NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems
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Free NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems Questions
1.
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.
2.
The nurse is admitting a patient with complaints of palpitations, excessive sweating, and the inability to tolerate heat. She also voices concerns that her appearance has changed over the past year stating, "My eyes look so big." The nurse knows that these signs and symptoms are most indicative of which of the following disorders?
- A Graves' Disease
- B Deficiency of iodine consumption
- C Thyroiditis
- D Hypothyroidism
Explanation
Explanation
Graves’ disease is an autoimmune disorder that causes hyperthyroidism. Classic symptoms include heat intolerance, palpitations, excessive sweating, weight loss, and anxiety due to increased metabolic rate. The hallmark sign is exophthalmos (bulging eyes), caused by autoimmune-mediated inflammation of the eye tissues.
Correct Answer Is:
Graves' Disease
Why the other options are incorrect:
Deficiency of iodine consumption
Iodine deficiency can lead to hypothyroidism and goiter, not hyperthyroidism with exophthalmos.
Thyroiditis
Thyroid inflammation can cause temporary hyperthyroidism but typically does not cause exophthalmos, which is specific to Graves’ disease.
Hypothyroidism
Characterized by fatigue, weight gain, cold intolerance, and bradycardia—not palpitations, heat intolerance, or bulging eyes.
Graves’ disease is an autoimmune disorder that causes hyperthyroidism. Classic symptoms include heat intolerance, palpitations, excessive sweating, weight loss, and anxiety due to increased metabolic rate. The hallmark sign is exophthalmos (bulging eyes), caused by autoimmune-mediated inflammation of the eye tissues.
Correct Answer Is:
Graves' Disease
Why the other options are incorrect:
Deficiency of iodine consumption
Iodine deficiency can lead to hypothyroidism and goiter, not hyperthyroidism with exophthalmos.
Thyroiditis
Thyroid inflammation can cause temporary hyperthyroidism but typically does not cause exophthalmos, which is specific to Graves’ disease.
Hypothyroidism
Characterized by fatigue, weight gain, cold intolerance, and bradycardia—not palpitations, heat intolerance, or bulging eyes.
3.
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.
4.
A nurse is caring for a patient who has just undergone a total thyroidectomy. Which explanation best describes the reason the nurse will monitor for signs of hypocalcemia?
- A The thyroid gland regulates calcium directly through calcitonin secretion
- B The parathyroid glands may have been inadvertently removed or damaged during surgery
- C Calcium absorption is impaired due to decreased thyroid hormone levels
- D Postoperative immobility leads to calcium redistribution from bones
Explanation
Explanation
The parathyroid glands, located behind the thyroid, regulate calcium levels by secreting parathyroid hormone (PTH). During a total thyroidectomy, these small glands can be accidentally removed or their blood supply disrupted, leading to decreased PTH secretion and resulting hypocalcemia. Monitoring for signs such as muscle cramps, tingling, or positive Chvostek’s/Trousseau’s signs is essential for early detection and treatment.
Correct Answer Is:
The parathyroid glands may have been inadvertently removed or damaged during surgery
Why the other options are incorrect:
The thyroid gland regulates calcium directly through calcitonin secretion
Although the thyroid secretes calcitonin, which lowers blood calcium, its role in calcium regulation is minor compared to PTH. Loss of calcitonin alone does not cause significant hypocalcemia.
Calcium absorption is impaired due to decreased thyroid hormone levels
Thyroid hormones primarily regulate metabolism, not calcium absorption. Calcium absorption is largely dependent on vitamin D status and parathyroid hormone activity, not thyroid hormone levels.
Postoperative immobility leads to calcium redistribution from bones
Immobility can cause calcium loss from bones over time, but this leads to hypercalcemia, not hypocalcemia, and is not an acute postoperative concern following thyroidectomy.
The parathyroid glands, located behind the thyroid, regulate calcium levels by secreting parathyroid hormone (PTH). During a total thyroidectomy, these small glands can be accidentally removed or their blood supply disrupted, leading to decreased PTH secretion and resulting hypocalcemia. Monitoring for signs such as muscle cramps, tingling, or positive Chvostek’s/Trousseau’s signs is essential for early detection and treatment.
Correct Answer Is:
The parathyroid glands may have been inadvertently removed or damaged during surgery
Why the other options are incorrect:
The thyroid gland regulates calcium directly through calcitonin secretion
Although the thyroid secretes calcitonin, which lowers blood calcium, its role in calcium regulation is minor compared to PTH. Loss of calcitonin alone does not cause significant hypocalcemia.
Calcium absorption is impaired due to decreased thyroid hormone levels
Thyroid hormones primarily regulate metabolism, not calcium absorption. Calcium absorption is largely dependent on vitamin D status and parathyroid hormone activity, not thyroid hormone levels.
Postoperative immobility leads to calcium redistribution from bones
Immobility can cause calcium loss from bones over time, but this leads to hypercalcemia, not hypocalcemia, and is not an acute postoperative concern following thyroidectomy.
5.
A patient diagnosed with COPD with a long smoking history. Which statement by the patient indicates effective teaching about this respiratory disease process?
- "Infection and inflammation are responsible for lung damage."
- "COPD is a result of air trapped in sacs in my lungs."
- "There is swelling in my airways."
- "I know this disease is caused by a lot of mucus in my lungs."
Explanation
Explanation
COPD is driven primarily by chronic airway inflammation from long-term exposure to noxious particles (most commonly cigarette smoke). This inflammation causes airway wall edema, narrowing, and remodeling, which increase airflow resistance and make exhalation difficult. Mucus hypersecretion and, in many patients, emphysematous destruction with air-trapping also occur, but the central pathologic process is persistent airway inflammation (“swelling in my airways”). Recognizing inflammation as the core mechanism reflects accurate understanding of COPD.
Correct Answer Is:
There is swelling in my airways.
Why the other options are incorrect:
"Infection and inflammation are responsible for lung damage."
Infections frequently trigger exacerbations and can worsen lung function, but they are not the primary cause of COPD. The disease arises from chronic inflammation due to inhaled irritants (e.g., tobacco smoke), not from recurrent infections themselves.
"COPD is a result of air trapped in sacs in my lungs."
Air-trapping (from loss of elastic recoil and small-airway collapse in emphysema) is common, but COPD is broader than emphysema alone. Limiting the explanation to air-trapping overlooks the central, ever-present airway inflammation and narrowing that define COPD—even in patients without marked emphysema.
"I know this disease is caused by a lot of mucus in my lungs."
Excess mucus (chronic bronchitis phenotype) contributes to symptoms and airflow obstruction, but COPD is not “caused” by mucus alone. It results from chronic inflammatory injury with airway remodeling; mucus hypersecretion is one component rather than the root cause.
COPD is driven primarily by chronic airway inflammation from long-term exposure to noxious particles (most commonly cigarette smoke). This inflammation causes airway wall edema, narrowing, and remodeling, which increase airflow resistance and make exhalation difficult. Mucus hypersecretion and, in many patients, emphysematous destruction with air-trapping also occur, but the central pathologic process is persistent airway inflammation (“swelling in my airways”). Recognizing inflammation as the core mechanism reflects accurate understanding of COPD.
Correct Answer Is:
There is swelling in my airways.
Why the other options are incorrect:
"Infection and inflammation are responsible for lung damage."
Infections frequently trigger exacerbations and can worsen lung function, but they are not the primary cause of COPD. The disease arises from chronic inflammation due to inhaled irritants (e.g., tobacco smoke), not from recurrent infections themselves.
"COPD is a result of air trapped in sacs in my lungs."
Air-trapping (from loss of elastic recoil and small-airway collapse in emphysema) is common, but COPD is broader than emphysema alone. Limiting the explanation to air-trapping overlooks the central, ever-present airway inflammation and narrowing that define COPD—even in patients without marked emphysema.
"I know this disease is caused by a lot of mucus in my lungs."
Excess mucus (chronic bronchitis phenotype) contributes to symptoms and airflow obstruction, but COPD is not “caused” by mucus alone. It results from chronic inflammatory injury with airway remodeling; mucus hypersecretion is one component rather than the root cause.
6.
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.
7.
A patient calls the respiratory clinic and states their current peak flow meter is 220 L/min. The patient reports their personal best is 450 L/min. Based on this information, what nursing action is the most appropriate to instruct the patient?
- A Seek emergency care
- B Encourage patient to repeat the test in 2 hours
- C Instruct to take prescribed antihistamines
- D Explore reasons why a change was noted
Explanation
Explanation
A peak flow reading of 220 L/min when the patient’s personal best is 450 L/min is less than 50% of their personal best, placing them in the red zone. This indicates severe airway narrowing and requires immediate emergency intervention, such as using a rescue inhaler and seeking urgent medical care to prevent respiratory failure.
Correct Answer Is:
Seek emergency care
Why the other options are incorrect:
Encourage patient to repeat the test in 2 hours
Delaying action can lead to worsening respiratory distress. Immediate treatment is needed, not observation.
Instruct to take prescribed antihistamines
Antihistamines are not appropriate for acute asthma exacerbations or severe airway obstruction; a bronchodilator is needed immediately.
Explore reasons why a change was noted
While identifying triggers is important for long-term management, it is not the priority during a severe drop in peak flow. Immediate intervention takes precedence over assessment in this scenario.
A peak flow reading of 220 L/min when the patient’s personal best is 450 L/min is less than 50% of their personal best, placing them in the red zone. This indicates severe airway narrowing and requires immediate emergency intervention, such as using a rescue inhaler and seeking urgent medical care to prevent respiratory failure.
Correct Answer Is:
Seek emergency care
Why the other options are incorrect:
Encourage patient to repeat the test in 2 hours
Delaying action can lead to worsening respiratory distress. Immediate treatment is needed, not observation.
Instruct to take prescribed antihistamines
Antihistamines are not appropriate for acute asthma exacerbations or severe airway obstruction; a bronchodilator is needed immediately.
Explore reasons why a change was noted
While identifying triggers is important for long-term management, it is not the priority during a severe drop in peak flow. Immediate intervention takes precedence over assessment in this scenario.
8.
A patient is prescribed an epinephrine auto-injector pen for a severe allergy. What instructions should the nurse provide? (SELECT ALL THAT APPLY)
- A "Call 911 immediately after using the injector"
- B "Inject into the outer thigh and hold for 10 seconds"
- C "Store the injector at room temperature and check the expiration date."
- D "Massage the injection site vigorously after administration."
- E "You may need a second dose if symptoms do not improve."
Explanation
Explanation
Call 911 immediately after using the injector
Epinephrine provides temporary relief from severe allergic reactions, but emergency medical care is still required as symptoms can return.
Inject into the outer thigh and hold for 10 seconds
The correct site for administration is the mid-outer thigh, even through clothing if necessary. Holding for 10 seconds ensures full medication delivery.
Store the injector at room temperature and check the expiration date.
Proper storage maintains drug potency, and expired injectors may not be effective during an emergency.
You may need a second dose if symptoms do not improve.
If symptoms persist or recur before emergency help arrives, a second dose can be given according to provider or manufacturer instructions.
Correct Answer Is:
"Call 911 immediately after using the injector"
"Inject into the outer thigh and hold for 10 seconds"
"Store the injector at room temperature and check the expiration date."
"You may need a second dose if symptoms do not improve."
Why the other options are incorrect:
Massage the injection site vigorously after administration
Massaging is no longer recommended as it can cause local irritation and is unnecessary for drug absorption.
Call 911 immediately after using the injector
Epinephrine provides temporary relief from severe allergic reactions, but emergency medical care is still required as symptoms can return.
Inject into the outer thigh and hold for 10 seconds
The correct site for administration is the mid-outer thigh, even through clothing if necessary. Holding for 10 seconds ensures full medication delivery.
Store the injector at room temperature and check the expiration date.
Proper storage maintains drug potency, and expired injectors may not be effective during an emergency.
You may need a second dose if symptoms do not improve.
If symptoms persist or recur before emergency help arrives, a second dose can be given according to provider or manufacturer instructions.
Correct Answer Is:
"Call 911 immediately after using the injector"
"Inject into the outer thigh and hold for 10 seconds"
"Store the injector at room temperature and check the expiration date."
"You may need a second dose if symptoms do not improve."
Why the other options are incorrect:
Massage the injection site vigorously after administration
Massaging is no longer recommended as it can cause local irritation and is unnecessary for drug absorption.
9.
A patient taking levothyroxine (Synthroid) reports palpitations and restlessness. What is the nurse's priority action?
- A Encourage the patient to drink more water
- B Administer an anti-anxiety medication
- C Instruct the patient to stop taking the medication
- D Assess the patient's heart rate and blood pressure
Explanation
Explanation
Palpitations and restlessness in a patient taking levothyroxine may indicate overreplacement or toxicity, leading to symptoms of hyperthyroidism, including tachycardia, hypertension, and arrhythmias. The priority action is to assess cardiovascular status by checking heart rate and blood pressure to determine the severity and guide further interventions. After assessment, the provider can be notified to adjust the dosage.
Correct Answer Is:
Assess the patient's heart rate and blood pressure
Why the other options are incorrect:
Encourage the patient to drink more water
Hydration will not address the underlying potential cardiovascular complication.
Administer an anti-anxiety medication
These symptoms are likely medication-related and not due to anxiety; treating the cause takes priority.
Instruct the patient to stop taking the medication
The nurse should not instruct a patient to stop a prescribed medication without provider direction; assessment comes first to provide the provider with accurate data.
Palpitations and restlessness in a patient taking levothyroxine may indicate overreplacement or toxicity, leading to symptoms of hyperthyroidism, including tachycardia, hypertension, and arrhythmias. The priority action is to assess cardiovascular status by checking heart rate and blood pressure to determine the severity and guide further interventions. After assessment, the provider can be notified to adjust the dosage.
Correct Answer Is:
Assess the patient's heart rate and blood pressure
Why the other options are incorrect:
Encourage the patient to drink more water
Hydration will not address the underlying potential cardiovascular complication.
Administer an anti-anxiety medication
These symptoms are likely medication-related and not due to anxiety; treating the cause takes priority.
Instruct the patient to stop taking the medication
The nurse should not instruct a patient to stop a prescribed medication without provider direction; assessment comes first to provide the provider with accurate data.
10.
A nurse is reviewing laboratory results of a patient who is being evaluated for primary hypothyroidism. Which of the following laboratory findings is expected for a patient who has this condition?
- A Elevated hemoglobin
- B Elevated TSH
- C Decreased triglycerides
- D Decreased serum cholesterol
Explanation
Explanation
In primary hypothyroidism, the thyroid gland fails to produce enough T3 and T4. As a result, the pituitary gland increases secretion of thyroid-stimulating hormone (TSH) in an attempt to stimulate the thyroid. Laboratory findings typically show high TSH and low T3/T4 levels. This helps differentiate primary hypothyroidism from secondary causes.
Correct Answer Is:
Elevated TSH
Why the other options are incorrect:
Elevated hemoglobin
Hypothyroidism does not cause elevated hemoglobin; in fact, anemia is more common due to reduced erythropoiesis.
Decreased triglycerides
Triglycerides are often normal or elevated in hypothyroidism due to reduced lipid metabolism, not decreased.
Decreased serum cholesterol
Hypothyroidism often causes increased cholesterol levels because of slower lipid breakdown, not decreased levels.
In primary hypothyroidism, the thyroid gland fails to produce enough T3 and T4. As a result, the pituitary gland increases secretion of thyroid-stimulating hormone (TSH) in an attempt to stimulate the thyroid. Laboratory findings typically show high TSH and low T3/T4 levels. This helps differentiate primary hypothyroidism from secondary causes.
Correct Answer Is:
Elevated TSH
Why the other options are incorrect:
Elevated hemoglobin
Hypothyroidism does not cause elevated hemoglobin; in fact, anemia is more common due to reduced erythropoiesis.
Decreased triglycerides
Triglycerides are often normal or elevated in hypothyroidism due to reduced lipid metabolism, not decreased.
Decreased serum cholesterol
Hypothyroidism often causes increased cholesterol levels because of slower lipid breakdown, not decreased levels.
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