a nurse is preparing to administer a dose of platelets to a client which of the following actions must the nurse perform before giving the platelets

NCLEX-RN

Safe and Effective Care Environment NCLEX RN Questions

1. A healthcare professional is preparing to administer a dose of platelets to a client. Which of the following actions must the healthcare professional perform before giving the platelets?

A. Start an IV of 0.9% Normal Saline to administer with the platelets
B. Ensure the container with the platelets is intact and not damaged
C. Verify the client's identity using two unique identifiers
D. Check the client's chart to ensure no contraindications to platelet transfusion

Correct answer: B

Rationale: Before administering platelets, it is crucial to check the integrity of the container holding the blood product. An intact container ensures the sterility and safety of the platelets, minimizing the risk of contamination or infection. Option A is incorrect as administering platelets typically does not require starting a new IV line unless indicated for the specific patient. Option C is not the priority as verifying the client's identity can be done at any point during the administration process but is not specific to the platelet transfusion itself. Option D, checking the client's chart for antibiotic use, is not directly related to ensuring the safety of the blood product container.

2. Where is the duodenum located in the digestive system?

A. It is the first part of the small intestine, located immediately after the stomach.
B. It is the section of the digestive system where the gall bladder delivers bile.
C. It is the section of the small intestine where the pancreas delivers digestive juices.
D. None of the above.

Correct answer: D

Rationale: The duodenum is the first part of the small intestine, located immediately after the stomach. It is where the majority of digestion takes place in the gut. The pancreas delivers digestive juices containing amylase and lipase, while the gall bladder delivers bile to aid in the digestion of fats. Choice A incorrectly states that the duodenum is the third section of the small intestine, which is inaccurate. Choice B incorrectly associates the duodenum with the gall bladder, which is not where the duodenum is located. Choice C incorrectly states that the duodenum is where the pancreas delivers digestive juices, which is partly correct but not the main function of the duodenum. Therefore, the correct answer is 'None of the above' as none of the choices accurately describe the location or functions of the duodenum.

3. Which of these guidelines would a healthcare professional follow when measuring a patient's weight?

A. The patient is always weighed wearing only undergarments.
B. The type of scale matters and should be consistent day to day.
C. The patient should remove heavy outer clothing, shoes, and jackets before weighing.
D. Attempts should be made to weigh the patient at approximately the same time of day if a sequence of weights is necessary.

Correct answer: D

Rationale: When measuring a patient's weight, it is important to ensure accuracy and consistency. If a sequence of repeated weights is necessary, the healthcare professional should attempt to weigh the patient at the same time of day and with the same types of clothing worn each time. It is crucial to use a standardized balance or electronic standing scale for accurate weight measurement. Choice A is incorrect as patients should remove heavy outer clothing, shoes, and jackets before being weighed for accurate results. Choice B is incorrect because the type of scale used does matter and should be consistent for reliable weight tracking. Choice C is incorrect as patients should not leave on heavy outer clothing, shoes, or jackets as these items can add to the weight recorded inaccurately.

4. Which of the following bony landmarks is described as a large, blunt, irregularly shaped process found on the lateral aspect of the proximal femur?

A. Tubercle
B. Tuberosity
C. Condyle
D. Trochanter

Correct answer: D

Rationale: The correct answer is D: Trochanter. The Greater Trochanter is located on the lateral aspect of the proximal femur and is a large, blunt, irregularly shaped bony process. It serves as an important attachment site for many muscles of the legs, providing leverage and movement. Choice A, Tubercle, is a small rounded projection, usually for the attachment of a ligament or tendon. Choice B, Tuberosity, is a large rounded projection, also typically for muscle attachment. Choice C, Condyle, refers to a rounded articular surface at the end of a bone, usually involved in joints.

5. Which of the following is an example of physical abuse?

A. A slap to the person's hand
B. Threatening the person
C. Ignoring and isolating a person
D. Leaving a patient soiled for hours

Correct answer: A

Rationale: The correct answer is 'A slap to the person's hand.' Slapping, hitting, and punching are clear examples of physical abuse. Physical abuse involves actions that can cause physical harm or injury to a person. Choice B, 'Threatening the person,' falls under the category of emotional or psychological abuse, where threats can cause fear and emotional distress but do not involve physical harm. Choice C, 'Ignoring and isolating a person,' is a form of neglect or emotional abuse, not physical abuse. Choice D, 'Leaving a patient soiled for hours,' is an example of neglect or lack of proper care, which is also not classified as physical abuse.