NCLEX Questions on Immune System
Home / Nursing & Allied Health Certifications / NCLEX PN / Immune System
Question 1 of 5.
The client has had an anaphylactic reaction to insect venom, a bee sting. Which discharge instruction should the nurse discuss with the client?
A. Take a corticosteroid dose pack when stung by a bee.
B. Take antihistamines prior to outdoor activities.
C. Use a cromolyn sodium (Intal) inhaler prophylactically.
D. Carry a bee sting kit, especially when going outside.
Explanation: Carrying a bee sting kit (EpiPen) is critical for managing future anaphylaxis. Steroids, antihistamines, and cromolyn are less effective prophylactically.
Question 2 of 5.
The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two (2) times in the month. Which question is most important for the nurse to ask the client?
A. Have you experienced any difficulty with your menstrual cycle?
B. Have you noticed a rash across the bridge of your nose?
C. Do you get tired easily and sometimes have problems swallowing?
D. Are you taking birth control pills to prevent conception?
Explanation: Fatigue and dysphagia are MS symptoms, and their presence supports the diagnosis. Menstrual issues, rashes (SLE-related), and birth control are less relevant to MS.
Question 3 of 5.
The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance?
A. The client refuses to have a gastrostomy feeding.
B. The client wants to discuss if she should tell her fiancé.
C. The client tells the nurse life is not worth living anymore.
D. The client needs the flu and pneumonia vaccines.
Explanation: Suicidal ideation indicates a mental health crisis, requiring immediate intervention. Gastrostomy refusal, disclosure to fiancé, and vaccines are less urgent.
Question 4 of 5.
The nurse writes the client problem of 'altered sexual functioning' for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented?
A. Encourage the couple to explore alternative ways of maintaining intimacy.
B. Make an appointment with a psychotherapist to counsel the couple.
C. Explain daily exercise will help increase libido and sexual arousal.
D. Discuss the importance of keeping physically calm during sexual intercourse.
Explanation: Exploring alternative intimacy methods addresses MS-related sexual dysfunction holistically. Psychotherapy is secondary, exercise may not improve libido, and physical calm is vague.
Question 5 of 5.
Which assessment intervention should the nurse implement specifically for the diagnosis of Guillain-Barré syndrome?
A. Assess deep tendon reflexes.
B. Complete a Glasgow Coma Scale.
C. Check for Babinski's reflex.
D. Take the client's vital signs.
Explanation: Decreased deep tendon reflexes are a hallmark of Guillain-Barré syndrome due to peripheral nerve involvement. Glasgow Coma Scale, Babinski's reflex, and vital signs are less specific.
Related Questions