NCLEX-PN
Immune System NCLEX Questions Questions
Extract:
Question 1 of 5
The charge nurse observes the primary nurse interacting with a client. Which action by the primary nurse warrants immediate intervention by the charge nurse?
Correct Answer: C
Rationale: Administering medication without checking allergies risks allergic reactions, requiring immediate intervention. Diuretic explanation, glove use, and UAP assistance are appropriate.
Question 2 of 5
The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention?
Correct Answer: D
Rationale: Congested cough and dysphagia indicate potential airway and swallowing issues, requiring immediate intervention to prevent aspiration or respiratory distress. Neurological symptoms like speech issues, diplopia, scotomas, weakness, and spasticity are expected in MS but less acute.
Question 3 of 5
The client diagnosed with multiple sclerosis is scheduled for a magnetic resonance imaging (MRI) scan of the head. Which information should the nurse teach the client about the test?
Correct Answer: B
Rationale: MRI machines are loud, and head immobility is critical for clear images. Wires/lights describe EEG, oral contrast is not used for brain MRI, and the test is not repeated over hours.
Question 4 of 5
Which priority client problem should be included in the care plan for the client diagnosed with Guillain-Barré syndrome?
Correct Answer: D
Rationale: Ascending paralysis in Guillain-Barré syndrome risks respiratory muscle involvement, making ineffective breathing pattern the priority. Injury, anxiety, and nutrition are secondary.
Question 5 of 5
The client diagnosed with an acute exacerbation of SLE is prescribed high-dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE?
Correct Answer: C
Rationale: Steroids suppress inflammation in SLE, reducing organ damage. They do not fight infection, prevent disease spread, or address skin scarring primarily.