Nursing Elites

1. Which of the following actions is appropriate when administering a blood transfusion?

• A. Verify patient identity
• B. Administer medication
• C. Monitor vital signs
• D. Start blood transfusion without verification

Correct answer: A

Rationale: Verifying the patient's identity is a critical step when administering a blood transfusion to ensure that the correct blood product is given to the right patient. This process helps prevent errors and enhances patient safety. Choice B, 'Administer medication,' is incorrect because the focus during a blood transfusion should be on ensuring the correct blood product is administered. Choice C, 'Monitor vital signs,' is also important but comes after verifying the patient's identity. Choice D, 'Start blood transfusion without verification,' is incorrect and unsafe as patient identification verification is essential prior to starting any medical procedure, especially one as important as a blood transfusion.

2. A nurse is caring for a client who is receiving chemotherapy. Which of the following laboratory values should the nurse report to the provider?

• A. WBC 4,500/mm3
• B. Hemoglobin 12 g/dL
• C. Platelet count 250,000/mm3
• D. Platelet count 100,000/mm3

Correct answer: D

Rationale: The correct answer is D. A platelet count of 100,000/mm3 is lower than the normal range, indicating thrombocytopenia, which is concerning in clients receiving chemotherapy. Thrombocytopenia can lead to an increased risk of bleeding and bruising. Choices A, B, and C fall within the normal range and would not be a cause for concern in a client receiving chemotherapy.

3. A nurse is providing discharge teaching to a client who has a new prescription for nitroglycerin sublingual tablets. Which of the following statements should the nurse include?

• A. Take the medication with food to reduce stomach upset.
• B. Store the medication in a cool, dry place.
• C. Take one tablet every 5 minutes until the pain is relieved, up to three doses.
• D. This medication may cause drowsiness.

Correct answer: C

Rationale: The correct answer is to instruct the client to take one nitroglycerin sublingual tablet every 5 minutes until the pain is relieved, up to three doses. This dosing regimen is essential for managing angina attacks effectively. Choice A is incorrect because nitroglycerin sublingual tablets should be placed under the tongue for rapid absorption, not taken with food. Choice B is incorrect because nitroglycerin tablets should be stored in their original container at room temperature, away from moisture and heat. Choice D is incorrect because nitroglycerin typically does not cause drowsiness as a side effect.

4. A nurse is planning care for a client with thrombocytopenia. Which of the following actions should the nurse include?

• A. Encourage the client to floss daily.
• B. Remove fresh flowers from the client's room.
• C. Provide the client with a stool softener.
• D. Avoid serving raw vegetables.

Correct answer: C

Rationale: The correct answer is C: Provide the client with a stool softener. Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. Providing the client with a stool softener is essential to prevent straining during bowel movements, which could result in bleeding for clients with thrombocytopenia. Encouraging the client to floss daily (choice A) is unrelated to the management of thrombocytopenia. Removing fresh flowers (choice B) is more relevant for clients with a compromised immune system. Avoiding serving raw vegetables (choice D) is important for clients with compromised immune systems to prevent foodborne illnesses, but it is not directly related to thrombocytopenia.

5. A nurse is assessing a client who is postoperative following a thyroidectomy. The nurse should identify which of the following findings as an indication of hypocalcemia?

• A. Tingling in the fingers.
• B. Elevated blood pressure.
• C. Positive Chvostek's sign.
• D. Positive Kernig's sign.

Correct answer: A

Rationale: The correct answer is A: Tingling in the fingers. Tingling in the fingers is a common sign of hypocalcemia, often seen after a thyroidectomy. Hypocalcemia can occur post-thyroidectomy due to inadvertent damage or removal of the parathyroid glands which regulate calcium levels. Choices B, C, and D are incorrect. Elevated blood pressure is not typically associated with hypocalcemia. Positive Chvostek's sign is a clinical sign of hypocalcemia but is usually assessed as facial muscle twitching, not tingling in the fingers. Positive Kernig's sign is a test for meningitis, not related to hypocalcemia.

Similar Questions