ATI Targeted Med-Surg Practice Assessment Immune System Questions Answered 100% Correct + Rationale

ATI Targeted Med-Surg Practice Assessment Immune System Questions Answered 100% Correct + Rationale

a A nurse is caring for a client who has neutropenia. Which of the following findings indicates a need for intervention?

A. The client's granddaughter is visiting and telling him about her first day of kindergarten

B. The client has a grilled cheese sandwich, a banana, and yogurt on his lunch tray

C. The client's family brings in a silk flower arrangement

D. The client's assistive personnel places paper cups and plastic utensils in his room

[Correct Ans:- A. The client's granddaughter is visiting and telling him about her first day of kindergarten

The client's grandchild is visiting and telling the client about the first day of kindergarten.MY ANSWERThe nurse should limit the client's visitors to healthy adults. A visit from a child who is attending school can place the client at risk for infection due to the client's immunocompromised status.

The client has a grilled ham and cheese sandwich, a banana, and yogurt on their lunch tray.The nurse should recognize that these foods are part of a low-bacteria diet and are acceptable for a client who is immunocompromised.

The client's family brings in a silk flower arrangement.The nurse should recognize that the client can have an artificial flower arrangement because it does not pose a risk of infection.

The client's assistive personnel places paper cups and plastic utensils in the client's room.The nurse should ensure that the client is provided with individually-wrapped paper and plastic utensils.

A nurse is teaching the parent of a child about administration guidelines for the HPV vaccine. Which of the following information should the nurse include?

A. One does is administered at birth and another is administered at age 5

B. the vaccine does not protect males

C. The vaccine protects against chlamydia

D. Three doses are administered to adolescents who start after age 15

[Correct Ans:- D. Three doses are administered to adolescents who start after age 15

One dose is administered at birth and another is administered at age 5.The nurse should inform the parent that the HPV vaccine is recommended for children beginning at 11 or 12 years of age.

The vaccine does not protect males.The nurse should inform the parent that the HPV vaccine is equally effective for both males and females.

The vaccine protects against chlamydia.The nurse should inform the parent that the HPV vaccine is not effective against chlamydia.

Three doses are administered to adolescents who start the series after age 15.MY ANSWERThe nurse should inform the parent that the HPV vaccine is recommended for children beginning at age 11 or 12 years. Children who receive the first dose before age 15 should receive two doses of the HPV vaccine. Adolescents who receive the first dose after age 15 should receive three doses of the HPV vaccine.

A nurse is providing teaching to a client who has rheumatoid arthritis and reports persistent pain. Which of the following responses should the nurse make?

A. Take a cool bath in the evening

B. Exercise every other day

C. Use pillows to support your joints while in bed

D. Ask a friend or family member to help with household chores

[Correct Ans:- D. Ask a friend or family member to help with household chores

"Take a cool bath in the evening."The nurse should instruct the client to take a warm shower instead of a tub bath due to the difficulty the client can experience getting in and out of the tub. A warm shower can also relax muscles and reduce pain.

"Exercise every other day."The nurse should instruct the client to exercise daily but to balance activity with rest.

"Use pillows to support your joints while in bed."The nurse should instruct the client to use only one small pillow, placed behind the head, while in bed to prevent flexion contractures.

"Ask a friend or a family member to help with household chores."MY ANSWERThe nurse should instruct the client to allow others to assist with household chores to reduce the risk for joint injury and to give the client the opportunity to rest.

A nurse is providing teaching to a client who has an allergy to peanuts. Which of the following instructions is the priority to include in the teaching?

A. Inform other healthcare professionals of the allergy

B. Wear a medical identification tag

C. Carry an emergency anaphylaxis kit

D. Keep a food diary

[Correct Ans:- C. Carry an emergency anaphylaxis kit

Inform other health care professionals of the allergy.The nurse should instruct the client to inform other health care professionals of the allergy. However, this is not the priority instruction to include in the teaching.

Wear a medical identification tag.The nurse should instruct the client to wear a medical identification tag. However, this is not the priority instruction to include in the teaching.

Carry an emergency anaphylaxis kit.MY ANSWERThe greatest risk to the client is injury or death from an anaphylactic reaction. Therefore, the priority instruction for the client is to be prepared for emergency treatment by carrying an emergency anaphylaxis kit.

Keep a food diary.The nurse should instruct the client to keep a food diary to identify other food allergies. However, this is not the priority instruction to include in the teaching.

A nurse is providing teaching to a client who has systemic lupus erythematosus. Which of the following statements by the client indicates an understanding of the teaching?

A. I should use a sunscreen with an SPF of at least 15

B. Long-term immunosuppressive therapy could cure this disease

C. I should wear gloves when it is cold outside

D. SLE should not affect my lungs or breathing

[Correct Ans:- C. I should wear gloves when it is cold outside

The client should select a sunscreen with an SPF of at least 30.

"Long-term immunosuppressive therapy could cure this disease."SLE is a lifelong chronic autoimmune disease.

"I should wear gloves when it is cold outside."Raynaud's phenomenon commonly accompanies SLE and can cause painful vasoconstriction in the client's fingers when exposed to cold temperatures.

"SLE should not affect my lungs or breathing."SLE can affect all of a client's body systems. Therefore, SLE can cause pleural effusions and pneumonia.