ATI LPN
Assessment of Hematologic System NCLEX Questions Questions
Question 1 of 5
Immune cells within the lymphatic circulation are directly deposited into which of the following anatomical sites so that the cells may reenter the bloodstream?
Correct Answer: B
Rationale: Step-by-step rationale: 1. Immune cells exit lymphatic circulation via thoracic duct. 2. Thoracic duct empties into left subclavian vein. 3. Immune cells reenter bloodstream through left subclavian vein. 4. Therefore, B (left subclavian vein) is correct. Summary: A: The right aorta does not connect to lymphatic circulation. C: The left carotid artery carries blood to the brain, not lymph. D: High endothelial venule is within lymph nodes, not the bloodstream.
Question 2 of 5
Which organ is adversely affected in hemolytic anemia? Select one that does not apply.
Correct Answer: C
Rationale: In hemolytic anemia, the red blood cells are destroyed prematurely, leading to an increased workload for the spleen as it tries to remove these damaged cells. The correct answer is C, the Small intestine. This is because the small intestine is not directly involved in the clearance or processing of red blood cells, unlike the spleen, liver, and bladder. The spleen and liver play key roles in recycling components of red blood cells, while the bladder is not involved in the process at all. Therefore, the small intestine is the organ that is least likely to be adversely affected in hemolytic anemia.
Question 3 of 5
A nurse is monitoring a client who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hr?
Correct Answer: A
Rationale: The correct answer is A: Ventricular dysrhythmias. After a myocardial infarction, the heart is at risk for arrhythmias due to damaged tissue and electrical instability. Monitoring for dysrhythmias is crucial to prevent life-threatening complications. Cardiogenic shock (B) typically occurs later, not within the first 24 hours. Pulmonary edema (C) is a potential complication but usually presents a bit later. Pericarditis (D) is also a potential complication but typically occurs days to weeks after a myocardial infarction.
Question 4 of 5
A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral arterial disease. Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A: Dry, pale skin with minimal body hair. In peripheral arterial disease, there is reduced blood flow to the extremities, leading to decreased oxygen and nutrients reaching the skin and hair follicles, resulting in dry, pale skin and reduced body hair. The lack of blood flow causes skin to appear pale due to reduced oxygenation. Additionally, decreased blood flow can lead to reduced hair growth. Choices B, C, and D are incorrect. Warm, red skin is more indicative of inflammation or infection. Swollen ankles are often seen in conditions such as heart failure or venous insufficiency. Thickened toenails are commonly seen in fungal infections or trauma to the nails.
Question 5 of 5
A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mm Hg, heart rate 102/min, respirations 22/min, and SpO2 95%. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Administer antihypertensive medication for blood pressure. Step-by-step rationale: 1. An abdominal aortic aneurysm is a serious condition that can lead to rupture if not managed properly. 2. The client's elevated blood pressure of 160/98 mm Hg can increase the risk of rupture. 3. Administering antihypertensive medication can help lower the blood pressure and reduce the risk of rupture. 4. By managing the blood pressure, the nurse is helping to stabilize the client before surgery. Summary of other choices: B: Increasing IV fluids may not directly address the elevated blood pressure and can potentially worsen the situation. C: Monitoring without intervention may lead to a missed opportunity to prevent a potential rupture. D: Administering oxygen is not the priority action in this scenario; addressing the elevated blood pressure is crucial.