MSN377 EXAM4 QUESTIONS AND VERIFIED ANSWERS 2024-2025
LATEST UPDATE//ALREADY GRADED A+
A patient is diagnosed with pheochromocytoma. From your nursing knowledge, you know that the
patient will present with hypertension, sweating, and palpations due to excessive catecholamine
production from the?
A. Adrenal Cortex
B. Adrenal Zona Fasciculata
C. Adrenal Medulla
D. Adrenal Glomerulosa - answer-The answer is C.
The adrenal medulla secretes catecholamines.
What cells are responsible for secreting catecholamines?
A. Chromaffin
B. Langerhans
C. Enkephalin
D. Parietal - answer-The answer is A.
These cells are known as chromaffin cells.
A patient has excessive catecholamines in the urine. Which of the following signs and symptoms would
the patient NOT exhibit? SELECT-ALL-THAT-APPLY:
A. Tachycardia
B. Anxiety
C. Hypoglycemia
D. Thermogenesis
E. Decreased Basal Metabolic Rate - answer-The answers are C and E.
The patient would have HYPERglycemia (not hypoglycemia) and INCREASED basal metabolic rate (not
decreased).
A patient is admitted with uncontrolled hypertension and the doctor suspects pheochromoctyoma. On
assessment, you note the blood pressure to be 196/120 and HR 130. The patient reports feeling very
,anxious, sweaty, and having palpations. What do you expect the doctor will order to confirm a diagnosis
of pheochromocytoma?
A. Urinalysis
B. Urine culture
C. 24-hour urine
D. 8-hour urine - answer-The answer is C.
A 24-hour urine is ordered to check for catecholamine and metanephrines (which are metabolites
formed when the body breaks down catecholamines).
Which statement is incorrect about pheochromocytoma?
A. This condition can be trigger by eating foods high in Tyramine such as hamburger meat and spinach.
B. Monoamine oxidase inhibitors can trigger signs and symptoms of pheochromocytoma.
C. An adrenalectomy is the only surgical treatment for pheochromocytoma.
D. Patients with pheochromocytoma are at risk for hypertensive crisis. - answer-The answer is A.
This statement is incorrect because hamburger meat and spinach are not high in Tyramine....foods that
are aged, pickled, and fermented (cheeses, red wine, smoke/dried meat, bananas, sauerkraut,
chocolate) can trigger signs and symptoms of pheochromocytoma.
A patient is scheduled for a bilateral adrenalectomy. Preoperatively, the patient is ordered by the doctor
to take an alpha-adrenergic blocker. After administering a dose of this medication, what type of side
effect will you monitor the patient for?
A. Bradypnea
B. Hyperglycemia
C. Reflex tachycardia
D. Hypertension - answer-The answer is C.
Alpha-adrenergic blockers (Cardura, Minipress, Hyrtin) block noradrenaline which reduces
catecholamine. This will help decrease blood pressure and prevent hypertensive crisis during surgery.
However, a side effect of this medication is reflex tachycardia due to the decrease in blood pressure.
The heart will try to compensate by increasing the heart rate.
you are educating the patient about the post-op care for a bilateral adrenalectomy. Which statement by
the patient indicates they understood your instructions?
,A. "I will have to take mineralocorticoids daily for 2 years."
B. "I will have to take glucocorticoids and mineralocorticoids daily for 2 years."
C. "When I experience signs of stress I will have to take mineralocorticoids as needed."
D. "I will have to take glucocorticoids and mineralocorticoids daily for life." - answer-The answer is D.
After a bilateral adrenalectomy, the patient will have to take glucocorticoids and mineralocorticoid for
life. If the patient was having a unilateral adrenalectomy they would have to take glucocorticoids for
approximately 2 years.
Which patient below is at MOST risk for developing a condition called autonomic dysreflexia?
A. A 24-year-old male patient with a traumatic brain injury.
B. A 15-year-old female patient with a spinal cord injury at C7.
C. A 35-year-old male patient with a spinal cord injury at L6.
D. A 42-year-old male patient recovering from a hemorrhagic stroke. - answer-The answer is B.
Patients who are at MOST risk for developing autonomic dysreflexia are patients who've experienced a
spinal cord injury at T6 or higher...this includes C7. L6 is below T6, and traumatic brain injury and
hemorrhagic stroke does not increase a patient risk of AD.
Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing headache.
What is your NEXT nursing action?
A. Perform a bladder scan
B. Perform a rectal digital examination
C. Assess the patient's blood pressure
D. Administer a PRN medication to alleviate pain and provide a dark, calm environment. - answer-The
answer is C.
This is the nurse's NEXT action. The patient is at risk for developing autonomic dysreflexia because of
their spinal cord injury at T3 (remember patients who have a SCI at T6 or higher are at MOST risk). If a
patient with this type of injury states they have a headache, the nurse should NEXT assess the patient's
blood pressure. If it is elevated, the nurse would take measures to check the bladder (a bladder issue is
the most common cause of AD), bowel, and skin for breakdown.
You're performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The patient is
restless, sweaty, and extremely flushed. You assess the patient's blood pressure and heart rate. The
, patient's blood pressure is 140/98 and heart rate is 52. You look at the patient's chart and find that their
baseline blood pressure is 106/76 and heart rate is 72. What action should the nurse take FIRST?
A. Reassess the patient's blood pressure.
B. Check the patient's blood glucose.
C. Position the patient at 90 degrees and lower the legs.
D. Provide cooling blankets for the patient. - answer-The answer is C.
Based on the patient findings and how the patient has a spinal cord injury at T6, they are experiencing
autonomic dysreflexia. Patients with this condition may have a blood pressure that is 20-40 mmHg
higher than their baseline and may experience bradycardia (heart rate less than 60). The FIRST action
the nurse should take when AD is suspected is to position the patient at 90 degree (high Fowler's) and
lower the legs. This will allow gravity to cause the blood to pool in the lower extremities and help
decrease the blood pressure. Then the nurse should try to find the cause of the autonomic dysreflexia,
which could be a full bladder, impacted bowel, or skin break down.
You're providing an in-service to a group of new nurse graduates on the causes of autonomic
dysreflexia. Select all the most common causes you will discuss during the in-service:
A. Hypoglycemia
B. Distended bladder
C. Sacral pressure injury
D. Fecal impaction
E. Urinary tract infection - answer-The answers are B, C, D, and E. Anything that can cause an irritating
stimulus below the site of the spinal injury (T6 or higher) can lead to autonomic dysreflexia, which
causes an exaggerated sympathetic reflex response and the parasympathetic system is unable to oppose
it. This will lead to severe hypertension. The most common cause of AD is a bladder issue (full/distended
bladder, urinary tract infection etc). Other common causes are due to a bowel issue like fecal impaction
or skin break down (pressure injury/ulcer, cut, infection etc.).
After taking all the necessary steps for a patient who has developed autonomic dysreflexia, what should
the nurse assess FIRST as a possible cause of this condition?
A. Skin break down
B. Blood glucose
C. Possible bladder irritant
D. Last bowel movement - answer-The answer is C.
LATEST UPDATE//ALREADY GRADED A+
A patient is diagnosed with pheochromocytoma. From your nursing knowledge, you know that the
patient will present with hypertension, sweating, and palpations due to excessive catecholamine
production from the?
A. Adrenal Cortex
B. Adrenal Zona Fasciculata
C. Adrenal Medulla
D. Adrenal Glomerulosa - answer-The answer is C.
The adrenal medulla secretes catecholamines.
What cells are responsible for secreting catecholamines?
A. Chromaffin
B. Langerhans
C. Enkephalin
D. Parietal - answer-The answer is A.
These cells are known as chromaffin cells.
A patient has excessive catecholamines in the urine. Which of the following signs and symptoms would
the patient NOT exhibit? SELECT-ALL-THAT-APPLY:
A. Tachycardia
B. Anxiety
C. Hypoglycemia
D. Thermogenesis
E. Decreased Basal Metabolic Rate - answer-The answers are C and E.
The patient would have HYPERglycemia (not hypoglycemia) and INCREASED basal metabolic rate (not
decreased).
A patient is admitted with uncontrolled hypertension and the doctor suspects pheochromoctyoma. On
assessment, you note the blood pressure to be 196/120 and HR 130. The patient reports feeling very
,anxious, sweaty, and having palpations. What do you expect the doctor will order to confirm a diagnosis
of pheochromocytoma?
A. Urinalysis
B. Urine culture
C. 24-hour urine
D. 8-hour urine - answer-The answer is C.
A 24-hour urine is ordered to check for catecholamine and metanephrines (which are metabolites
formed when the body breaks down catecholamines).
Which statement is incorrect about pheochromocytoma?
A. This condition can be trigger by eating foods high in Tyramine such as hamburger meat and spinach.
B. Monoamine oxidase inhibitors can trigger signs and symptoms of pheochromocytoma.
C. An adrenalectomy is the only surgical treatment for pheochromocytoma.
D. Patients with pheochromocytoma are at risk for hypertensive crisis. - answer-The answer is A.
This statement is incorrect because hamburger meat and spinach are not high in Tyramine....foods that
are aged, pickled, and fermented (cheeses, red wine, smoke/dried meat, bananas, sauerkraut,
chocolate) can trigger signs and symptoms of pheochromocytoma.
A patient is scheduled for a bilateral adrenalectomy. Preoperatively, the patient is ordered by the doctor
to take an alpha-adrenergic blocker. After administering a dose of this medication, what type of side
effect will you monitor the patient for?
A. Bradypnea
B. Hyperglycemia
C. Reflex tachycardia
D. Hypertension - answer-The answer is C.
Alpha-adrenergic blockers (Cardura, Minipress, Hyrtin) block noradrenaline which reduces
catecholamine. This will help decrease blood pressure and prevent hypertensive crisis during surgery.
However, a side effect of this medication is reflex tachycardia due to the decrease in blood pressure.
The heart will try to compensate by increasing the heart rate.
you are educating the patient about the post-op care for a bilateral adrenalectomy. Which statement by
the patient indicates they understood your instructions?
,A. "I will have to take mineralocorticoids daily for 2 years."
B. "I will have to take glucocorticoids and mineralocorticoids daily for 2 years."
C. "When I experience signs of stress I will have to take mineralocorticoids as needed."
D. "I will have to take glucocorticoids and mineralocorticoids daily for life." - answer-The answer is D.
After a bilateral adrenalectomy, the patient will have to take glucocorticoids and mineralocorticoid for
life. If the patient was having a unilateral adrenalectomy they would have to take glucocorticoids for
approximately 2 years.
Which patient below is at MOST risk for developing a condition called autonomic dysreflexia?
A. A 24-year-old male patient with a traumatic brain injury.
B. A 15-year-old female patient with a spinal cord injury at C7.
C. A 35-year-old male patient with a spinal cord injury at L6.
D. A 42-year-old male patient recovering from a hemorrhagic stroke. - answer-The answer is B.
Patients who are at MOST risk for developing autonomic dysreflexia are patients who've experienced a
spinal cord injury at T6 or higher...this includes C7. L6 is below T6, and traumatic brain injury and
hemorrhagic stroke does not increase a patient risk of AD.
Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing headache.
What is your NEXT nursing action?
A. Perform a bladder scan
B. Perform a rectal digital examination
C. Assess the patient's blood pressure
D. Administer a PRN medication to alleviate pain and provide a dark, calm environment. - answer-The
answer is C.
This is the nurse's NEXT action. The patient is at risk for developing autonomic dysreflexia because of
their spinal cord injury at T3 (remember patients who have a SCI at T6 or higher are at MOST risk). If a
patient with this type of injury states they have a headache, the nurse should NEXT assess the patient's
blood pressure. If it is elevated, the nurse would take measures to check the bladder (a bladder issue is
the most common cause of AD), bowel, and skin for breakdown.
You're performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The patient is
restless, sweaty, and extremely flushed. You assess the patient's blood pressure and heart rate. The
, patient's blood pressure is 140/98 and heart rate is 52. You look at the patient's chart and find that their
baseline blood pressure is 106/76 and heart rate is 72. What action should the nurse take FIRST?
A. Reassess the patient's blood pressure.
B. Check the patient's blood glucose.
C. Position the patient at 90 degrees and lower the legs.
D. Provide cooling blankets for the patient. - answer-The answer is C.
Based on the patient findings and how the patient has a spinal cord injury at T6, they are experiencing
autonomic dysreflexia. Patients with this condition may have a blood pressure that is 20-40 mmHg
higher than their baseline and may experience bradycardia (heart rate less than 60). The FIRST action
the nurse should take when AD is suspected is to position the patient at 90 degree (high Fowler's) and
lower the legs. This will allow gravity to cause the blood to pool in the lower extremities and help
decrease the blood pressure. Then the nurse should try to find the cause of the autonomic dysreflexia,
which could be a full bladder, impacted bowel, or skin break down.
You're providing an in-service to a group of new nurse graduates on the causes of autonomic
dysreflexia. Select all the most common causes you will discuss during the in-service:
A. Hypoglycemia
B. Distended bladder
C. Sacral pressure injury
D. Fecal impaction
E. Urinary tract infection - answer-The answers are B, C, D, and E. Anything that can cause an irritating
stimulus below the site of the spinal injury (T6 or higher) can lead to autonomic dysreflexia, which
causes an exaggerated sympathetic reflex response and the parasympathetic system is unable to oppose
it. This will lead to severe hypertension. The most common cause of AD is a bladder issue (full/distended
bladder, urinary tract infection etc). Other common causes are due to a bowel issue like fecal impaction
or skin break down (pressure injury/ulcer, cut, infection etc.).
After taking all the necessary steps for a patient who has developed autonomic dysreflexia, what should
the nurse assess FIRST as a possible cause of this condition?
A. Skin break down
B. Blood glucose
C. Possible bladder irritant
D. Last bowel movement - answer-The answer is C.
