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Questions 148

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Question 1 of 5

A nurse prepares to administer a transfusion of RBCs and takes the client's vital signs. The client's temperature is 102.7°F, but other vitals are within normal limits. The nurse should

Correct Answer: D

Rationale: Fever (102.7°F) may indicate an infection or transfusion reaction risk. The physician should be contacted before proceeding with the transfusion.

Question 2 of 5

A client is admitted to the medical-surgical unit with a report of severe hematemesis. The nurse should give priority to:

Correct Answer: C

Rationale: Severe hematemesis indicates significant bleeding, requiring immediate IV access with a large-bore needle for fluid and blood resuscitation to stabilize the client.

Question 3 of 5

A client has recently been diagnosed with open-angle glaucoma. The nurse should tell the client to avoid taking:

Correct Answer: B

Rationale: Benadryl, an antihistamine, can increase intraocular pressure, worsening open-angle glaucoma, and should be avoided.

Question 4 of 5

A 32-year-old woman comes into the clinic for a well-woman exam and asks for information on an intrauterine device (IUD) for contraception. The nurse should explain that all of the following are potential risks EXCEPT

Correct Answer: A

Rationale: IUD risks include pelvic infections, abnormal bleeding, and ectopic pregnancy. Stroke is not a recognized risk associated with IUD use.

Question 5 of 5

The nurse is teaching a client with a new diagnosis of heart failure about sodium restriction. Which of the following foods should the client avoid?

Correct Answer: B

Rationale: canned soups are high in sodium, which should be limited in heart failure to prevent fluid retention

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