops after direct exposure to the pathogen.
Correct Answer Is:
Acquired immunity
Why the other options are incorrect:
Innate immunity
Innate immunity is the body’s immediate, non-specific defense (e.g., skin barrier, phagocytes) and does not involve long-term, pathogen-specific memory.
Artificial immunity
Artificial immunity is acquired through medical intervention, such as vaccines or immune globulin—not from natural infection.
Passive immunity
Passive immunity involves receiving antibodies from another source, such as maternal antibodies through the placenta or immune globulin injections, and does not produce long-term protection.
Having chickenpox as a child provided the patient with active acquired immunity. The immune system responded to the infection by producing antibodies and memory cells specific to the varicella-zoster virus. This protection is long-lasting and develops after direct exposure to the pathogen.
Correct Answer Is:
Acquired immunity
Why the other options are incorrect:
Innate immunity
Innate immunity is the body’s immediate, non-specific defense (e.g., skin barrier, phagocytes) and does not involve long-term, pathogen-specific memory.
Artificial immunity
Artificial immunity is acquired through medical intervention, such as vaccines or immune globulin—not from natural infection.
Passive immunity
Passive immunity involves receiving antibodies from another source, such as maternal antibodies through the placenta or immune globulin injections, and does not produce long-term protection.
6.
A 45-year-old patient arrives in the ED with facial swelling, tongue protrusion, and difficulty swallowing after taking an ACE inhibitor. Which nursing intervention is the highest priority?
- A Administer diphenhydramine 50 mg IV
- B Place patient in a high Fowler's position
- C Prepare for possible intubation
- D Apply a cool compress to swollen areas
Explanation
Explanation
This patient is experiencing angioedema, a potentially life-threatening reaction associated with ACE inhibitors. Swelling of the face, tongue, and airway structures can rapidly progress to complete airway obstruction. The highest priority is maintaining a patent airway, and preparing for intubation (or emergency airway management) is essential before swelling worsens.
Correct Answer Is:
Prepare for possible intubation
Why the other options are incorrect:
Administer diphenhydramine 50 mg IV
While antihistamines may help reduce swelling, they do not act quickly enough to secure the airway in an emergency. Airway management takes precedence.
Place patient in a high Fowler's position
This can aid breathing but does not address the imminent threat of airway closure. It is supportive, not the primary life-saving intervention.
Apply a cool compress to swollen areas
This may provide comfort but does not address the airway compromise, which is the critical concern in angioedema.
This patient is experiencing angioedema, a potentially life-threatening reaction associated with ACE inhibitors. Swelling of the face, tongue, and airway structures can rapidly progress to complete airway obstruction. The highest priority is maintaining a patent airway, and preparing for intubation (or emergency airway management) is essential before swelling worsens.
Correct Answer Is:
Prepare for possible intubation
Why the other options are incorrect:
Administer diphenhydramine 50 mg IV
While antihistamines may help reduce swelling, they do not act quickly enough to secure the airway in an emergency. Airway management takes precedence.
Place patient in a high Fowler's position
This can aid breathing but does not address the imminent threat of airway closure. It is supportive, not the primary life-saving intervention.
Apply a cool compress to swollen areas
This may provide comfort but does not address the airway compromise, which is the critical concern in angioedema.
7.
A patient presents with a severe asthma exacerbation. The nurse is aware the highest priority for care includes which goal?
- A Avoiding dehydration and exhaustion.
- B Correcting hypoxemia and improving ventilation.
- C Managing hypertension and sinus tachycardia.
- D Reducing inflammation and avoiding triggers.
Explanation
Explanation
In a severe asthma attack, airway narrowing and bronchospasm impair oxygen exchange. The immediate priority is to restore adequate oxygenation and ventilation to prevent respiratory failure. This involves administering supplemental oxygen, using rapid-acting bronchodilators, and closely monitoring respiratory status to ensure effective gas exchange.
Correct Answer Is:
Correcting hypoxemia and improving ventilation
Why the other options are incorrect:
Avoiding dehydration and exhaustion
While important for overall patient stability, these are not the immediate life-saving priorities during a severe asthma attack.
Managing hypertension and sinus tachycardia
These may be side effects of medications or stress but are secondary concerns once oxygenation is stabilized.
Reducing inflammation and avoiding triggers
These are key long-term management strategies, but in the acute setting, restoring oxygen and ventilation is the top priority.
In a severe asthma attack, airway narrowing and bronchospasm impair oxygen exchange. The immediate priority is to restore adequate oxygenation and ventilation to prevent respiratory failure. This involves administering supplemental oxygen, using rapid-acting bronchodilators, and closely monitoring respiratory status to ensure effective gas exchange.
Correct Answer Is:
Correcting hypoxemia and improving ventilation
Why the other options are incorrect:
Avoiding dehydration and exhaustion
While important for overall patient stability, these are not the immediate life-saving priorities during a severe asthma attack.
Managing hypertension and sinus tachycardia
These may be side effects of medications or stress but are secondary concerns once oxygenation is stabilized.
Reducing inflammation and avoiding triggers
These are key long-term management strategies, but in the acute setting, restoring oxygen and ventilation is the top priority.
8.
During cardiopulmonary rehabilitation for a patient with COPD, the nurse teaches the patient how to perform pursed-lip breathing. This technique is used primarily for which benefit?
- A Prevents typically moist mucosa from drying out so shrinks airways.
- B Keeps airways open longer increasing oxygenation.
- C Increases respiratory muscle strength causing fatigue.
- D Promotes relaxation of abdominal muscles and all membranes.
Explanation
Explanation
Pursed-lip breathing slows exhalation and creates back pressure in the airways, preventing premature airway collapse. This helps improve gas exchange, increase oxygenation, and reduce the feeling of breathlessness in patients with COPD. It also promotes better control over breathing patterns.
Correct Answer Is:
Keeps airways open longer increasing oxygenation.
Why the other options are incorrect:
Prevents typically moist mucosa from drying out so shrinks airways
Pursed-lip breathing does not function to moisturize or dry the airway mucosa.
Increases respiratory muscle strength causing fatigue
This technique is not primarily for muscle strengthening and should not cause fatigue when done correctly.
Promotes relaxation of abdominal muscles and all membranes
While it may reduce anxiety and promote relaxation, its main purpose is to improve oxygenation by keeping airways open longer.
Pursed-lip breathing slows exhalation and creates back pressure in the airways, preventing premature airway collapse. This helps improve gas exchange, increase oxygenation, and reduce the feeling of breathlessness in patients with COPD. It also promotes better control over breathing patterns.
Correct Answer Is:
Keeps airways open longer increasing oxygenation.
Why the other options are incorrect:
Prevents typically moist mucosa from drying out so shrinks airways
Pursed-lip breathing does not function to moisturize or dry the airway mucosa.
Increases respiratory muscle strength causing fatigue
This technique is not primarily for muscle strengthening and should not cause fatigue when done correctly.
Promotes relaxation of abdominal muscles and all membranes
While it may reduce anxiety and promote relaxation, its main purpose is to improve oxygenation by keeping airways open longer.
9.
Which symptom should the nurse monitor in a patient with hypoparathyroidism?
- A Increased deep tendon reflexes
- B Hypercalcemia
- C Tetany and muscle cramps
- D Hypotension and bradycardia
Explanation
Explanation
Hypoparathyroidism leads to decreased secretion of parathyroid hormone (PTH), resulting in hypocalcemia. Low calcium levels increase neuromuscular excitability, causing tetany, muscle cramps, tingling in the extremities, and possible positive Chvostek’s and Trousseau’s signs. Monitoring for these symptoms helps detect worsening hypocalcemia early and prevent complications such as laryngospasm or seizures.
Correct Answer Is:
Tetany and muscle cramps
Why the other options are incorrect:
Increased deep tendon reflexes
While hypocalcemia can cause hyperreflexia, tetany and muscle cramps are more significant and specific early signs to monitor in hypoparathyroidism.
Hypercalcemia
Hypoparathyroidism causes low calcium levels, not high. Hypercalcemia is more likely in hyperparathyroidism.
Hypotension and bradycardia
These may occur in severe electrolyte imbalances but are not the primary or most characteristic signs of hypoparathyroidism.
Hypoparathyroidism leads to decreased secretion of parathyroid hormone (PTH), resulting in hypocalcemia. Low calcium levels increase neuromuscular excitability, causing tetany, muscle cramps, tingling in the extremities, and possible positive Chvostek’s and Trousseau’s signs. Monitoring for these symptoms helps detect worsening hypocalcemia early and prevent complications such as laryngospasm or seizures.
Correct Answer Is:
Tetany and muscle cramps
Why the other options are incorrect:
Increased deep tendon reflexes
While hypocalcemia can cause hyperreflexia, tetany and muscle cramps are more significant and specific early signs to monitor in hypoparathyroidism.
Hypercalcemia
Hypoparathyroidism causes low calcium levels, not high. Hypercalcemia is more likely in hyperparathyroidism.
Hypotension and bradycardia
These may occur in severe electrolyte imbalances but are not the primary or most characteristic signs of hypoparathyroidism.
10.
A patient with chronic bronchitis who has a new prescription for fluticasone and albuterol asks the nurse the purpose of using two drugs. What is the most appropriate explanation?
- A The two drugs work together to block the effects of histamine on the bronchioles.
- B The combination of two drugs works more quickly in an acute asthma attack.
- C The two drugs are a combination of long-acting and slow-acting bronchodilators.
- D One drug decreases inflammation, and the other is a bronchodilator.
Explanation
Explanation
Fluticasone is an inhaled corticosteroid that decreases airway inflammation and mucus production, improving long-term control of chronic bronchitis and other obstructive airway diseases. Albuterol is a short-acting beta2 agonist (SABA) that quickly relaxes bronchial smooth muscle, providing rapid relief of bronchospasm. Using both addresses two key problems in chronic bronchitis: airway inflammation and bronchoconstriction.
Correct Answer Is:
One drug decreases inflammation, and the other is a bronchodilator.
Why the other options are incorrect:
The two drugs work together to block the effects of histamine on the bronchioles
This describes antihistamines, not corticosteroids or beta2 agonists.
The combination of two drugs works more quickly in an acute asthma attack
Fluticasone is not a rescue medication; it works over time to reduce inflammation, so it is not intended for acute symptom relief.
The two drugs are a combination of long-acting and slow-acting bronchodilators
Fluticasone is not a bronchodilator at all, so this statement is incorrect.
Fluticasone is an inhaled corticosteroid that decreases airway inflammation and mucus production, improving long-term control of chronic bronchitis and other obstructive airway diseases. Albuterol is a short-acting beta2 agonist (SABA) that quickly relaxes bronchial smooth muscle, providing rapid relief of bronchospasm. Using both addresses two key problems in chronic bronchitis: airway inflammation and bronchoconstriction.
Correct Answer Is:
One drug decreases inflammation, and the other is a bronchodilator.
Why the other options are incorrect:
The two drugs work together to block the effects of histamine on the bronchioles
This describes antihistamines, not corticosteroids or beta2 agonists.
The combination of two drugs works more quickly in an acute asthma attack
Fluticasone is not a rescue medication; it works over time to reduce inflammation, so it is not intended for acute symptom relief.
The two drugs are a combination of long-acting and slow-acting bronchodilators
Fluticasone is not a bronchodilator at all, so this statement is incorrect.
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