2016 NCLEX Practice Questions on Blood Infusion 81-85

81. A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that which is the rationale for transfusing fresh-frozen plasma to this client?

a) To treat the loss of platelets
b) To promote rapid volume expansion
c) Because a transfusion must be done slowly
d) Because it will increase the hemoglobin and hematocrit levels

82. The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which item is important to check regarding the age of blood cells before the transfusion is begun?

a) Expiration date
b) Presence of clots
c) Blood group and type
d) Blood identification number

83. A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to take which action(s) to reduce the risk of possible transfusion complications? Select all that apply.

a) Ask a family member to donate blood ahead of time.
b) Give an autologous blood donation before the surgery.
c) Take iron supplements before surgery to boost hemoglobin levels.
d) Request that any donated blood be screened twice by the blood bank.
e) Take adequate amounts of vitamin C several days prior to the surgery date.

84. A client with severe blood loss resulting from multiple trauma requires rapid transfusion of several units of blood. The nurse asks another health team member to obtain which device for use during the transfusion procedure to help reduce the risk of cardiac dysrhythmias?

a) Infusion pump
b) Pulse oximeter
c) Cardiac monitor
d) Blood-warming device

85. A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which intravenous (IV) solution from the IV storage area to hang with the blood product at the client’s bedside?

1. Lactated Ringer’s
2. 0.9% sodium chloride
3. 5% dextrose in 0.9% sodium chloride
4. 5% dextrose in 0.45% sodium chloride

NCLEX Practice Questions
Answers and Rationale

81) B
- Rationale: Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level.

- Test-Taking Strategy: Focus on the subject of the question, the purpose for transfusing fresh frozen plasma. Note the relationship between the words experienced blood loss and the correct option.

82) A
- Rationale: The nurse notes the expiration date on the unit of blood to ensure that the blood is fresh. Blood cells begin to deteriorate over time, so safe storage usually is limited to 35 days. Careful notation of the expiration date by the nurse is an essential part of the verification process before hanging a unit of blood. The nurse also notes the blood identification (unit) number, blood group and type, and client’s name. The nurse also inspects the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted.

Test-Taking Strategy: Focus on the subject , measures to verify prior to blood administration. Note the word deteriorate . To answer this question correctly, you must know which part of the pretransfusion verification procedure relates to the freshness of the unit of blood. Keeping this in mind should direct you to the correct option.

83) A, B
- Rationale: A donation of the client’s own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is to ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are helpful for iron deficiency anemia but are not helpful in replacing blood lost during the surgery. Vitamin C enhances iron absorption, but also is not helpful in replacing blood lost during surgery.

- Test-Taking Strategy: Focus on the subject , reducing the risk of possible transfusion complications. Recalling that an autologous transfusion is the collection of the client’s own blood and also that family donation of blood is usually effective will direct you to the correct options.

84) D
- Rationale: If several units of blood are to be administered, a blood warmer should be used. Rapid transfusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device. Pulse oximetry and cardiac monitoring equipment are useful for the early assessment of complications but do not reduce the occurrence of cardiac dysrhythmias. Electronic infusion devices are not helpful in this case because the infusion must be rapid, and infusion devices generally are used to control the flow rate. In addition, not all infusion devices are made to handle blood or blood products.

- Test-Taking Strategy: Note the words rapid and reduce the risk . These words tell you that the infusions will infuse quickly and that the correct option is the one that will minimize the risk of cardiac dysrhythmias. Eliminate the pulse oximeter and cardiac monitor first because these items are comparable or alike and are used to assess for rather than reduce the risk of complications. From the remaining options, use knowledge related to the complications of transfusion therapy and note the relationship between the words several units of blood in the question and blood-warming device in the correct option.

85) B
- Rationale: Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells. Lactated Ringer’s is not the solution of choice with this procedure.

- Test-Taking Strategy: Eliminate options that contain dextrose first because they are comparable or alike . From the remaining options, remember that normal saline is an isotonic solution and the solution compatible with red blood cells.

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Parenteral Nutrition NCLEX Questions (Fundamentals 76-80)

76. The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client. The nurse should obtain which most essential piece of equipment before hanging the solution?
a) Urine test strips
b) Blood glucose meter
c) Electronic infusion pump
d) Noninvasive blood pressure monitor

77. The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an assigned client is empty. Which solution readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit?

a) 5% dextrose in water
b) 10% dextrose in water
c) 5% dextrose in Ringer’s lactate
d) 5% dextrose in 0.9% sodium chloride

78. The nurse is monitoring the status of a client’s fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind. Which action should the nurse take?

a) Adjust the infusion rate to catch up over the next hour.
b) Increase the infusion rate to catch up over the next 2 hours.
c) Ensure that the fat emulsion infusion rate is infusing at the prescribed rate.
d) Adjust the infusion rate to run wide open until the solution is back on time.

79. A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next assess the client for the presence of which condition?

a) Thirst
b) Polyuria
c) Decreased blood pressure
d) Crackles on auscultation of the lungs

80. The nurse is caring for a restless client who is beginning nutritional therapy with parenteral nutrition (PN). The nurse should plan to ensure that which action is taken to prevent the client from sustaining injury?

a) Calculate daily intake and output.
b) Monitor the temperature once daily.
c) Secure all connections in the PN system.
d) Monitor blood glucose levels every 12 hours.

81. A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy?

a) Sepsis
b) Air embolism
c) Hypervolemia
d) Hyperglycemia

Answers and Rationale

 76) C
- The nurse obtains an electronic infusion pump before hanging a PN solution. Because of the high glucose content, use of an infusion pump is necessary to ensure that the solution does not infuse too rapidly or fall behind. Because the client’s blood glucose level is monitored every 4 to 6 hours during administration of PN, a blood glucose meter also will be needed, but this is not the most essential item needed before hanging the solution. Urine test strips (to measure glucose) rarely are used because of the advent of blood glucose monitoring. Although the blood pressure will be monitored, a noninvasive blood pressure monitor is not the most essential piece of equipment needed for this procedure.

77) B
- The client is at risk for hypoglycemia; therefore the solution containing the highest amount of glucose should be hung until the new PN solution becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose in water solution is the best of the choices presented. The solution selected should be one that minimizes the risk of hypoglycemia. The remaining options will not be as effective in minimizing the risk of hypoglycemia.

78) C
- The nurse should not increase the rate of a fat emulsion to make up the difference if the infusion timing falls behind. Doing so could place the client at risk for fat overload. In addition, increasing the rate suddenly can cause fluid overload. The same principle (not increasing the rate) applies to PN or any intravenous (IV) infusion. Therefore the remaining options are incorrect.

79) D
- Optimal weight gain when the client is receiving PN is 1 to 2 lb/week. The client who has a weight gain of 5 lb/week while receiving PN is likely to have fluid retention. This can result in hypervolemia. Signs of hypervolemia include increased blood pressure, crackles on lung auscultation, a bounding pulse, jugular vein distention, headache, and weight gain more than desired. Thirst and polyuria are associated with hyperglycemia. A decreased blood pressure is likely to be noted in deficient fluid volume.

80) C
- The nurse should plan to secure all connections in the tubing (tape is used per agency protocol). This helps prevent the restless client from pulling the connections apart accidentally. The nurse should also monitor intake and output, but this does not relate specifically to a risk for injury as presented in the question. Also, monitoring the temperature and blood glucose levels does not relate to a risk for injury as presented in the question. In addition, the client’s temperature and blood glucose levels are monitored more frequently than the time frames identified in the options to detect signs of infection and hyperglycemia, respectively.

81) C
- Hypervolemia is a critical situation and occurs from excessive fluid administration or administration of fluid too rapidly. Clients with cardiac, renal, or hepatic dysfunction are also at increased risk. The client’s signs and symptoms presented in the question are consistent with hypervolemia. The increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles. The signs and symptoms presented in the question do not indicate sepsis, air embolism, or hyperglycemia.

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Parenteral Nutrition NCLEX Questions (Fundamentals 81-85)

Fluid and Electrolytes NCLEX Questions (81-85)

Welcome to Fluid and Electrolytes NCLEX Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. 

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81. The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco 2 of 30 mm Hg, and of 20 mEq/L. The nurse analyzes these results as indicating which condition?

a) Metabolic acidosis, compensated
b) Respiratory alkalosis, compensated
c) Metabolic alkalosis, uncompensated
d) Respiratory acidosis, uncompensated

82. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder?

a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis

83. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding?

a) A decreased pH and an increased CO 2
b) An increased pH and a decreased CO 2
c) A decreased pH and a decreased
d) An increased pH with an increased

84. The nurse caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder?

a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis

85. The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. On the basis of this documentation, which pattern did the nurse observe?

a) Respirations that cease for several seconds
b) Respirations that are regular but abnormally slow
c) Respirations that are labored and increased in depth and rate
d) Respirations that are abnormally deep, regular, and increased in rate

Fluid and Electrolytes NCLEX Questions
Answers and Rationale

81) B
- The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco 2 . In this situation, the pH is at the high end of the normal value and the Pco 2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.

82) B
- Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.

 83) D
- Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and to increase. Symptoms experienced by the client would include hypoventilation and tachycardia. Option A reflects a respiratory acidotic condition. Option B reflects a respiratory alkalotic condition, and option C reflects a metabolic acidotic condition.

84) A
- Metabolic acidosis is defined as a total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. This results from loss of buffer bases or retention of too many acids without sufficient bases, and occurs in conditions such as kidney disease; diabetic ketoacidosis; high fat diet; insufficient metabolism of carbohydrates; malnutrition; ingestion of toxins, such as acetylsalicylic acid (aspirin); malnutrition; or severe diarrhea. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes, an ileostomy, or diarrhea. These conditions result in metabolic acidosis. The remaining options are incorrect interpretations and are not associated with the client with an ileostomy.

 85) D
- Kussmaul’s respirations are abnormally deep, regular, and increased in rate. Apnea is described as respirations that cease for several seconds. In bradypnea, respirations are regular but abnormally slow. In hyperpnea, respirations are labored and increased in depth and rate.

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Fluid and Electrolytes NCLEX Questions (1-6)

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Respiratory NCLEX Questions with Rationale 1-9