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Questions 148

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Question 1 of 5

A client has surgery scheduled in 2 weeks. He decides to donate his own blood ahead of time to be stored and used in case he needs a blood transfusion during his surgery. This type of blood donation is referred to as

Correct Answer: C

Rationale: Autologous donation involves donating one’s own blood for personal use during surgery, reducing transfusion risks.

Question 2 of 5

A client has experienced 48 hours of severe repeated bouts of vomiting. Which acid-base imbalance is of most concern?

Correct Answer: D

Rationale: Severe vomiting causes loss of gastric acid, leading to metabolic alkalosis (
D). Respiratory imbalances (A,
B) and metabolic acidosis (
C) are less likely.

Question 3 of 5

The nurse is preparing to administer a dose of hydralazine (Apresoline) to a client with hypertension. The client’s blood pressure is 90/60 mmHg. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: hydralazine is a vasodilator, and a blood pressure of 90/60 mmHg indicates hypotension, so the dose should be withheld

Question 4 of 5

Which of the following tasks are appropriate for the nurse to delegate to unlicensed assistive personnel? Select all that apply.

Correct Answer: B,C,E

Rationale: Unlicensed assistive personnel can perform routine tasks like checking routine vital signs (
B), measuring urinary output (
C), and assisting with ambulation (E). Checking vital signs in an acutely ill client (
A) and monitoring a transfusion (
D) require a nurse's assessment skills.

Question 5 of 5

The client is admitted to the chemical dependence unit with an order for continuous observation. The nurse is aware that the doctor has ordered continuous observation because:

Correct Answer: B

Rationale: Continuous observation is needed due to the altered perception caused by hallucinogens, which can lead to unsafe behaviors.

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