NCLEX Secrets - Level of Cognitive Ability
26. A client is hypovolemic and plasma expanders are not available. The nurse anticipates that which of the following solutions available on the nursing unit will be prescribed by the physician?
a) 5% dextrose in water
b) 0.9% sodium chloride
c) 0.45% sodium chloride
d) 5% dextrose in 0.45% sodium chloride
27. The nurse hears an attending physician asking an intern to prescribe a hypotonic intravenous (IV) solution for a client. Which of the following IV solutions would the nurse expect the intern to prescribe?
a) 5% dextrose in water
b) 10% dextrose in water
c) 0.45% sodium chloride
d) 5% dextrose in 0.9% sodium chloride
28. A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The nurse takes the client's blood pressure and it is 90/50 mm Hg, from a baseline of 125/78 mm Hg. The client's temperature is 100.8F orally, from a baseline of 99.2F orally. The nurse determines that the client may be experiencing which complication of a blood transfusion?
a) septicemia
b) hyperkalemia
b) circulatory overload
d) delayed transfusion reaction
29. The nurse is told by a physician that a client in hypovolemic shock will require plasma expansion. The nurse anticipates receiving an order to transfuse which product?
a) albumin
b) platelets
c) cryoprecipitate
d) packed red blood cells
30. A physician tells a client that the client needs a blood transfusion and that the blood sample must be drawn first for blood typing and crossmatching. After the physician leaves, the client asks the nurse, "What exactly is blood type, anyway?" The nurse responds with which of the following statements?
a) the blood type represents an antigen found on the surface of the red blood cells
b) the blood type represents an antibody found on the surface of the red blood cells
c) the blood type represents an antibody that normally circulates in the blood plasma
d) the blood type represents an antigen that normally circulates in the blood plasma
NCLEX Secrets - Level of Cognitive Ability:
ANSWERS AND RATIONALE
26.D
- a solution of 5% dextrose in 0.45% sodium chloride is hypertonic. An advantage of hypertonic solutions is that they may be used to treat hypovolemia when plasma expanders are not readily available. Options A and B are isotonic solutions. Option C is a hypotonic solution.
27) C
- hypotonic solutions contain a lower concentration of salt or more water than an isotonic solution. A solution of 0.45% sodium chloride is hypotonic. A solution of 5% dextrose in water (D5W) is isotonic. Solutions of 10% dextrose in water (D10W) and 5% dextrose in 0.9% sodium chloride are hypertonic solutions.
28) A
- septicemia occurs with transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and the development of shock. Hyperkalemia causes weakness, paresthesias, abdominal cramps, diarrhea, and dysrhythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. A delayed transfusion reaction can occur days to years after transfusion. Signs include fever, mild jaundice, and decreased hematocrit level.
29) A
- albumin may be used as plasma expander. Platelets are used when the client's platelet count is low. Cryoprecipitate is useful in treating bleeding from hrmophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed RBC replace erythrocytes and not a plasma expander.
30) A
- the major blood types are A, B, AB, and O. The blood type indicates an antigen found on the surface of the red blood cell. Acute hemolytic transfusion reaction (ABO incompatibility) can occur if a client receives blood that is not compatible with his or her blood type. Acute hemolytic reaction is the most serious adverse reaction to a blood transfusion.
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NCLEX Secrets - Level of Cognitive Ability (Analysis 26-30)
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