ATI LPN
Assessment of Hematologic System NCLEX Questions Questions
Question 1 of 5
Nursing care of the child with Kawasaki disease is challenging because of:
Correct Answer: A
Rationale: The correct answer is A because Kawasaki disease is characterized by high fever, irritability, and mucous membrane changes. The child's irritability can make nursing care challenging due to difficulties in assessing and managing their symptoms and needs effectively. The other choices are incorrect because: B - Kawasaki disease has an unpredictable course with potential complications; C - Antibiotics are not the primary treatment for Kawasaki disease; D - Requests for food are not typically a significant challenge in caring for a child with this condition. In summary, the correct answer highlights the primary symptom that can complicate nursing care, while the other choices are not directly related to the challenges of managing Kawasaki disease.
Question 2 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 3 of 5
The nurse is aware that blood type O is considered the universal donor. This means all patients can receive blood type O. Knowing this, which of the following blood can be administered to which patient. (Select all that apply.)
Correct Answer: A
Rationale: Step 1: Blood type O is considered the universal donor because it lacks A and B antigens on its red blood cells. Step 2: A patient with blood type A can receive blood type A (as it matches) and blood type O (since O lacks A and B antigens). Step 3: Therefore, the correct answer is A, as patients with blood type A can receive blood type A and O. Summary: Choice A is correct because patients with blood type A can receive blood type A and O due to the compatibility of antigens. Choices B, C, and D are incorrect because they do not consider the antigen compatibility and restrictions of blood types.
Question 4 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 5 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.