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Questions 160

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Question 1 of 5

A client diagnosed with a GI bleed has received an order for a blood transfusion. Place the nursing actions in the correct order for administering the blood transfusion.

Correct Answer: B,E,A,C,D

Rationale: 1. Obtain baseline vital signs to assess for changes. 2. Prime IV tubing with normal saline to ensure compatibility. 3. Verify identity and blood product to prevent errors. 4. Start transfusion slowly to monitor for reactions. 5. Monitor for transfusion reactions throughout.

Question 2 of 5

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. Indicate with an X the area on the illustration where the heartbeat's electrical impulse is initiated.

Correct Answer: A

Rationale: The sinoatrial (S
A) node, located in the right atrium, initiates the heartbeat's electrical impulse. (Note: No illustration provided, but SA node is the standard answer.)

Question 3 of 5

A client with a history of congestive heart failure is prescribed furosemide (Lasix). Which instruction should the nurse include?

Correct Answer: A

Rationale: Furosemide causes potassium loss; eating potassium-rich foods prevents hypokalemia.

Question 4 of 5

The nurse is assessing a client with suspected meningitis. Which finding is most concerning?

Correct Answer: A

Rationale: Nuchal rigidity (stiff neck) is a hallmark sign of meningitis, indicating potential meningeal irritation.

Question 5 of 5

The female client has been diagnosed with genital warts. Which assessment findings should the nurse associate with genital warts?

Correct Answer: C

Rationale: A. Painful vesicles on the labia, perineum, or anus describe the lesions of genital herpes (herpes simplex virus 2). B. Painful ulcerations of the vagina, labia, or perineum describe the lesions of genital herpes (herpes simplex virus 2). C. In females, genital warts appear as painless lesions near the vaginal opening, anus, vagina, or cervix. The lesions are textured, cauliflower appearing, and remain unchanged over time. D. A chancre is associated with syphilis, not genital warts.

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