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NUR 4717C ACM EXAM 1 SUMMER 2026 Keiser University

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A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient? a. Packed red blood cells (PRBCs) b. Vitamin K c. Oral anticoagulants d. Heparin infusion 2. You are making initial shift assessments on your patients. While assessing one patient peripheral IV site, you note edema around the insertion site. How would you document this complication related to IV therapy? a. air emboli b. phlebitis c. infiltration d. fluid overload 3. A nurse determines that a client receiving a unit of packed red blood cells (PRBCs) is experiencing a transfusion reaction. After stopping the blood transfusion, what actions should the nurse promptly take next? Select all that apply a. The health care provider should be notified b. Obtain a white blood cell count c. Run normal saline at keep vein open (KVO) rate d. Infuse a normal saline bolus e. Obtain vital signs every 4 hours

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1. A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of
bleeding esophageal varices; an attempt to stop the bleeding has been only partially
successful. What would the critical care nurse expect the care team to order for this
patient?
a. Packed red blood cells (PRBCs)
b. Vitamin K
c. Oral anticoagulants
d. Heparin infusion

2. You are making initial shift assessments on your patients. While assessing one patient
peripheral IV site, you note edema around the insertion site. How would you document this
complication related to IV therapy?
a. air emboli
b. phlebitis
c. infiltration
d. fluid overload

3. A nurse determines that a client receiving a unit of packed red blood cells (PRBCs) is
experiencing a transfusion reaction. After stopping the blood transfusion, what actions
should the nurse promptly take next? Select all that apply
a. The health care provider should be notified
b. Obtain a white blood cell count
c. Run normal saline at keep vein open (KVO) rate
d. Infuse a normal saline bolus
e. Obtain vital signs every 4 hours

4. You are the nurse caring for a patient who is to receive IV daunorubicin, a
chemotherapeutic agent. You start the infusion and check the insertion site as per protocol.
During your most recent check, you note that the IV has infiltrated so you stop the infusion.
What is your main concern with this infiltration?
a. Extravasation of the medication
b. discomfort to the patient
c. blanching at the site
d. hypersensitivity reaction to the medication

5. A client who is receiving a 5% dextrose in 0.45% sodium chloride has a prescription to
receive one unit of packed red blood cells period prior to hanging the blood, the nurse
will prime the blood tubing with which solution?
a. 5% dextrose
b. lactated ringer's
c. 0.9 normal saline
d. 5% dextrose in 0.45% sodium chloride

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