ATI LPN
Multiple Choice Questions on Immune System Questions
Question 1 of 5
A nurse is caring for a toddler who has a Wilms’ tumor. Which of the following should be included in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Preparation for surgery. Surgery is the primary treatment for Wilms' tumor in children. The rationale includes removing the tumor and affected kidney to prevent spread. The other choices are incorrect because: A: Abdominal palpation can cause tumor rupture. C: Teaching about dialysis is not typically needed for Wilms' tumor. D: Obtaining a 24-hr urine specimen is not a priority in the immediate care plan.
Question 2 of 5
The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine?
Correct Answer: A
Rationale: The presence of blood in the urine (hematuria) is a common indicator of glomerulonephritis due to inflammation of the glomeruli in the kidneys, causing leakage of red blood cells into the urine. White blood cells and glucose are typically not associated with this condition. Albumin is commonly seen in conditions like nephrotic syndrome, not necessarily in glomerulonephritis. In summary, observing blood in the urine is crucial for detecting glomerulonephritis, as it indicates kidney inflammation and damage.
Question 3 of 5
A nurse is reviewing a patient’s chart and notices that the child suffers from a urinary tract infection. Which of the following microorganisms is related to this condition?
Correct Answer: C
Rationale: The correct answer is C: Escherichia coli. E. coli is a common cause of urinary tract infections due to its ability to colonize the urinary tract and cause infection. It is a gram-negative bacterium commonly found in the gut. Clostridium botulinum causes botulism, Corynebacterium diphtheriae causes diphtheria, and Helicobacter pylori causes stomach ulcers, not urinary tract infections. E. coli's presence in the urinary tract can lead to inflammation and infection, making it the correct choice in this scenario.
Question 4 of 5
The nurse is planning postoperative care for an infant after a cleft-lip repair. Which nursing intervention is most appropriate for this infant?
Correct Answer: C
Rationale: The correct answer is C: Supine or side-lying positioning. This positioning helps prevent trauma to the surgical site, promotes comfort, and facilitates optimal healing. Prone positioning (A) may increase the risk of pressure on the surgical area. Suctioning with a Yankauer device (B) is not indicated unless necessary for airway clearance. Avoiding soft elbow restraints (D) is not directly related to cleft-lip repair care.
Question 5 of 5
A child experienced a lacerated spleen in a motor vehicle accident. Which is the highest-priority nursing intervention on admission to the pediatric intensive care unit (PICU) following surgery?
Correct Answer: A
Rationale: The correct answer is A: Observing for signs of hypovolemic shock. This is the highest-priority nursing intervention because a lacerated spleen can lead to severe internal bleeding and hypovolemic shock, which is a life-threatening condition. Monitoring for signs such as tachycardia, hypotension, pallor, and altered mental status is crucial for early detection and prompt intervention. Maintaining IV fluids (B) is important, but monitoring for shock takes precedence. Implementing strict bedrest (C) may be necessary, but it is not the highest priority. Administering blood products (D) may be needed, but assessing for shock comes first to guide the need for blood products.