ATI RN
Maternity and Pediatric Nursing 4th Edition Test Bank Questions
Question 1 of 5
The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
Correct Answer: C
Rationale: Monitoring body temperature is important in clients with systemic lupus erythematosus (SLE) because fever can indicate an infection or a disease flare-up. Clients with SLE are at higher risk of infections due to their compromised immune system, and fever can be a sign of an underlying issue that needs prompt attention. It is essential for the nurse to educate the client about monitoring body temperature regularly and seeking medical advice if there is a sudden increase in temperature.
Question 2 of 5
The nurse is observing a client receiving antiplatelet therapy for adverse reactions. Antiplatelet drugs most commonly produce which hypersensitivity reaction?
Correct Answer: C
Rationale: Antiplatelet drugs most commonly produce bronchospasm as a hypersensitivity reaction. This adverse reaction occurs due to the release of bronchoconstrictive mediators, leading to narrowing of the airways and potentially causing respiratory distress. It is important for nurses to closely monitor clients receiving antiplatelet therapy for signs of bronchospasm, such as wheezing, shortness of breath, and chest tightness, and to intervene promptly to prevent further complications. Difficulty hearing, confusion, and agranulocytosis are not typically associated with antiplatelet therapy.
Question 3 of 5
In an individual with Sjogren's syndrome, nursing care should focus on:
Correct Answer: A
Rationale: Sjogren's syndrome is an autoimmune disorder characterized by dryness of the eyes and mouth due to the destruction of moisture-producing glands. Nursing care for individuals with Sjogren's syndrome should focus on addressing the symptoms related to dryness. Moisture replacement is key in managing dry eyes and dry mouth, which can improve the patient's comfort and quality of life. Strategies for moisture replacement may include the use of artificial tears, saliva substitutes, and humidifiers to maintain adequate hydration and alleviate dryness. Nutritional supplementation, electrolyte balance, and arrhythmia management are not typically the primary focus of nursing care in individuals with Sjogren's syndrome.
Question 4 of 5
The cause of death of most AIDS patients who develop multiple opportunistic infections is/are the following: a.Weakened immune system impairs response to therapy
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 5 of 5
A child is to receive a blood transfusion, if an allergic reaction to the blood occurs, the nurse's first intervention should be:
Correct Answer: C
Rationale: In the scenario of a child experiencing an allergic reaction during a blood transfusion, the nurse's first intervention should always be to stop the blood immediately. This is crucial to prevent further complications and adverse reactions in the child. Pausing the transfusion allows for assessment of the allergic reaction's severity, immediate treatment initiation, and alerting the healthcare team for further management. Relieving symptoms with antihistamines or slowing the flow rate would not address the primary concern of stopping the allergen from entering the child's system. Therefore, stopping the blood immediately is the most appropriate and urgent action to take in this situation.