Question 1

You are caring for a patient who has been in a multiple trauma that has lead to severe blood loss. What type of device will you need to acquire to transfuse several units of blood quickly?
A)Cardiac monitor
B)Pulse oximetry
C)Blood warming device
D)Infusion controller

Accepted Answer

In order to transfuse several units quickly without causing cardiac dysrhythmia, the nurse would need a blood warming device. Blood products must be warmed if they are going to be administered quickly. In this situation, the patient would not benefit from administering the blood slow.

Question 2

You began administering blood to a patient 45 minutes ago. You enter the room to assess the patient and find the patient flushed and dyspneic. On auscultation the patient has crackles in the bases of both lungs. What complication of blood transfusion therapy is the patient most likely experiencing?
A)Hypovolemia
B)Transfusion reaction
C)Fluid overload
D)Bacteremia

Accepted Answer

The patient is displaying all the symptoms of fluid overload. If the patient were experiencing a transfusion reaction, there would also be itching and a rash. Bacteremia would lead to the patient having a fever. Fluid overload is the best answer due to the crackles in the lungs indicating fluid has become a problem.

Question 3

You are caring for a patient who is receiving a platelet transfusion. Which of the following would indicate a therapeutic effect of the transfusion?
A)A decrease in temperature
B)A decrease of blood oozing from puncture sites and gums
C)An increase hemoglobin
D)An increase hematocrit

Accepted Answer

The patient receiving a platelet transfusion should begin to have a decrease in blood oozing from puncture sites and gums. Platelets are necessary for proper clotting. Granulocytes would be given to decrease fever, and red blood cells would be given to raise hemoglobin and hematocrit.

Question 4

You are preparing to give a patient a transfusion. The patient states that in previous transfusions he has always developed a rash. What medication do you suspect the physician will order prior to the transfusion?
A)Diphenhydramine (Benadryl)
B)Acetylsalicylic acid (ASA, aspirin)
C)Acetaminophen (Tylenol)
D)Ibuprofen (Motrin)

Accepted Answer

The patient should receive a dose of diphenhydramine (Benadryl) prior to the transfusion to decrease the chances of an allergic reaction. Acetylsalicylic acid and acetaminophen are analgesics. Ibuprofen is a nonsteroidal anti-inflammatory medication.

Question 5

You are caring for a patient in hypovalemic shock who will require plasma expansion. What do you suspect the physician will order?
A)Cryoprecipitate
B)Packed red blood cells
C)Albumin
D)Platelets

Accepted Answer

Albumin would be given as a plasma expander. Cryoprecipitate is used with hemophilia patients who are bleeding because it is rich in clotting factors. Platelets are used on patients who have a low platelet count and packed red blood cells are given to replace erythrocytes.

Question 6

Your patient has come into the emergency department with a self-inflicted wrist laceration that has severe bleeding. You have begun to apply pressure to the wound. What would your immediate priority be?
A)See to the patient's need for psychiatric evaluation.
B)Lower the patient's body temperature to decrease circulation.
C)Place the extremity below the level of the heart.
D)Monitor the patient for signs of shock.

Accepted Answer

The nurse would need to monitor this patient for hypovalemic shock. Symptoms of shock would include tachycardia, cool, clammy skin and a change in level of consciousness. Hypovolemia leads to vasoconstriction and shunting of blood to central circulation. The patient will need to have a psychiatric evaluation, but it is not priority.

Question 7

Your patient has been stung by a bee. What signs and symptoms would you see if the patient had an allergic reaction to the sting?
A)Normal respiratory rate
B)Prolonged expiratory phase
C)Wheezing on inspiration
D)Decreased respiratory rate

Accepted Answer

The nurse would want to monitor the patient for a prolonged expiratory phase. The allergic reaction would lead to air trapping and alveoli distention that occurs as a result of an anaphylactic response. Respiratory rate will be within normal limits, and wheezing occurs on expiration due to constricted bronchi.

Question 8

You are caring for a patient in shock. Which parameter would you want to monitor to determine if treatment is effective?
A)Cardiac output
B)Respiratory rate
C)Peripheral pulse rate
D)Central venous pressure

Accepted Answer

The nurse needs to monitor the cardiac output to determine if treatment is effective. The cardiac output monitors the left ventricular function of the heart. The peripheral pulses and respiratory rate may remain within normal, so they are not the best indicators of treatment effectiveness.

Question 9

Which finding would make you suspect that your patient might be in cardiogenic shock?
A)Decreased or muffled heart sounds
B)A cardiac index greater than 2.2 L/min
C)Bounding pulses
D)Increased cardiac output

Accepted Answer

In cardiogenic shock the patient heart sounds will become decreased or muffled. This is caused by the myocardium's decreased ability to pump due to weakening by blood or fluid. This would cause a decreased cardiac index, decreased cardiac output and weak, thready pulses.

Question 10

You are caring for a patient who was brought into the emergency department unresponsive, hypotensive and tachypneic. Upon further assessment, you realize that the patient's temperature is 106 degrees Fahrenheit. You suspect heat stroke. What would your priority nursing intervention be?
A)Obtain a history from the patient.
B)Take oral temperature to monitor effectiveness of treatment.
C)Call the family for consent to treat.
D)Take off the patient's clothing, wrap him or her in wet towels and place a fan on the patient.

Accepted Answer

The nurse's priority would be to undress and wrap the patient in wet towels and place a fan on him or her. Interventions must be taken quickly to lower the body temperature because heat stroke is life threatening. Core body temperatures should be monitored for effective treatment.

Question 11

You are about to administer blood to a patient. You have verified that it is the correct blood for the patient with another nurse. What do you need to assess before you start the blood?
A)Vital signs
B)Skin color
C)Hemoglobin level
D)Creatinine level

Accepted Answer

The nurse needs to assess vital signs prior to beginning a transfusion. Most transfusion reactions happen in the first 15 minutes of a reaction. It is important for the nurse to have set of baseline vital signs to determine if the patient is having a reaction.

Question 12

Which IV fluids would you need to hang with a transfusion?
A)Lactated ringers
B)Dextrose 5% and normal saline 0.9%
C)Dextrose 5% and normal saline 0.45%
D)Normal saline 0.9%

Accepted Answer

The nurse should hang normal saline 0.9% with a transfusion. All other options are contraindicated due to clotting and hemolysis. Normal saline is the only option that can be hung with a transfusion.

Question 13

You are caring for a patient who has been receiving a blood transfusion for the last 30 minutes. On assessment, you find the patient to be dyspneic and show bilateral crackles and a heart rate of 110. Which of the following complications do you suspect the patient is experiencing?
A)Immune response
B)Hypovolemia
C)Fluid overload
D)Polycythemia vera

Accepted Answer

The patient exhibiting these signs and symptoms is most likely going into fluid overload. Crackles in the lungs would not be associated with the other options. The physician should be notified to get a diuretic for the patient.

Question 14

You determine that the patient you are caring for is having a transfusion reaction. You stop the blood immediately. Which action would you take next?
A)Notify a physician.
B)Determine the patient's white blood cell count.
C)Administer normal saline at KVO.
D)Administer normal saline bolus.

Accepted Answer

The nurse should start normal saline at KVO for this patient to keep the IV open. Then the nurse should notify the physician of the reaction. The physician may order a white blood cell count or normal saline bolus, but the nurse should not initiate either without an order.

Question 15

You are caring for a patient with a gunshot wound. As a result of the patient's Coumadin therapy, the prothrombin time is twice the normal amount. Which blood product do you expect the physician to order?
A)Fresh frozen plasma
B)Random donor platelets
C)Red blood cells
D)Crystalloids

Accepted Answer

The patient with a prothrombin time greater than 1.5 times normal who is bleeding should receive fresh frozen plasma. A patient with thrombocytopenia would receive platelets. Anemic patients receive red blood cells, and crystalloids help establish and maintain fluid and electrolyte balance.

Question 16

An elderly patient comes into the emergency department to rule out stroke. On admission, vital signs are pulse 90, blood pressure 150/100 and respirations 20. Upon reassessment 30 minutes later, vital signs are pulse 78, blood pressure 170/90 and respirations 24 and irregular. What should be the nurse's first priority?
A)Have the patient describe how they are feeling.
B)Check the patient's Dilantin level.
C)Decrease fluids.
D)Encourage the patient to drink.

Accepted Answer

The nurse should decrease the fluids based on this assessment. The patient is showing signs of hypervolemia and increased intracranial pressure. The other three options are inappropriate for a patient who is be monitored for a stroke.

Question 17

You are caring for a postpartum mother who is in hypovalemic shock from hemorrhage. What would you expect to be the priority for this patient?
A)Oxygen at 3 to 4 liters
B)Oxytocic drug via IV
C)Heart rate every 5 minutes
D)Increase IV fluid rate

Accepted Answer

A patient in hypovalemic shock would benefit most from increasing IV fluids. Increasing the IV fluids helps to replace the fluids lost by the patient during the hemorrhage. Blood products may also be necessary but may take a while to obtain. Oxygen and oxytocic drugs will also be required but are not the priority for this patient.

Question 18

What would the nurse do to prevent a woman who had a cesarean birth from having early postpartum hemorrhage?
A)IV fluids at 125 mL/hr
B)Assess uterus every 15 minutes
C)Abdominal dressing for drainage
D)Monitor urinary output

Accepted Answer

The nurse would want to assess the uterus every 15 minutes to prevent early postpartum hemorrhage. Early detection of a boggy uterus will allow for interventions to prevent postpartum hemorrhage. Other choices are not appropriate in preventing postpartum hemorrhage.

Question 19

You are caring for a patient who has been taking methylergonovine maleate (Methergine) for postpartum hemorrhage. It is not helping to control the hemorrhage. What procedure will most likely be ordered for this patient?
A)Dilatation and curettage
B)Laparotomy
C)Hysterotomy
D)Hysterectomy

Accepted Answer

The patient will most likely need a dilatation and curettage. This vaginal procedure is to remove retained tissue from the uterus. The other procedures would be inappropriate for this type of hemorrhage.

Question 20

You are caring for a patient who has been stung by a bee. The patient has dyspnea, pruritis and localized swelling on the arm where he was stung. What would your priority intervention be for this patient?
A)Remove the stinger.
B)Place blankets over the patient.
C)Listen for stridor and check the patient's tongue for swelling.
D)Put the patient in the Trendelenburg position.

Accepted Answer

The priority for this patient would be to assess for stridor and swelling of the tongue. The patient is displaying signs of anaphylactic reaction and will need to be treated immediately. Stridor and tongue swelling are signs of impending airway obstruction. Epinephrine will need to be administered to correct the problem.

Quiz 6: Shock

You are caring for a patient who has been in a multiple trauma that has lead to severe blood loss. What type of device will you need to acquire to transfuse several units of blood quickly?

You began administering blood to a patient 45 minutes ago. You enter the room to assess the patient and find the patient flushed and dyspneic. On auscultation the patient has crackles in the bases of both lungs. What complication of blood transfusion therapy is the patient most likely experiencing?

You are caring for a patient who is receiving a platelet transfusion. Which of the following would indicate a therapeutic effect of the transfusion?

You are preparing to give a patient a transfusion. The patient states that in previous transfusions he has always developed a rash. What medication do you suspect the physician will order prior to the transfusion?

You are caring for a patient in hypovalemic shock who will require plasma expansion. What do you suspect the physician will order?

Your patient has come into the emergency department with a self-inflicted wrist laceration that has severe bleeding. You have begun to apply pressure to the wound. What would your immediate priority be?

Your patient has been stung by a bee. What signs and symptoms would you see if the patient had an allergic reaction to the sting?

You are caring for a patient in shock. Which parameter would you want to monitor to determine if treatment is effective?

Which finding would make you suspect that your patient might be in cardiogenic shock?

You are caring for a patient who was brought into the emergency department unresponsive, hypotensive and tachypneic. Upon further assessment, you realize that the patient's temperature is 106 degrees Fahrenheit. You suspect heat stroke. What would your priority nursing intervention be?

You are about to administer blood to a patient. You have verified that it is the correct blood for the patient with another nurse. What do you need to assess before you start the blood?

Which IV fluids would you need to hang with a transfusion?

You are caring for a patient who has been receiving a blood transfusion for the last 30 minutes. On assessment, you find the patient to be dyspneic and show bilateral crackles and a heart rate of 110. Which of the following complications do you suspect the patient is experiencing?

You determine that the patient you are caring for is having a transfusion reaction. You stop the blood immediately. Which action would you take next?

You are caring for a patient with a gunshot wound. As a result of the patient's Coumadin therapy, the prothrombin time is twice the normal amount. Which blood product do you expect the physician to order?

You are caring for a postpartum mother who is in hypovalemic shock from hemorrhage. What would you expect to be the priority for this patient?

What would the nurse do to prevent a woman who had a cesarean birth from having early postpartum hemorrhage?

You are caring for a patient who has been taking methylergonovine maleate (Methergine) for postpartum hemorrhage. It is not helping to control the hemorrhage. What procedure will most likely be ordered for this patient?

You are caring for a patient who has been stung by a bee. The patient has dyspnea, pruritis and localized swelling on the arm where he was stung. What would your priority intervention be for this patient?