Med Surg-Exam 2 NCLEX Questions with correct answers

When assessing a patient's nutritional-metabolic pattern related to hematologic health, what should the nurse do? Inspect the skin for petechiae. Ask the patient about joint pain. Assess for vitamin C deficiency. Determine if the patient can perform ADLs. A When assessing laboratory values on a patient admitted with septicemia, what should the nurse expect to find? Increased platelets Decreased red blood cells Decreased erythrocyte sedimentation rate (ESR) Increased bands in the white blood cell (WBC) differential (shift to the left) D Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse should recognize that this diagnostic finding most likely suggests which problem? Hypoxemia An infection A risk of hypocoagulation An acute thrombotic event B A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen (select all that apply)? Impaired fibrinolysis Increased platelet levels Increased eosinophil levels Fatigue and cold intolerance Impaired immunologic function B, E The nurse is providing care for older adults on a subacute, geriatric medicine unit. What effect is aging likely to have on hematologic function of older adults? Thrombocytosis Decreased hemoglobin Decreased WBC count Decreased blood volume B A blood type and cross-match has been ordered for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains what this means? The patient can be transfused with type AB blood. The patient may only receive a type A transfusion. .The patient has A antigens on his red blood cells (RBCs). Antibodies are present on the surface of the patient's RBCs. C The patient has anemia and has had laboratory tests done to diagnose the cause. Which results should the nurse know indicates a lack of nutrients needed to produce new red blood cells (select all that apply)? Increased homocysteine Decreased reticulocyte count Decreased cobalamin (vitamin B12) Increased methylmalonic acid (MMA) Elevated erythrocyte sedimentation rate (ESR) A, C, D In assessing the patient, which abnormal finding should the nurse relate to hemostasis abnormalities? Purpura Pruritus Weakness Pale conjunctiva A During the admission assessment, the nurse discovers that the patient has used illicit drugs. Related to the hematologic system, what question should the nurse next ask the patient? "Do you have any blood in your stools?" "What agent and when did you last use it?" "Have you had any surgeries causing pain?" "Do you have shortness of breath with activity?" B The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? Position the patient prone. Apply a pressure dressing. Administer analgesic for pain. Return metal objects to the patient. B When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? Thirst Fatigue Headache Abdominal pain B The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? Unit secretary A physician's assistant Another registered nurse An unlicensed assistive personnel C Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? 5 15 30 60 B When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? Lactated Ringer's 5% dextrose in water 0.9% sodium chloride 0.45% sodium chloride C The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 11:45 AM 12:00 noon 12:30 PM 3:30 PM B The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? Infuse the fresh frozen plasma as rapidly as the patient will tolerate. Hang the fresh frozen plasma as a piggyback to the primary IV solution. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl. A Before beginning a transfusion of RBCs, which action by the nurse would be of highest priority to avoid an error during this procedure? Check the identifying information on the unit of blood against the patient's ID bracelet. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow. A The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? Immediately pick up both units of blood from the blood bank. Infuse the blood slowly for the first 15 minutes of the transfusion. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. Set up the Y-tubing of the blood set with dextrose in water as the flush solution. B Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A 59-year-old man whose alcoholism has precipitated folic acid deficiency A 23-year-old African American man who has a diagnosis of sickle cell disease A 30-year-old woman with a history of "heavy periods" accompanied by anemia A 3-year-old child whose impaired growth and development is attributable to thalassemi B