NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems
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Free NU216_Fall25_T3_Endocrine, Respiratory, and Immune Systems Questions
1.
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.
2.
A nurse is assessing a patient who presents with a red, itchy rash 48 hours after hiking. The patient reports contact with poison ivy. Which type of hypersensitivity reaction is the nurse most likely observing?
- A Type I - Immediate hypersensitivity
- B Type II - Cytotoxic hypersensitivity
- C Type III - Immune complex hypersensitivity
- D Type IV - Delayed cell-mediated hypersensitivity
Explanation
Explanation
Poison ivy reactions are classic examples of Type IV hypersensitivity, which is mediated by T lymphocytes rather than antibodies. This reaction develops 24–72 hours after exposure and involves localized inflammation, redness, and itching. The delay occurs because T cells must recognize the antigen and release cytokines that recruit immune cells, causing the skin reaction.
Correct Answer Is:
Type IV - Delayed cell-mediated hypersensitivity
Why the other options are incorrect:
Type I - Immediate hypersensitivity
This is IgE-mediated and occurs within minutes of exposure to allergens like pollen or insect venom, causing symptoms such as hives, anaphylaxis, or asthma—not a delayed rash.
Type II - Cytotoxic hypersensitivity
This involves IgG or IgM antibodies binding to cell surfaces, leading to cell destruction. Examples include hemolytic anemia or transfusion reactions, not contact dermatitis.
Type III - Immune complex hypersensitivity
This occurs when antigen-antibody complexes deposit in tissues, leading to inflammation, such as in lupus or serum sickness, not in poison ivy reactions.
Poison ivy reactions are classic examples of Type IV hypersensitivity, which is mediated by T lymphocytes rather than antibodies. This reaction develops 24–72 hours after exposure and involves localized inflammation, redness, and itching. The delay occurs because T cells must recognize the antigen and release cytokines that recruit immune cells, causing the skin reaction.
Correct Answer Is:
Type IV - Delayed cell-mediated hypersensitivity
Why the other options are incorrect:
Type I - Immediate hypersensitivity
This is IgE-mediated and occurs within minutes of exposure to allergens like pollen or insect venom, causing symptoms such as hives, anaphylaxis, or asthma—not a delayed rash.
Type II - Cytotoxic hypersensitivity
This involves IgG or IgM antibodies binding to cell surfaces, leading to cell destruction. Examples include hemolytic anemia or transfusion reactions, not contact dermatitis.
Type III - Immune complex hypersensitivity
This occurs when antigen-antibody complexes deposit in tissues, leading to inflammation, such as in lupus or serum sickness, not in poison ivy reactions.
3.
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.
4.
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.
5.
A patient with hyperthyroidism is admitted with restlessness, tachycardia (HR 145), and a temperature of 103°F (39.4°C). The patient reports severe anxiety and diaphoresis. What is the priority action?
- A Administer IV propranolol and fluids
- B Assess the patient's deep tendon reflexes
- C Administer acetaminophen and a cooling blanket
- D Check for Chvostek's and Trousseau's signs
Explanation
Explanation
The patient is exhibiting signs of thyroid storm, a life-threatening complication of hyperthyroidism characterized by hypermetabolism, hyperthermia, tachycardia, and severe anxiety. Immediate priority is to stabilize vital functions—beta-blockers like propranolol reduce heart rate and control adrenergic symptoms, while IV fluids support circulation and prevent shock.
Correct Answer Is:
Administer IV propranolol and fluids
Why the other options are incorrect:
Assess the patient's deep tendon reflexes
This is not a priority in an acute emergency. Neurological checks may be done later, but stabilizing airway, breathing, and circulation comes first.
Administer acetaminophen and a cooling blanket
Temperature control is important but secondary. Reducing cardiac workload and preventing cardiovascular collapse takes precedence in thyroid storm management.
Check for Chvostek's and Trousseau's signs
These assess hypocalcemia, which can occur post-thyroidectomy, but are not relevant for an acute thyroid storm scenario in this patient.
The patient is exhibiting signs of thyroid storm, a life-threatening complication of hyperthyroidism characterized by hypermetabolism, hyperthermia, tachycardia, and severe anxiety. Immediate priority is to stabilize vital functions—beta-blockers like propranolol reduce heart rate and control adrenergic symptoms, while IV fluids support circulation and prevent shock.
Correct Answer Is:
Administer IV propranolol and fluids
Why the other options are incorrect:
Assess the patient's deep tendon reflexes
This is not a priority in an acute emergency. Neurological checks may be done later, but stabilizing airway, breathing, and circulation comes first.
Administer acetaminophen and a cooling blanket
Temperature control is important but secondary. Reducing cardiac workload and preventing cardiovascular collapse takes precedence in thyroid storm management.
Check for Chvostek's and Trousseau's signs
These assess hypocalcemia, which can occur post-thyroidectomy, but are not relevant for an acute thyroid storm scenario in this patient.
6.
When a patient with COPD is receiving oxygen, which is the best action by the nurse?
- A Maintain pulse oximetry between 89% and 92%.
- B Increase oxygen to 8 liters/minute or when the patient is comfortable.
- C Administer oxygen according to the patient's request.
- D Increase rate of administration of oxygen up to 16 liters/min via high-flow ventimask.
Explanation
Explanation
In patients with COPD, especially those with chronic CO₂ retention, high oxygen levels can reduce the hypoxic drive to breathe, leading to worsening hypercapnia and respiratory acidosis. The goal is to provide enough oxygen to maintain safe saturation — typically 88–92% — without causing oxygen-induced hypoventilation. Oxygen is administered via the lowest flow rate necessary to achieve this target, and continuous monitoring with pulse oximetry is essential.
Correct Answer Is:
Maintain pulse oximetry between 89% and 92%.
Why the other options are incorrect:
Increase oxygen to 8 liters/minute or when the patient is comfortable
Increasing oxygen purely for comfort without monitoring risks causing CO₂ retention and respiratory depression in COPD patients.
Administer oxygen according to the patient’s request
Oxygen administration should be based on clinical need and monitored oxygen saturation, not patient request alone.
Increase rate of administration of oxygen up to 16 liters/min via high-flow ventimask
Such high oxygen levels can be dangerous in COPD patients with chronic hypercapnia and are generally reserved for acute emergencies with severe hypoxemia under close monitoring.
In patients with COPD, especially those with chronic CO₂ retention, high oxygen levels can reduce the hypoxic drive to breathe, leading to worsening hypercapnia and respiratory acidosis. The goal is to provide enough oxygen to maintain safe saturation — typically 88–92% — without causing oxygen-induced hypoventilation. Oxygen is administered via the lowest flow rate necessary to achieve this target, and continuous monitoring with pulse oximetry is essential.
Correct Answer Is:
Maintain pulse oximetry between 89% and 92%.
Why the other options are incorrect:
Increase oxygen to 8 liters/minute or when the patient is comfortable
Increasing oxygen purely for comfort without monitoring risks causing CO₂ retention and respiratory depression in COPD patients.
Administer oxygen according to the patient’s request
Oxygen administration should be based on clinical need and monitored oxygen saturation, not patient request alone.
Increase rate of administration of oxygen up to 16 liters/min via high-flow ventimask
Such high oxygen levels can be dangerous in COPD patients with chronic hypercapnia and are generally reserved for acute emergencies with severe hypoxemia under close monitoring.
7.
A patient scheduled to receive an influenza vaccination asks the nurse, "How do those things work anyway?" What is the nurse's best response?
- A "Immunizations work to keep you from getting blood diseases. So, you need one!"
- B "Immunizations help your body to prepare antibodies against a future exposure to the same antigen."
- C "Immunizations work by activating unstimulated internal proteins which are part of the immune response."
- D "Immunizations work by giving you antibodies to stimulate immediate protection if exposed to an antigen."
Explanation
Explanation
Vaccinations introduce a weakened or inactivated form of a pathogen, or parts of it, to the immune system. This triggers the production of antibodies and memory cells without causing illness. When the body encounters the real pathogen later, it can mount a rapid and effective immune response, preventing or reducing illness severity.
Correct Answer Is:
"Immunizations help your body to prepare antibodies against a future exposure to the same antigen."
Why the other options are incorrect:
"Immunizations work to keep you from getting blood diseases. So, you need one!"
This statement is vague, inaccurate, and misleading, as vaccines prevent many types of infectious diseases, not just bloodborne ones.
"Immunizations work by activating unstimulated internal proteins which are part of the immune response."
This is unclear and does not accurately explain the immune mechanism of vaccines.
"Immunizations work by giving you antibodies to stimulate immediate protection if exposed to an antigen."
This describes passive immunity (e.g., immune globulin), not active immunity provided by most vaccines like the influenza vaccine.
Vaccinations introduce a weakened or inactivated form of a pathogen, or parts of it, to the immune system. This triggers the production of antibodies and memory cells without causing illness. When the body encounters the real pathogen later, it can mount a rapid and effective immune response, preventing or reducing illness severity.
Correct Answer Is:
"Immunizations help your body to prepare antibodies against a future exposure to the same antigen."
Why the other options are incorrect:
"Immunizations work to keep you from getting blood diseases. So, you need one!"
This statement is vague, inaccurate, and misleading, as vaccines prevent many types of infectious diseases, not just bloodborne ones.
"Immunizations work by activating unstimulated internal proteins which are part of the immune response."
This is unclear and does not accurately explain the immune mechanism of vaccines.
"Immunizations work by giving you antibodies to stimulate immediate protection if exposed to an antigen."
This describes passive immunity (e.g., immune globulin), not active immunity provided by most vaccines like the influenza vaccine.
8.
Which of the following risk factors does the nurse recognize as most significant in the development of COPD? (SELECT ALL THAT APPLY)
- A Exposure to occupational air pollutants
- B Use of illegal substances and malnutrition
- C Family history of asthma
- D Environmental exposure to allergens
- E History of smoking and exposure to secondhand smoke
Explanation
Explanation
Exposure to occupational air pollutants
Long-term inhalation of dust, chemicals, and fumes in certain work environments (e.g., mining, manufacturing, agriculture) significantly increases the risk of developing COPD due to chronic airway irritation and inflammation.
History of smoking and exposure to secondhand smoke
Cigarette smoking is the leading cause of COPD. Tobacco smoke, including secondhand exposure, damages the cilia, irritates the airways, and leads to chronic inflammation, all of which contribute to airway obstruction.
Correct Answer Is:
Exposure to occupational air pollutants
History of smoking and exposure to secondhand smoke
Why the other options are incorrect:
Use of illegal substances and malnutrition
While poor nutrition can weaken the immune system and substance abuse can harm respiratory health, they are not primary or most significant risk factors for COPD compared to smoking and occupational exposure.
Family history of asthma
Asthma is a different chronic airway condition. Although some genetic factors overlap, family history of asthma is not a major direct risk factor for COPD.
Environmental exposure to allergens
Allergens trigger asthma and allergic rhinitis more than COPD. Chronic irritants, not allergens, are the primary cause of COPD.
Exposure to occupational air pollutants
Long-term inhalation of dust, chemicals, and fumes in certain work environments (e.g., mining, manufacturing, agriculture) significantly increases the risk of developing COPD due to chronic airway irritation and inflammation.
History of smoking and exposure to secondhand smoke
Cigarette smoking is the leading cause of COPD. Tobacco smoke, including secondhand exposure, damages the cilia, irritates the airways, and leads to chronic inflammation, all of which contribute to airway obstruction.
Correct Answer Is:
Exposure to occupational air pollutants
History of smoking and exposure to secondhand smoke
Why the other options are incorrect:
Use of illegal substances and malnutrition
While poor nutrition can weaken the immune system and substance abuse can harm respiratory health, they are not primary or most significant risk factors for COPD compared to smoking and occupational exposure.
Family history of asthma
Asthma is a different chronic airway condition. Although some genetic factors overlap, family history of asthma is not a major direct risk factor for COPD.
Environmental exposure to allergens
Allergens trigger asthma and allergic rhinitis more than COPD. Chronic irritants, not allergens, are the primary cause of COPD.
9.
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.
10.
A patient is being admitted with a diagnosis of hyperthyroidism. What clinical manifestations would the nurse assess in this patient? (SELECT ALL THAT APPLY)
- A Gynecomastia
- B Somnolence
- C Nodular thyroid
- D Palmar erythema
- E Hyperactive bowel sounds
- F Hypothermia
- G Exophthalmos
Explanation
Explanation
Nodular thyroid
Hyperthyroidism, particularly toxic multinodular goiter or thyroid adenoma, may present with nodules in the thyroid gland that secrete excess thyroid hormone, causing metabolic overactivity.
Palmar erythema
Increased blood flow from hypermetabolism can cause redness of the palms, which is sometimes seen in hyperthyroidism.
Hyperactive bowel sounds
Excess thyroid hormone increases gastrointestinal motility, leading to hyperactive bowel sounds, diarrhea, and frequent stools.
Exophthalmos
Protrusion of the eyes is a hallmark sign of Graves’ disease, a common cause of hyperthyroidism, resulting from autoimmune-mediated inflammation of orbital tissues.
Correct Answer Is:
Nodular thyroid
Palmar erythema
Hyperactive bowel sounds
Exophthalmos
Why the other options are incorrect:
Gynecomastia
This is more often linked to hormonal imbalances involving estrogen and testosterone, not hyperthyroidism.
Somnolence
Drowsiness and fatigue are more common in hypothyroidism; hyperthyroid patients typically have restlessness and insomnia.
Hypothermia
Hyperthyroidism increases metabolic rate, leading to heat intolerance, not hypothermia.
Nodular thyroid
Hyperthyroidism, particularly toxic multinodular goiter or thyroid adenoma, may present with nodules in the thyroid gland that secrete excess thyroid hormone, causing metabolic overactivity.
Palmar erythema
Increased blood flow from hypermetabolism can cause redness of the palms, which is sometimes seen in hyperthyroidism.
Hyperactive bowel sounds
Excess thyroid hormone increases gastrointestinal motility, leading to hyperactive bowel sounds, diarrhea, and frequent stools.
Exophthalmos
Protrusion of the eyes is a hallmark sign of Graves’ disease, a common cause of hyperthyroidism, resulting from autoimmune-mediated inflammation of orbital tissues.
Correct Answer Is:
Nodular thyroid
Palmar erythema
Hyperactive bowel sounds
Exophthalmos
Why the other options are incorrect:
Gynecomastia
This is more often linked to hormonal imbalances involving estrogen and testosterone, not hyperthyroidism.
Somnolence
Drowsiness and fatigue are more common in hypothyroidism; hyperthyroid patients typically have restlessness and insomnia.
Hypothermia
Hyperthyroidism increases metabolic rate, leading to heat intolerance, not hypothermia.
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