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 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.
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 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.
4.
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.
5.
A patient with Graves' disease is prepared for a subtotal thyroidectomy with drug therapy of iodine before surgery. When teaching the patient about the drugs, the nurse explains that this drug is administered preoperatively to perform which function?
- A Assist in differentiating the thyroid and parathyroid glands during surgery.
- B Decrease the size and vascularity of the thyroid gland.
- C Eliminate the risk for tetany during the postoperative period.
- D Decrease the risk of hypometabolism during and after the surgery.
Explanation
Explanation
Preoperative iodine therapy (e.g., Lugol’s solution or potassium iodide) temporarily reduces thyroid hormone release and decreases the gland’s vascularity and size. This helps minimize blood loss during surgery and makes the gland easier to remove. It also reduces the risk of thyroid storm during the perioperative period.
Correct Answer Is:
Decrease the size and vascularity of the thyroid gland
Why the other options are incorrect:
Assist in differentiating the thyroid and parathyroid glands during surgery
Iodine does not help in identifying gland structures during surgery.
Eliminate the risk for tetany during the postoperative period
Postoperative tetany is caused by hypocalcemia from parathyroid injury or removal, not by a lack of iodine preparation.
Decrease the risk of hypometabolism during and after the surgery
Iodine reduces thyroid activity, but hypometabolism is more of a postoperative concern if too much thyroid tissue is removed—not something iodine prevents.
Preoperative iodine therapy (e.g., Lugol’s solution or potassium iodide) temporarily reduces thyroid hormone release and decreases the gland’s vascularity and size. This helps minimize blood loss during surgery and makes the gland easier to remove. It also reduces the risk of thyroid storm during the perioperative period.
Correct Answer Is:
Decrease the size and vascularity of the thyroid gland
Why the other options are incorrect:
Assist in differentiating the thyroid and parathyroid glands during surgery
Iodine does not help in identifying gland structures during surgery.
Eliminate the risk for tetany during the postoperative period
Postoperative tetany is caused by hypocalcemia from parathyroid injury or removal, not by a lack of iodine preparation.
Decrease the risk of hypometabolism during and after the surgery
Iodine reduces thyroid activity, but hypometabolism is more of a postoperative concern if too much thyroid tissue is removed—not something iodine prevents.
6.
The nurse is caring for a patient with asthma who is scheduled to receive a short-acting beta2 agonist as prescribed. Which assessment finding would require re-assessment prior to administration of a beta2 agonist?
- A Temperature of 99°
- B Heart rate of 116
- C Blood pressure 118/88
- D Respiratory rate of 18
Explanation
Explanation
Short-acting beta2 agonists (e.g., albuterol) stimulate beta2 receptors in the lungs to cause bronchodilation but can also stimulate beta1 receptors in the heart, leading to tachycardia. If the patient’s baseline heart rate is already elevated (such as 116 bpm), the nurse should re-assess and notify the provider before administration to determine if the benefit outweighs the risk, as the medication may further increase the heart rate and precipitate cardiac complications.
Correct Answer Is:
Heart rate of 116
Why the other options are incorrect:
Temperature of 99°
This is only mildly elevated and not a contraindication to giving a beta2 agonist.
Blood pressure 118/88
This is within an acceptable range and does not require holding the medication.
Respiratory rate of 18
This is normal and does not require re-assessment before administering the medication.
Short-acting beta2 agonists (e.g., albuterol) stimulate beta2 receptors in the lungs to cause bronchodilation but can also stimulate beta1 receptors in the heart, leading to tachycardia. If the patient’s baseline heart rate is already elevated (such as 116 bpm), the nurse should re-assess and notify the provider before administration to determine if the benefit outweighs the risk, as the medication may further increase the heart rate and precipitate cardiac complications.
Correct Answer Is:
Heart rate of 116
Why the other options are incorrect:
Temperature of 99°
This is only mildly elevated and not a contraindication to giving a beta2 agonist.
Blood pressure 118/88
This is within an acceptable range and does not require holding the medication.
Respiratory rate of 18
This is normal and does not require re-assessment before administering the medication.
7.
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.
8.
A patient is admitted to the emergency department with status asthmaticus. The patient is using accessory muscles to breathe, has diminished breath sounds, and is not responding to repeated doses of inhaled albuterol. What is the nurse's priority action?
- A Administer IV corticosteroids as prescribed
- B Prepare for intubation and mechanical ventilation
- C Encourage pursed-lip breathing
- D Obtain a sputum culture
Explanation
Explanation
Status asthmaticus is a severe, life-threatening asthma exacerbation unresponsive to standard bronchodilator therapy. Diminished breath sounds in this context indicate severely limited airflow and possible impending respiratory arrest. The priority is to secure the airway and ensure adequate oxygenation and ventilation by preparing for intubation and mechanical ventilation.
Correct Answer Is:
Prepare for intubation and mechanical ventilation
Why the other options are incorrect:
Administer IV corticosteroids as prescribed
Steroids reduce airway inflammation but take hours to work, so they are not the immediate life-saving intervention.
Encourage pursed-lip breathing
This is useful for chronic COPD management, not for a patient in acute, life-threatening respiratory failure.
Obtain a sputum culture
Identifying infectious organisms is not a priority when the patient has impending respiratory arrest; airway management comes first.
Status asthmaticus is a severe, life-threatening asthma exacerbation unresponsive to standard bronchodilator therapy. Diminished breath sounds in this context indicate severely limited airflow and possible impending respiratory arrest. The priority is to secure the airway and ensure adequate oxygenation and ventilation by preparing for intubation and mechanical ventilation.
Correct Answer Is:
Prepare for intubation and mechanical ventilation
Why the other options are incorrect:
Administer IV corticosteroids as prescribed
Steroids reduce airway inflammation but take hours to work, so they are not the immediate life-saving intervention.
Encourage pursed-lip breathing
This is useful for chronic COPD management, not for a patient in acute, life-threatening respiratory failure.
Obtain a sputum culture
Identifying infectious organisms is not a priority when the patient has impending respiratory arrest; airway management comes first.
9.
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.
10.
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.
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