the nurse is preparing to administer a unit of packed red blood cells prbcs to a client which action is most important for the nurse to take
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Nursing Elites

HESI RN

HESI RN CAT Exit Exam

1. The nurse is preparing to administer a unit of packed red blood cells (PRBCs) to a client. Which action is most important for the nurse to take?

Correct answer: A

Rationale: Verifying the client's blood type is crucial before administering PRBCs to ensure compatibility and prevent transfusion reactions. Checking the client's blood type is essential in blood transfusions. Ensuring the PRBCs are warm is not a priority as the temperature should be within a specific range regardless of the client's preference. Checking the client's vital signs is important but not as crucial as verifying the blood type before a blood transfusion. Obtaining the client's consent is important for any procedure but does not directly impact the safety and success of administering PRBCs.

2. What instruction is most important for the nurse to provide a female client who has just been diagnosed with trichomoniasis?

Correct answer: B

Rationale: The most important instruction for a female client diagnosed with trichomoniasis is to treat sexual partner(s) concurrently. This is crucial to prevent reinfection and the spread of the infection. Choice A, avoiding douching, is generally recommended for vaginal health but is not the most critical instruction in this case. Choice C, avoiding moist washcloths when bathing, is not directly related to the transmission or treatment of trichomoniasis. Choice D, postponing pregnancy until the infection is treated, is important but treating sexual partners concurrently takes precedence to prevent reinfection.

3. A 24-year-old female client who has a history of rheumatoid arthritis (RA) is taking ibuprofen (Motrin) for pain relief. Which information should the nurse provide the client about taking this medication?

Correct answer: C

Rationale: The correct answer is to instruct the client to report any changes in stool color to the healthcare provider. This is important because changes in stool color can indicate gastrointestinal bleeding, a serious side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Choice A is incorrect because while taking ibuprofen with meals can help reduce stomach upset, it is not the most crucial information to provide. Choice B is incorrect as taking ibuprofen with an antacid is not a standard recommendation. Choice D is also incorrect because while ibuprofen and aspirin are both NSAIDs, they can be taken together under certain circumstances, but it's important to be cautious and follow healthcare provider recommendations.

4. The healthcare provider prescribes a diet high in vitamin C for a client with a leg wound. Which food should the nurse encourage the client to eat?

Correct answer: D

Rationale: Tomatoes and lettuce are high in vitamin C, making them suitable choices for a diet prescribed for wound healing. Bananas and pineapple (Choice A) are not particularly high in vitamin C compared to tomatoes and lettuce. Cottage cheese and crackers (Choice B) as well as peanut butter and jelly (Choice C) do not provide significant amounts of vitamin C, which is essential for wound healing.

5. The nurse is evaluating the health status of an older client. Which finding is most important for the nurse to report to the healthcare provider?

Correct answer: C

Rationale: Pain in the lower back is a significant finding in an older client as it can indicate underlying issues such as kidney problems, spinal issues, or even aortic aneurysm. These conditions can be serious and require prompt medical attention. Decreased urine output (choice A) could indicate dehydration or kidney issues but is not as urgent as lower back pain. Loss of appetite (choice B) may be concerning but is not as critical as the potential life-threatening conditions associated with lower back pain. A persistent cough (choice D) is important to assess but is generally not as urgent as the potential serious implications of lower back pain in an older client.

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