NCLEX-RN
NCLEX RN Medical Surgical Questions Questions
Extract:
Question 1 of 5
When a blood transfusion is terminated following a reaction, the nurse must do which of the following? Select all that apply.
Correct Answer: A,B
Rationale: After a transfusion reaction, the nurse should send urine samples to check for hemolysis and return the remaining blood unit to the blood bank for analysis. The IV administration set is not typically returned, and while Risk Management and Infection Control may be notified, these are not immediate actions.
Question 2 of 5
A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO3ˆ’, 24 mEq/L. Based upon the client's PaO2, which of the following conclusions would be accurate?
Correct Answer: A
Rationale: A PaO2 of 50 mm Hg indicates severe hypoxia (normal is 75–100 mm Hg), requiring urgent oxygen therapy. It poses significant risk and is not normal or manageable with low concentrations.
Question 3 of 5
Which of the following is contraindicated for a client with seizure precautions?
Correct Answer: C
Rationale: Using a glass thermometer is contraindicated due to the risk of breakage and injury during a seizure. Personal hygiene, wearing own clothing, and being out of bed are safe and promote independence.
Question 4 of 5
A client refuses to remove a religious necklace before surgery despite hospital policy. The nurse's best response is:
Correct Answer: B
Rationale: Taping the necklace securely respects the client's beliefs while ensuring safety by preventing the item from interfering with the surgical field.
Question 5 of 5
The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy?
Correct Answer: D
Rationale: Hypophysectomy can impair pituitary function, leading to hypopituitarism, with symptoms like fatigue, weakness, and hormonal deficiencies.