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 is caring for a patient who is admitted with a pulmonary embolism (PE). The patient is active and has no known risk factors for PE. What nursing actions are most appropriate? Select all that apply.
- A Ensure patient safely and prevent bleeding.
- B Monitor the pulse oximetry once per shift.
- C Provide supplemental oxygen therapy as needed
- D Encourage the patient to ambulate every two hours.
- E Assess the patient's respiratory status.
- F Maintain and monitor anticoagulation therapy as ordered.
- G Keep the patient in a semi-Fowler's position.
Explanation
Explanation
Ensure patient safety and prevent bleeding
Patients with PE are often started on anticoagulants, which increase bleeding risk. Safety measures and bleeding precautions are essential.
Provide supplemental oxygen therapy as needed
Oxygen helps correct hypoxemia caused by impaired pulmonary perfusion from the clot.
Assess the patient’s respiratory status
Frequent assessment of respiratory effort, breath sounds, and oxygen saturation detects worsening hypoxemia or respiratory failure.
Maintain and monitor anticoagulation therapy as ordered
Anticoagulants prevent further clot formation and are a primary treatment for PE. Monitoring ensures therapeutic levels and reduces complications.
Keep the patient in a semi-Fowler's position
This position promotes optimal lung expansion and improves ventilation, reducing work of breathing.
Correct Answer Is:
Ensure patient safety and prevent bleeding.
Provide supplemental oxygen therapy as needed.
Assess the patient's respiratory status.
Maintain and monitor anticoagulation therapy as ordered.
Keep the patient in a semi-Fowler's position.
Why the other options are incorrect:
Monitor the pulse oximetry once per shift
For PE, continuous or frequent oxygen monitoring is necessary, not just once per shift.
Encourage the patient to ambulate every two hours
Ambulation is not appropriate in the acute phase of PE, as it may worsen symptoms and strain the cardiopulmonary system until the patient is stabilized.
Ensure patient safety and prevent bleeding
Patients with PE are often started on anticoagulants, which increase bleeding risk. Safety measures and bleeding precautions are essential.
Provide supplemental oxygen therapy as needed
Oxygen helps correct hypoxemia caused by impaired pulmonary perfusion from the clot.
Assess the patient’s respiratory status
Frequent assessment of respiratory effort, breath sounds, and oxygen saturation detects worsening hypoxemia or respiratory failure.
Maintain and monitor anticoagulation therapy as ordered
Anticoagulants prevent further clot formation and are a primary treatment for PE. Monitoring ensures therapeutic levels and reduces complications.
Keep the patient in a semi-Fowler's position
This position promotes optimal lung expansion and improves ventilation, reducing work of breathing.
Correct Answer Is:
Ensure patient safety and prevent bleeding.
Provide supplemental oxygen therapy as needed.
Assess the patient's respiratory status.
Maintain and monitor anticoagulation therapy as ordered.
Keep the patient in a semi-Fowler's position.
Why the other options are incorrect:
Monitor the pulse oximetry once per shift
For PE, continuous or frequent oxygen monitoring is necessary, not just once per shift.
Encourage the patient to ambulate every two hours
Ambulation is not appropriate in the acute phase of PE, as it may worsen symptoms and strain the cardiopulmonary system until the patient is stabilized.
2.
A patient arrives at the emergency department with severe fatigue, bradycardia (HR 48), and altered mental status. The nurse notes cold, dry skin and a puffy face. The patient's TSH is 25 mU/L (high), and T3/T4 levels are low. What is the priority nursing intervention?
- A Administer IV levothyroxine
- B Encourage oral fluid intake
- C Monitor blood glucose levels
- D Apply warming blankets
Explanation
Explanation
The patient is exhibiting signs of myxedema coma, a life-threatening complication of severe hypothyroidism. The priority intervention is rapid thyroid hormone replacement with IV levothyroxine to restore metabolic function and prevent cardiovascular collapse. Supportive measures like IV fluids and warming may follow, but hormone replacement is the definitive treatment to reverse the crisis.
Correct Answer Is:
Administer IV levothyroxine
Why the other options are incorrect:
Encourage oral fluid intake
The patient’s altered mental status makes oral intake unsafe due to aspiration risk. IV support is required instead.
Monitor blood glucose levels
While hypoglycemia can occur in hypothyroidism, monitoring glucose is supportive—not the primary lifesaving intervention in myxedema coma.
Apply warming blankets
Gradual warming is part of supportive care, but it does not address the underlying cause. Thyroid hormone replacement is the immediate priority to stabilize the patient.
The patient is exhibiting signs of myxedema coma, a life-threatening complication of severe hypothyroidism. The priority intervention is rapid thyroid hormone replacement with IV levothyroxine to restore metabolic function and prevent cardiovascular collapse. Supportive measures like IV fluids and warming may follow, but hormone replacement is the definitive treatment to reverse the crisis.
Correct Answer Is:
Administer IV levothyroxine
Why the other options are incorrect:
Encourage oral fluid intake
The patient’s altered mental status makes oral intake unsafe due to aspiration risk. IV support is required instead.
Monitor blood glucose levels
While hypoglycemia can occur in hypothyroidism, monitoring glucose is supportive—not the primary lifesaving intervention in myxedema coma.
Apply warming blankets
Gradual warming is part of supportive care, but it does not address the underlying cause. Thyroid hormone replacement is the immediate priority to stabilize the patient.
3.
A patient with asthma is experiencing wheezing and shortness of breath. The nurse administers a prescribed short-acting beta-agonist. Which finding indicates the medication is effective?
- A Increased oxygen saturation
- B Productive cough
- C Decreased wheezing
- D Decreased respiratory rate
Explanation
Explanation
Short-acting beta-agonists (e.g., albuterol) cause bronchodilation, relaxing airway smooth muscles and improving airflow. A reduction in wheezing after administration indicates that airflow through the bronchi has improved, confirming the medication’s effectiveness.
Correct Answer Is:
Decreased wheezing
Why the other options are incorrect:
Increased oxygen saturation
While this may occur with improved ventilation, it is not the most direct or immediate indicator of bronchodilator effectiveness.
Productive cough
A productive cough is not a primary indicator of short-acting beta-agonist effectiveness and may relate to other conditions.
Decreased respiratory rate
A lower respiratory rate may happen after symptom relief, but the clearest sign of improved airway patency is the reduction in wheezing.
Short-acting beta-agonists (e.g., albuterol) cause bronchodilation, relaxing airway smooth muscles and improving airflow. A reduction in wheezing after administration indicates that airflow through the bronchi has improved, confirming the medication’s effectiveness.
Correct Answer Is:
Decreased wheezing
Why the other options are incorrect:
Increased oxygen saturation
While this may occur with improved ventilation, it is not the most direct or immediate indicator of bronchodilator effectiveness.
Productive cough
A productive cough is not a primary indicator of short-acting beta-agonist effectiveness and may relate to other conditions.
Decreased respiratory rate
A lower respiratory rate may happen after symptom relief, but the clearest sign of improved airway patency is the reduction in wheezing.
4.
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.
5.
A patient is admitted with symptoms of edema, bradycardia, and lethargy. The nurse understands based on these symptoms which of the following can cause myxedema coma?
- A Untreated hypothyroidism
- B End-stage Graves' disease
- C Overdose of propylthiouracil
- D Uncontrolled diabetes
Explanation
Explanation
Myxedema coma is a life-threatening complication of severe, long-standing hypothyroidism, often precipitated by infection, cold exposure, or medications. It results from profound metabolic slowing and is characterized by symptoms such as edema, bradycardia, lethargy, hypothermia, and respiratory depression. Immediate thyroid hormone replacement and supportive care are required.
Correct Answer Is:
Untreated hypothyroidism
Why the other options are incorrect:
End-stage Graves' disease
Graves’ disease is a cause of hyperthyroidism, not hypothyroidism. Its late stages can cause thyrotoxic crisis, but not myxedema coma, which is linked to low thyroid hormone levels.
Overdose of propylthiouracil
Propylthiouracil is used to treat hyperthyroidism. Overdose can cause hypothyroidism, but it is unlikely to cause myxedema coma acutely unless the hypothyroidism is prolonged and untreated.
Uncontrolled diabetes
Uncontrolled diabetes can cause diabetic ketoacidosis or hyperosmolar hyperglycemic state, but it does not cause myxedema coma, which is specific to severe hypothyroidism.
Myxedema coma is a life-threatening complication of severe, long-standing hypothyroidism, often precipitated by infection, cold exposure, or medications. It results from profound metabolic slowing and is characterized by symptoms such as edema, bradycardia, lethargy, hypothermia, and respiratory depression. Immediate thyroid hormone replacement and supportive care are required.
Correct Answer Is:
Untreated hypothyroidism
Why the other options are incorrect:
End-stage Graves' disease
Graves’ disease is a cause of hyperthyroidism, not hypothyroidism. Its late stages can cause thyrotoxic crisis, but not myxedema coma, which is linked to low thyroid hormone levels.
Overdose of propylthiouracil
Propylthiouracil is used to treat hyperthyroidism. Overdose can cause hypothyroidism, but it is unlikely to cause myxedema coma acutely unless the hypothyroidism is prolonged and untreated.
Uncontrolled diabetes
Uncontrolled diabetes can cause diabetic ketoacidosis or hyperosmolar hyperglycemic state, but it does not cause myxedema coma, which is specific to severe hypothyroidism.
6.
A patient is admitted with severe weight loss of 15 lbs. over the past month despite no change in activity level and an insatiable appetite. The patient is diagnosed with Graves’ disease. What other signs and symptoms would support this diagnosis? (SELECT ALL THAT APPLY)
- A Protrusion of the eyeballs
- B Heat intolerance
- C Rapid, bounding pulse
- D Nervousness
- E Bradycardia
- F Sleepiness
Explanation
Explanation
Protrusion of the eyeballs
Exophthalmos is a hallmark sign of Graves’ disease caused by autoimmune inflammation of orbital tissues.
Heat intolerance
Due to an increased metabolic rate, patients with hyperthyroidism are unable to tolerate warm temperatures and often feel overheated.
Rapid, bounding pulse
Hyperthyroidism increases heart rate and cardiac output, producing tachycardia and a bounding pulse.
Nervousness
Excess thyroid hormone stimulates the nervous system, leading to irritability, anxiety, and restlessness.
Correct Answer Is:
Protrusion of the eyeballs
Heat intolerance
Rapid, bounding pulse
Nervousness
Why the other options are incorrect:
Bradycardia
Hyperthyroidism typically causes tachycardia, not bradycardia.
Sleepiness
Patients with hyperthyroidism usually have insomnia and restlessness, not excessive sleepiness, which is more common in hypothyroidism.
Protrusion of the eyeballs
Exophthalmos is a hallmark sign of Graves’ disease caused by autoimmune inflammation of orbital tissues.
Heat intolerance
Due to an increased metabolic rate, patients with hyperthyroidism are unable to tolerate warm temperatures and often feel overheated.
Rapid, bounding pulse
Hyperthyroidism increases heart rate and cardiac output, producing tachycardia and a bounding pulse.
Nervousness
Excess thyroid hormone stimulates the nervous system, leading to irritability, anxiety, and restlessness.
Correct Answer Is:
Protrusion of the eyeballs
Heat intolerance
Rapid, bounding pulse
Nervousness
Why the other options are incorrect:
Bradycardia
Hyperthyroidism typically causes tachycardia, not bradycardia.
Sleepiness
Patients with hyperthyroidism usually have insomnia and restlessness, not excessive sleepiness, which is more common in hypothyroidism.
7.
A nurse is caring for a patient with hyperthyroidism. Which interventions should be included in the care plan? (SELECT ALL THAT APPLY)
- A Monitor for tachycardia and hypertension
- B Encourage high-iodine foods
- C Provide a cool, quiet environment
- D Administer beta-blockers as prescribed
- E Educate about radioactive iodine therapy
Explanation
Explanation
Monitor for tachycardia and hypertension
Hyperthyroidism increases metabolic rate, which overstimulates the cardiovascular system. Monitoring for tachycardia and hypertension allows early detection of complications like arrhythmias or thyroid storm, enabling timely intervention to prevent deterioration.
Provide a cool, quiet environment
Patients with hyperthyroidism often have heat intolerance and heightened nervous system activity. A cool, quiet environment helps reduce body temperature, minimize stress, and limit stimulation that could exacerbate symptoms.
Administer beta-blockers as prescribed
Beta-blockers help control symptoms such as tachycardia, palpitations, and tremors by blocking adrenergic effects. They provide symptomatic relief while definitive treatment for hyperthyroidism is being implemented.
Educate about radioactive iodine therapy
Radioactive iodine is a common treatment to destroy overactive thyroid tissue. Patient education includes preparation, possible side effects, and post-treatment precautions to ensure safety and compliance with therapy.
Correct Answer Is:
Monitor for tachycardia and hypertension
Provide a cool, quiet environment
Administer beta-blockers as prescribed
Educate about radioactive iodine therapy
Why the other options are incorrect:
Monitor for tachycardia and hypertension
Hyperthyroidism increases metabolic rate, which overstimulates the cardiovascular system. Monitoring for tachycardia and hypertension allows early detection of complications like arrhythmias or thyroid storm, enabling timely intervention to prevent deterioration.
Provide a cool, quiet environment
Patients with hyperthyroidism often have heat intolerance and heightened nervous system activity. A cool, quiet environment helps reduce body temperature, minimize stress, and limit stimulation that could exacerbate symptoms.
Administer beta-blockers as prescribed
Beta-blockers help control symptoms such as tachycardia, palpitations, and tremors by blocking adrenergic effects. They provide symptomatic relief while definitive treatment for hyperthyroidism is being implemented.
Educate about radioactive iodine therapy
Radioactive iodine is a common treatment to destroy overactive thyroid tissue. Patient education includes preparation, possible side effects, and post-treatment precautions to ensure safety and compliance with therapy.
Correct Answer Is:
Monitor for tachycardia and hypertension
Provide a cool, quiet environment
Administer beta-blockers as prescribed
Educate about radioactive iodine therapy
Why the other options are incorrect:
8.
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.
9.
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.
10.
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.
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