ATI LPN
Immune System Questions Questions
Question 1 of 5
A child who has nephrotic syndrome is admitted to the pediatric unit. Which of the following should the nurse expect to find? (Select one that does not apply.)
Correct Answer: A
Rationale: The correct answer is A: Decreased urine specific gravity. In nephrotic syndrome, there is increased protein loss in the urine, leading to proteinuria and hypoalbuminemia. This results in a decrease in colloid osmotic pressure, causing fluid to leak into the interstitial spaces, leading to edema. Hyperlipidemia occurs due to the liver's response to low serum albumin levels. However, urine specific gravity is typically normal or even increased due to the concentrated urine caused by the loss of proteins and other solutes. Therefore, the nurse should not expect to find decreased urine specific gravity in a child with nephrotic syndrome.
Question 2 of 5
A child with severe gastroenteritis is admitted to a semiprivate room on the pediatric unit. The charge nurse should place this client with which roommate?
Correct Answer: C
Rationale: The correct answer is C. Placing the child with another child with gastroenteritis is the best option to prevent transmission of the infection to other vulnerable patients. Choosing option A would risk exposing the child with meningitis to gastroenteritis. Option B involves a child with neutropenia who is immunocompromised and at high risk for infection. Option D may not be ideal as the child recovering from an appendectomy may have a weakened immune system and could be at risk for acquiring gastroenteritis. Placing the child with another case of gastroenteritis minimizes the risk of spreading the infection and ensures appropriate care and isolation measures are in place.
Question 3 of 5
The nurse is teaching the parents of a 4-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feeding and not letting the infant go to sleep with the bottle. Which disorder is associated with propped feedings and going to sleep with the bottle?
Correct Answer: A
Rationale: The correct answer is A: Otitis media. Propped feedings and letting the baby sleep with a bottle can lead to increased risk of otitis media, an ear infection. When a baby is propped up during feeding, there is a greater chance of liquid entering the middle ear through the Eustachian tube, leading to infection. All other choices (B: Aspiration, C: Malocclusion problems, D: Sleeping disorders) are not directly associated with propped feedings and bottle sleeping in infants.
Question 4 of 5
A mother asks when toilet training is most appropriately initiated. What would be the nurse’s best response?
Correct Answer: B
Rationale: The correct answer is B because toilet training should be initiated when the child shows signs of physical and psychological readiness, such as staying dry for longer periods, showing interest in using the toilet, and being able to communicate their needs. This approach ensures a more successful and less stressful toilet training experience for both the child and the parent. Choice A is incorrect because starting toilet training based solely on age may not align with the child's individual readiness. Choice C is incorrect as walking ability does not necessarily indicate readiness for toilet training. Choice D is incorrect because the ability to sit on the potty for a specific time does not guarantee readiness for toilet training.
Question 5 of 5
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is 'too wet.' The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following?
Correct Answer: D
Rationale: The correct initial nursing action is D: Apply direct pressure above catheterization site. This is the correct answer because applying direct pressure above the catheterization site will help control the bleeding and prevent further blood loss. Here is a step-by-step rationale: 1. Direct pressure is the first-line intervention for controlling bleeding. 2. It helps to promote clot formation and stop the bleeding. 3. Placing the child in Trendelenburg position is not indicated and can potentially worsen the situation by increasing blood flow to the site. 4. Applying a new bandage with more pressure can disrupt any clot formation and is not recommended as the first action. 5. Notifying the physician is important but should not be the initial action when dealing with active bleeding.