1.

When assessing a patient's nutritional-metabolic pattern related to hematologic

health, the nurse would:

A. Inspect the skin for petechiae.

B. Ask the patient about joint pain.
C. Assess for vitamin C deficiency.
D. Determine if the patient can perform ADLs.
Any changes in the skin's texture or color should be explored when assessing the
patient's nutritional-metabolic pattern related to hematologic health. The presences of
petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to
poor nutritional intake or related causes.
Points Earned: 1/1
Correct Answer: A
Your Response: A

2. When assessing lab values on a patient admitted with septicemia, the nurse would
expect to find:

A. Increased platelets
B. Decreased red blood cells
C. Decreased erythrocyte sedimentation rate (ESR)
D. Increased bands in the WBC differential (shift to the left)
When infections are severe, such as in septicemia, more granulocytes are released from
the bone marrow as a compensatory mechanism. To meet the increased demand, many
young, immature polymorphonuclear neutrophils (bands) are released into circulation.
WBCs are usually reported in order of maturity, with the less mature forms on the left
side of a written report. Hence, the term "shift to the left" is used to denote an increase
in the number of bands.
Points Earned: 1/1
Correct Answer: D
Your Response: D

3. When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level
of 8.7 g/dl and hematocrit of 26%. The nurse would place highest priority on
initiating interventions that will reduce which of the following?

A. Fatigue
B. Thirst
C. Headache
D. Abdominal pain
The patient with a low hemoglobin and hematocrit (normal values approximately 13.5%
to 17% and 40% to 54%, respectively) is anemic and would be most likely to experience
fatigue. This symptom develops because of the lowered oxygen-carrying capacity that
leads to reduced tissue oxygenation to carry out cellular functions.
Points Earned: 0/1
Correct Answer: A
Your Response:

4. The nurse is caring for a patient who is to receive a transfusion of two units of
packed red blood cells. After obtaining the first unit from the blood bank, the nurse
 would ask which of the following health team members in the nurses' station to
assist in checking the unit before administration?

A. Unit secretary
B. Another registered nurse
C. A physician’s assistant
D. A phlebotomist
Before hanging a transfusion, the registered nurse must check the unit with another RN
or with a licensed practical (vocational) nurse, depending on agency policy.
Points Earned: 0/1
Correct Answer: B
Your Response:

5. Before starting a transfusion of packed red blood cells for an anemic patient, the
nurse would arrange for a peer to monitor his or her other assigned patients for how
many minutes when the nurse begins the transfusion?

A. 60
B. 5
C. 30
D. 15
As part of standard procedure, the nurse remains with the patient for the first 15 minutes
after hanging a blood transfusion. Patients who are likely to have a transfusion reaction
will more often exhibit signs within the first 15 minutes that the blood is infusing.
Points Earned: 0/1
Correct Answer: D
Your Response:

6. When preparing to administer an ordered blood transfusion, the nurse selects which
of the following intravenous solutions to use when priming the blood tubing?

A. 5% dextrose in water
B. Lactated Ringer’s
C. 0.9% sodium chloride
D. 0.45% sodium chloride
The blood set should be primed before the transfusion with 0.9% sodium chloride, also
known as normal saline. It is also used to flush the blood tubing after the infusion is
complete to ensure the patient receives blood that is left in the tubing when the bag is
empty.
Points Earned: 0/1
Correct Answer: C
Your Response:

7. The nurse notes a physician's order written at 10:00 AM for 2 units of packed red
blood cells to be administered to a patient who is anemic secondary to chronic blood
loss. If the transfusion is picked up at 11:30, the nurse should plan to hang the unit
no later than which of the following times?

A. 11:45 AM
B. 12:00 noon
C. 12:30 PM
 D. 3:30 PM
The nurse must hang the unit of packed red blood cells within 30 minutes of signing them
out from the blood bank.
Points Earned: 0/1
Correct Answer: B
Your Response:

8. The nurse receives a physician's order to transfuse fresh frozen plasma to a patient
suffering from an acute blood loss. Which of the following procedures is most
appropriate for infusing this blood product?

A. Hand the fresh frozen plasma as a piggyback to a new bag of primary IV solution
without KCl.
B. Infuse the fresh frozen plasma as rapidly as the patient will tolerate.
C. Hang the fresh frozen plasma as a piggyback to the primary IV solution.
D. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal
saline.
The fresh frozen plasma should be administered as rapidly as possible and should be
used within 2 hours of thawing. Fresh frozen plasma is infused using any straight-line
infusion set. Any existing IV should be interrupted while the fresh frozen plasma is
infused, unless a second IV line has been started for the transfusion.
Points Earned: 0/1
Correct Answer: B
Your Response:

9. Before beginning a transfusion of RBCs, which of the following actions by the nurse
would be of highest priority to avoid an error during this procedure?

A. Check the identifying information on the unit of blood against the patient’s ID
bracelet.
B. Select new primary IV tubing primed with lactated Ringer’s solution to use for the
transfusion.
C. Add the blood transfusion as a secondary line to the existing IV and used the IV
controller to maintain correct flow.
D. Remain with the patient for 60 minutes after beginning the transfusion to watch
for signs of a transfusion reaction.
The patient's identifying information (name, date of birth, medical record number) on the
identification bracelet should exactly match the information on the blood bank tag that
has been placed on the unit of blood. If any information does not match, the transfusions
should not be hung because of possible error and risk to the patient.
Points Earned: 0/1
Correct Answer: A
Your Response:

10. The blood bank notifies the nurse that the two units of blood ordered for an
anemic patient are ready for pick up. The nurse should take which of the
following actions to prevent an adverse effect during this procedure?

A. Immediately pick up both units of blood from the blood bank.

B. Regulate the flow rate so that each unit takes at least 4 hours to transfuse.
C. Set up the Y-tubing of the blood set with dextrose in water as the flush
solution.
 D. Infuse the blood slowly for the first 15 minutes of the transfusion.
Because a transfusion reaction is more likely to occur at the beginning of a transfusion,
the nurse should initially infuse the blood at a rate no faster than 2 ml/min and remain
with the patient for the first 15 minutes after hanging a unit of blood.
Points Earned: 0/1
Correct Answer: D
Your Response: