Adult Health Final Exam Nclex -
Review for weeks 4-7 2026
Exam Questions with 100%
Correct Answers | Latest Update
the nurse has obtained a unit of blood from the blood bank and has
checked the blood bag properly with another nurse. Just before the
beginning transfusion, the nurse assesses which of the following items?
,A. Vital signs B. Skin Color C. Urine output D. Latest hematocrit level. - 🧠
ANSWER ✔✔a
The physician orders 2 units of packed RBCs to be administered to the
client. At 0600 the night shift nurse initiates the first unit's transfusion
before going off shift. At 1000 the day shift nurse notes the IV line has
clotted off and the transfusion has not been completed. The nursing
assessment revealed the transfusion was only approximately 75%
complete. Which of the actions by the nurse is most appropriate?
A. Advise the blood bank about the delay for the next unit.
B. Restart another peripheral line with 0.9% NS and restart the blood
transfusion with the remaining blood unit.
C. Discontinue the transfusion.
D. Document the amount infused thus far and continue the transfusion." - 🧠
ANSWER ✔✔c
About ten minutes after the nurse begins an infusion of packed RBCs, the
patient complains of chills, chest and back pain, and nausea. His face is
flushed, and he's anxious. Which is the priority nursing action?
,1. Administering antihistamines STAT for an allergic reaction.
2. Notifying the physician of a possible transfusion reaction.
3. Obtaining a urine and serum specimen to send to the lab immediately.
4. Stopping hte transfusion and maintaining a patent IV catheter." - 🧠
ANSWER ✔✔4
The nurse is administering packed red blood cells (PRBCs) to a client. The
nurse should first:
"1. Discontinue the I.V. catheter if a blood transfusion reaction occurs.
2. Administer the PRBCs through a percutaneously inserted centralcatheter
line with a 20-gauge needle.
3. Flush PRBCs with 5% dextroseand 0.45% normal saline solution.
4. Stay with the client during thefirst 15 minutes of infusion. - 🧠 ANSWER
✔✔4 (The most likely time for a blood transfusion reaction to occur is
during the first 15 minutes or first 50 mL of the infusion. If a blood
transfusion reaction does occur, it is imperative to keep an established I.V.
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STATEMENT. ALL RIGHTS RESERVED
3
, line so that medication can be administered to prevent or treat
cardiovascular collapse in case of anaphylaxis. PRBCs should be
administered through a 19-gauge or larger needle; a peripherally inserted
central catheter line is not recommended, in order to avoid a slow flow.
RBCs will hemolyze in dextrose or lactated Ringer's solution and should be
infused with only normal saline solution.)
The nurse enters a client's room to assess the client, who began receiving
a blood transfusion 45 minutes earlier, and notes that the client is flushed
and dyspneic. On assessment, the nurse auscultates the presence of
crackles in the lung bases. The nurse determines that this client most likely
is experiencing which complication of blood transfusion therapy?
1) Bacteriemia.
2) Hypovolemia.
3) Fluid overload
4) Transfusion reaction - 🧠 ANSWER ✔✔3
"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
Review for weeks 4-7 2026
Exam Questions with 100%
Correct Answers | Latest Update
the nurse has obtained a unit of blood from the blood bank and has
checked the blood bag properly with another nurse. Just before the
beginning transfusion, the nurse assesses which of the following items?
,A. Vital signs B. Skin Color C. Urine output D. Latest hematocrit level. - 🧠
ANSWER ✔✔a
The physician orders 2 units of packed RBCs to be administered to the
client. At 0600 the night shift nurse initiates the first unit's transfusion
before going off shift. At 1000 the day shift nurse notes the IV line has
clotted off and the transfusion has not been completed. The nursing
assessment revealed the transfusion was only approximately 75%
complete. Which of the actions by the nurse is most appropriate?
A. Advise the blood bank about the delay for the next unit.
B. Restart another peripheral line with 0.9% NS and restart the blood
transfusion with the remaining blood unit.
C. Discontinue the transfusion.
D. Document the amount infused thus far and continue the transfusion." - 🧠
ANSWER ✔✔c
About ten minutes after the nurse begins an infusion of packed RBCs, the
patient complains of chills, chest and back pain, and nausea. His face is
flushed, and he's anxious. Which is the priority nursing action?
,1. Administering antihistamines STAT for an allergic reaction.
2. Notifying the physician of a possible transfusion reaction.
3. Obtaining a urine and serum specimen to send to the lab immediately.
4. Stopping hte transfusion and maintaining a patent IV catheter." - 🧠
ANSWER ✔✔4
The nurse is administering packed red blood cells (PRBCs) to a client. The
nurse should first:
"1. Discontinue the I.V. catheter if a blood transfusion reaction occurs.
2. Administer the PRBCs through a percutaneously inserted centralcatheter
line with a 20-gauge needle.
3. Flush PRBCs with 5% dextroseand 0.45% normal saline solution.
4. Stay with the client during thefirst 15 minutes of infusion. - 🧠 ANSWER
✔✔4 (The most likely time for a blood transfusion reaction to occur is
during the first 15 minutes or first 50 mL of the infusion. If a blood
transfusion reaction does occur, it is imperative to keep an established I.V.
COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
3
, line so that medication can be administered to prevent or treat
cardiovascular collapse in case of anaphylaxis. PRBCs should be
administered through a 19-gauge or larger needle; a peripherally inserted
central catheter line is not recommended, in order to avoid a slow flow.
RBCs will hemolyze in dextrose or lactated Ringer's solution and should be
infused with only normal saline solution.)
The nurse enters a client's room to assess the client, who began receiving
a blood transfusion 45 minutes earlier, and notes that the client is flushed
and dyspneic. On assessment, the nurse auscultates the presence of
crackles in the lung bases. The nurse determines that this client most likely
is experiencing which complication of blood transfusion therapy?
1) Bacteriemia.
2) Hypovolemia.
3) Fluid overload
4) Transfusion reaction - 🧠 ANSWER ✔✔3
"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
