ATI LPN
Immune System Practice Questions Questions
Question 1 of 5
The nurse should expect to administer this drug for a sickle cell pain crisis:
Correct Answer: A
Rationale: The correct answer is A: Morphine sulfate. Morphine is the preferred analgesic for severe pain in sickle cell crisis due to its potent pain-relieving effects. It works by binding to opioid receptors in the brain, reducing pain perception. Meperidine (B) is not recommended due to its toxic metabolite accumulation in renal impairment. Acetaminophen (C) and Ibuprofen (D) are not sufficient for managing severe pain in a sickle cell crisis.
Question 2 of 5
A client with disseminated intravascular coagulation (DIC) has a nursing diagnosis of Impaired Gas Exchange. Which action is inappropriate when providing care based on this nursing diagnosis?
Correct Answer: A
Rationale: Correct answer: A. Placing the client in a low-Fowler position is inappropriate because it can worsen gas exchange in a client with DIC. Rationale: 1. In DIC, impaired gas exchange is often due to microthrombi formation in the lungs, leading to ventilation-perfusion mismatch. 2. Placing the client in a low-Fowler position can further compromise ventilation by decreasing lung expansion and worsening perfusion. 3. Monitoring oxygen saturation continuously (B) is essential in assessing gas exchange status. 4. Maintaining bed rest (C) helps reduce oxygen demand and prevent complications from movement. 5. Encouraging deep breathing and coughing (D) can help maintain lung expansion and prevent atelectasis. In summary, placing the client in a low-Fowler position is inappropriate as it can worsen gas exchange, while monitoring oxygen saturation, maintaining bed rest, and promoting deep breathing and coughing are appropriate interventions for a client with DIC and impaired gas exchange.
Question 3 of 5
The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child?
Correct Answer: C
Rationale: The correct answer is C: A white pupil. Retinoblastoma is a malignant tumor of the retina that can present as a white pupil in flash photography, known as leukocoria. This is due to the tumor blocking the normal red reflex from the retina. A red reflex (choice A) is a normal finding and not expected in retinoblastoma. Yellow sclera (choice B) and blue-tinged sclera (choice D) are not typically associated with retinoblastoma.
Question 4 of 5
A nurse enters the room of a teenager after the physician has obtained informed consent for a voiding cystourethrogram. The teenager asks the nurse to explain the procedure again. The nurse tells the client that the client is asked to void after:
Correct Answer: C
Rationale: The correct answer is C: Injection of contrast dye into the bladder via a catheter. In a voiding cystourethrogram, contrast dye is indeed injected into the bladder via a catheter to visualize the urinary tract during voiding. This allows for the assessment of bladder and urethra function. Choices A and D are incorrect because radioisotopes are not typically used in this procedure. Choice B is incorrect as contrast dye is not injected into the bloodstream but rather directly into the bladder. Therefore, the correct answer is C as it accurately describes the procedure for a voiding cystourethrogram.
Question 5 of 5
A nurse is assisting with the admission of a toddler who has nephrotic syndrome. Which of the following objective data should the nurse anticipate collecting from the child?
Correct Answer: A
Rationale: The correct answer is A: Elevated blood pressure. In nephrotic syndrome, there is a loss of protein in the urine, leading to hypoalbuminemia and fluid retention, which can result in elevated blood pressure. This is due to the body's attempt to maintain fluid balance. Option B is incorrect because in nephrotic syndrome, serum cholesterol and fat levels are typically elevated, not lower than normal. Option C is incorrect as 3+ to 4+ protein in the urine is indicative of proteinuria, a common finding in nephrotic syndrome. Option D is incorrect as thin limbs with loose skin are not typically associated with nephrotic syndrome.