A.) inhaled albuterol
GRADE A+ NCLEX Immune B.) intramuscular epinephrine
C.) intravenous methylprednisone
Questions and Rationales with ans Rationale: Call for help is first action
maintain airway, administer high flow o2 mask
2025 epinephrine, intramuscular should be next
elevate the legs
resuscitation with IV fluids
Bronchodilator (albuterol)
Antihistamine (diphenhydramine)
corticosteroids (methylprednisone)
A.) abrupt onset hypertension and headache
a client allergic to bee stings was stung about 20 minutes ago at a Rationale: scleroderma is an overproduction of collagen that
picnic. based on the assessment data, the nurse anticipates which causes tightening and hardening got the skin and connective
immediate actions? select all that apply tissue. progressive disease without. a cure. renal crisis is life
threatening complication that causes malignant hypertension due
A.) inhaled albuterol to the narrowing of the vessels that provide blood to the kidneys.
B.) intramuscular epinephrine early recognition and treatment of renal crisis needs to be treated
C.) intravenous methylprednisone quickly.
D.) intravenous metoprolol
E.) intravenous nitroglycerin
C.) redness at the injection sites and a mild fever are common
Rationale: common side effects of immunizations are a mild fever
the nurse is caring for a client with scleroderma. which assess- and soreness and redness at the injection site. should be instruct-
ment finding indicates the most serious complication of the dis- ed to apply a warm compress to the injection site and taught how
ease and requires priority intervention to correctly calculate the dose of acetaminophen needed for these
symptoms
A.) abrupt onset hypertension and headache
B.) blue and cold fingertips
C.) dry cough and exertion dyspnea A.) we are planning to purchase a vacuum with a high efficiency
D.) heartburn and difficulty swallowing particulate air filter
C.) we should place hypoallergenic covers on our Childs mattress
the nurse just administered routine immunizations to a healthy 15 and pillow
month old. that information should the nurse provide the care- D.) we will dust our furniture with a damp washcloth every week
givers before they leave the clinic
Rationale: interventions to reduce exposure to household and
A.) call the office if the toddlers temperature is higher than 100 F environmental allergens include:
B.) fussiness and anorexia are common for 1 week after immu- installing high efficiency particulate air conditioner filters
nizations
C.) redness at the injection sites and a mild fever are common
D.) the toddlers activity level should be restricted for 24 hours
the nurse is providing education to the parents of a child diag-
nosed with chronic allergic rhinitis that is triggered by dust and
pollen. which of the following statements by the parents indicate
that the teaching has been effective. select all that apply
A.) we are planning to purchase a vacuum with a high efficiency
particulate air filter
B.) we must find a new home for our two family dogs
C.) we should place hypoallergenic covers on our Childs mattress keeping windows closed and staying indoors
and pillow applying hypoallergenic pillow and mattress covers to prevent
D.) we will dust our furniture with a damp washcloth every week exposure to Dust mites
E.) we will keep our windows open during warm weather to air out removing carpet/area rugs
the house HEPA filter vacuum
damp dusting furniture at least once a week
the nurse is caring for a client with immune thrombocytopenia pur- C.) I use a safety razor and gently shaving cream
E.) when I have a headache, I take over the counter ibuprofen
port. which client statements induced a need for further teaching.
Select all that apply
1/5
, A.) I use a soft bristle toothbrush and mild mouth rinse
Rationale: ITP is an autoimmune disease in which antibodies
B.) I enjoy walking and wear nonskid footwear for safety
destroy platelets. increased risk for bleeding. use soft bristled
C.) I use a safety razor and gently shaving cream
toothbrushes. avoid activities that may cause trauma. low impact
D.) sometimes I get constipated, also I have been taking docusate
activity while wearing nonskid shoes. take stool softeners and
E.) when I have a headache, I take over the counter ibuprofen
laxatives as needed, helps prevent straining and fissuring that
causes bleeding. clients should avoid NSAIDS, which further im-
the nurse cares for a client with an exacerbation of inflammatory
pair platelet functioning
bowel disease (IBD). the client tells the nurse about being infected
with tuberculosis (TB) 10 years ago but never being medicated.
which prescription is of concern and prompt the nurse to notify C.) prednisone
the health care provider (HCP).
Rationale: malignancy, immunosuppressant medications, includ-
2/5
GRADE A+ NCLEX Immune B.) intramuscular epinephrine
C.) intravenous methylprednisone
Questions and Rationales with ans Rationale: Call for help is first action
maintain airway, administer high flow o2 mask
2025 epinephrine, intramuscular should be next
elevate the legs
resuscitation with IV fluids
Bronchodilator (albuterol)
Antihistamine (diphenhydramine)
corticosteroids (methylprednisone)
A.) abrupt onset hypertension and headache
a client allergic to bee stings was stung about 20 minutes ago at a Rationale: scleroderma is an overproduction of collagen that
picnic. based on the assessment data, the nurse anticipates which causes tightening and hardening got the skin and connective
immediate actions? select all that apply tissue. progressive disease without. a cure. renal crisis is life
threatening complication that causes malignant hypertension due
A.) inhaled albuterol to the narrowing of the vessels that provide blood to the kidneys.
B.) intramuscular epinephrine early recognition and treatment of renal crisis needs to be treated
C.) intravenous methylprednisone quickly.
D.) intravenous metoprolol
E.) intravenous nitroglycerin
C.) redness at the injection sites and a mild fever are common
Rationale: common side effects of immunizations are a mild fever
the nurse is caring for a client with scleroderma. which assess- and soreness and redness at the injection site. should be instruct-
ment finding indicates the most serious complication of the dis- ed to apply a warm compress to the injection site and taught how
ease and requires priority intervention to correctly calculate the dose of acetaminophen needed for these
symptoms
A.) abrupt onset hypertension and headache
B.) blue and cold fingertips
C.) dry cough and exertion dyspnea A.) we are planning to purchase a vacuum with a high efficiency
D.) heartburn and difficulty swallowing particulate air filter
C.) we should place hypoallergenic covers on our Childs mattress
the nurse just administered routine immunizations to a healthy 15 and pillow
month old. that information should the nurse provide the care- D.) we will dust our furniture with a damp washcloth every week
givers before they leave the clinic
Rationale: interventions to reduce exposure to household and
A.) call the office if the toddlers temperature is higher than 100 F environmental allergens include:
B.) fussiness and anorexia are common for 1 week after immu- installing high efficiency particulate air conditioner filters
nizations
C.) redness at the injection sites and a mild fever are common
D.) the toddlers activity level should be restricted for 24 hours
the nurse is providing education to the parents of a child diag-
nosed with chronic allergic rhinitis that is triggered by dust and
pollen. which of the following statements by the parents indicate
that the teaching has been effective. select all that apply
A.) we are planning to purchase a vacuum with a high efficiency
particulate air filter
B.) we must find a new home for our two family dogs
C.) we should place hypoallergenic covers on our Childs mattress keeping windows closed and staying indoors
and pillow applying hypoallergenic pillow and mattress covers to prevent
D.) we will dust our furniture with a damp washcloth every week exposure to Dust mites
E.) we will keep our windows open during warm weather to air out removing carpet/area rugs
the house HEPA filter vacuum
damp dusting furniture at least once a week
the nurse is caring for a client with immune thrombocytopenia pur- C.) I use a safety razor and gently shaving cream
E.) when I have a headache, I take over the counter ibuprofen
port. which client statements induced a need for further teaching.
Select all that apply
1/5
, A.) I use a soft bristle toothbrush and mild mouth rinse
Rationale: ITP is an autoimmune disease in which antibodies
B.) I enjoy walking and wear nonskid footwear for safety
destroy platelets. increased risk for bleeding. use soft bristled
C.) I use a safety razor and gently shaving cream
toothbrushes. avoid activities that may cause trauma. low impact
D.) sometimes I get constipated, also I have been taking docusate
activity while wearing nonskid shoes. take stool softeners and
E.) when I have a headache, I take over the counter ibuprofen
laxatives as needed, helps prevent straining and fissuring that
causes bleeding. clients should avoid NSAIDS, which further im-
the nurse cares for a client with an exacerbation of inflammatory
pair platelet functioning
bowel disease (IBD). the client tells the nurse about being infected
with tuberculosis (TB) 10 years ago but never being medicated.
which prescription is of concern and prompt the nurse to notify C.) prednisone
the health care provider (HCP).
Rationale: malignancy, immunosuppressant medications, includ-
2/5
