ATI LPN
Foundations and Adult Health Nursing Test Bank
Chapter 55 Questions
Question 1 of 5
Which situation is an example of immunocompetence?
Correct Answer: C
Rationale: Immunocompetence is demonstrated by the immune system responding appropriately to a foreign stimulus and the body's integrity is maintained as with cold symptoms that resolve without residual illness.
Question 2 of 5
An anxious patient enters the emergency room with angioedema of the lips and tongue, dyspnea, urticaria, and wheezing after having eaten a peanut butter sandwich. Which action will be the nurse's first intervention?
Correct Answer: B
Rationale: Provision of oxygen is the initial primary intervention. Anaphylaxis may advance very rapidly and the patient may have to be intubated. Covering the patient with a warm blanket is not wrong, but not an initial intervention.
Question 3 of 5
What is the etiology of autoimmune diseases based on?
Correct Answer: D
Rationale: Autoimmune disorders are failures of the tolerance to 'self.' B and T cells produce autoantibodies that can cause pathophysiologic tissue damage. Autoimmune disorders may be described as an immune attack on the self and result from the failure to distinguish 'self' protein from 'foreign' protein.
Question 4 of 5
A patient is admitted with a secondary immunodeficiency from chemotherapy. The nurse expects the plan of care to focus on which aspect?
Correct Answer: A
Rationale: Immune deficient persons are at risk for infection and need to be protected aggressively for contagion.
Question 5 of 5
The nurse takes into consideration that when the antigen and antibody react, the complement system is activated. This results in which activity?
Correct Answer: C
Rationale: The complement system is a group of plasma proteins that are dormant until there is an antigen-antibody interaction. The proteins destroy the cell membrane and attract phagocytes.