ATI LPN
Immune System Practice Questions Questions
Question 1 of 5
The most common type of leukaemia in adults over 55 is:
Correct Answer: D
Rationale: The correct answer is D: Chronic lymphocytic leukaemia (CLL). CLL is the most common type of leukaemia in adults over 55, characterized by the slow accumulation of abnormal lymphocytes in the blood and bone marrow. This type of leukaemia typically progresses slowly and may not require immediate treatment. Rationale: 1. Age group: CLL predominantly affects older adults, making it the most common type of leukaemia in individuals over 55. 2. Chronic nature: CLL is a chronic leukaemia, characterized by a slow progression of the disease. 3. Lymphocytic origin: CLL involves abnormal lymphocytes, which are a type of white blood cell. Summary: A: Acute lymphatic leukaemia (ALL) is more common in children and young adults. B: Acute myeloid leukaemia (AML) is more common in older adults but not the most common in individuals over 55. C: Chronic myeloid
Question 2 of 5
What is the best way for the nurse to detect fluid retention in a child with nephrotic syndrome who has not yet been toilet-trained?
Correct Answer: A
Rationale: The correct answer is A: Weigh the child daily. Daily weight monitoring is essential in detecting fluid retention in a child with nephrotic syndrome as it is a sensitive indicator of changes in fluid status. Fluid retention can lead to weight gain, indicating a worsening condition. Checking urine for blood (B) is more relevant for detecting renal issues, not fluid retention. Measuring abdominal girth weekly (C) may not be as sensitive or specific as daily weight monitoring. Counting the number of wet diapers (D) is more relevant for assessing hydration status rather than fluid retention. In summary, daily weight monitoring is the most accurate and sensitive method for detecting fluid retention in this scenario.
Question 3 of 5
The nurse should expect to administer this drug for a sickle cell pain crisis:
Correct Answer: A
Rationale: The correct answer is A: Morphine sulfate. Morphine is the preferred analgesic for severe pain in sickle cell crisis due to its potent pain-relieving effects. It works by binding to opioid receptors in the brain, reducing pain perception. Meperidine (B) is not recommended due to its toxic metabolite accumulation in renal impairment. Acetaminophen (C) and Ibuprofen (D) are not sufficient for managing severe pain in a sickle cell crisis.
Question 4 of 5
The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which nursing intervention is a priority for this child?
Correct Answer: B
Rationale: The correct answer is B: Maintenance of skin integrity. For a child with DIC, skin integrity is a priority due to the risk of bleeding and clotting. Skin breakdown can lead to infection and further complications. Monitoring fluid restriction (choice C) may be important, but skin integrity takes precedence. Frequent ambulation (choice A) may be beneficial but not as crucial as maintaining skin integrity. Preparation for x-ray procedures (choice D) is not a priority compared to preventing skin breakdown in a child with DIC.
Question 5 of 5
A client with disseminated intravascular coagulation (DIC) has a nursing diagnosis of Impaired Gas Exchange. Which action is inappropriate when providing care based on this nursing diagnosis?
Correct Answer: A
Rationale: Correct answer: A. Placing the client in a low-Fowler position is inappropriate because it can worsen gas exchange in a client with DIC. Rationale: 1. In DIC, impaired gas exchange is often due to microthrombi formation in the lungs, leading to ventilation-perfusion mismatch. 2. Placing the client in a low-Fowler position can further compromise ventilation by decreasing lung expansion and worsening perfusion. 3. Monitoring oxygen saturation continuously (B) is essential in assessing gas exchange status. 4. Maintaining bed rest (C) helps reduce oxygen demand and prevent complications from movement. 5. Encouraging deep breathing and coughing (D) can help maintain lung expansion and prevent atelectasis. In summary, placing the client in a low-Fowler position is inappropriate as it can worsen gas exchange, while monitoring oxygen saturation, maintaining bed rest, and promoting deep breathing and coughing are appropriate interventions for a client with DIC and impaired gas exchange.