NCLEX-PN
Immune System NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse and a female unlicensed assistive personnel (UAP) are caring for a group of clients on a medical floor. Which action by the UAP warrants immediate intervention by the nurse?
Correct Answer: B
Rationale: Sterile gloves are unnecessary for catheter removal, risking improper technique and infection. Handwashing, Fowler’s position, and ice bag use are appropriate.
Question 2 of 5
Which assessment data should the nurse assess in the client diagnosed with Guillain-Barré syndrome?
Correct Answer: D
Rationale: Guillain-Barré syndrome presents with ascending paralysis and numbness due to peripheral nerve demyelination. Startle reflex, rigidity, and facial pain suggest other conditions.
Question 3 of 5
The client is known to be HIV positive. Which data indicate to the nurse that the client has now progressed to the diagnosis of Acquired Immune Deficiency Syndrome (AIDS)?
Correct Answer: A
Rationale: A CD4 count below 200 defines AIDS in HIV-positive clients. Anemia, infiltrates, and headaches are non-specific.
Question 4 of 5
The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits?
Correct Answer: C
Rationale: Flu and pneumonia vaccines prevent infections, critical in RA due to immunosuppression. X-rays, ESR, and joint assessments are diagnostic, not preventive.
Question 5 of 5
The nurse is caring for the client diagnosed with acquired immunodeficiency syndrome (AIDS) dementia. Which action by the unlicensed assistive personnel (UAP) requires immediate intervention by the nurse?
Correct Answer: B
Rationale: Sterile gloves are unnecessary for bathing, risking improper technique. Sitting, shaving, and massage are appropriate UAP tasks.