NCLEX-RN
Basic Adult Health Care NCLEX Heart Questions Questions
Extract:
Question 1 of 5
The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first:
Correct Answer: D
Rationale: The nurse should stay with the client during the first 15 minutes of a blood transfusion, as this is the most likely time for a transfusion reaction to occur. Close monitoring allows for immediate intervention if a reaction is detected. Discontinuing the IV is only done if a reaction occurs, PRBCs should not be administered via a 20-gauge needle (a larger gauge is needed), and dextrose solutions are incompatible with PRBCs.
Question 2 of 5
The nurse is instructing a client who is at risk for peripheral vascular disease how to use knee-length elastic stockings (support hose). The teaching plan should include which of the following? Check all that apply.
Correct Answer: A,C
Rationale: Rationales:
A) Applying elastic stockings in the morning before edema worsens helps promote venous return.
C) Applying them while in bed (before standing) minimizes swelling and eases application.
B) Removing stockings for swelling requires medical evaluation, not automatic removal.
D) Rolling down to form a cuff creates pressure points, impairing circulation. E) Stockings should be removed daily for skin inspection and hygiene, not kept on for 48 hours.
Question 3 of 5
A client who has undergone a mastectomy is worried about her body image and its impact on her sexual relationship. The nurse should suggest:
Correct Answer: A
Rationale: Wearing a prosthesis can help the client feel more confident about her body image during intimate moments, supporting her sexual relationship.
Question 4 of 5
When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism, the nurse should inform the client that these feelings are:
Correct Answer: D
Rationale: Low thyroid hormone levels in hypothyroidism can cause depression and sadness, which typically improve with thyroid hormone replacement therapy.
Question 5 of 5
The nurse should do which of the following to decrease a female client's anxiety about being placed in the lithotomy position for surgery?
Correct Answer: B
Rationale: Determining the client's specific concerns about the lithotomy position allows the nurse to address her anxiety directly, promoting trust and tailored reassurance.