A nurse is assisting with the care of a client who is receiving 1 unit of packed RBCs. The client is coughing and reports a headache and difficulty breathing. The client's vital signs indicate tachycardia and hypertension. The nurse should identify that the client is experiencing which of the following types of transfusion reactions?

Circulatory overload

Mild allergic

Febrile nonhemolytic

Sepsis

Answer and Explanation

The Correct Answer is A

A. Circulatory overload
Signs like cough, dyspnea, tachycardia, and hypertension are classic features of fluid overload due to rapid transfusion or volume excess.

B. Mild allergic
Presents with itching, hives, or flushing—not respiratory distress or hypertension.

C. Febrile nonhemolytic
Presents with fever, chills, and malaise, but not cough, headache, or hypertension.

D. Sepsis
Involves hypotension, fever, chills, and shock-like symptoms—not hypertension.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. Tachycardia
Bradycardia (not tachycardia) is more common during withdrawal.

B. Weight loss
Weight gain, not loss, is a more likely withdrawal effect due to increased appetite.

C. Vomiting
Gastrointestinal upset may occur, but vomiting is not a primary symptom of nicotine withdrawal.

D. Nervousness
Nervousness, irritability, restlessness, and difficulty concentrating are common symptoms of acute nicotine withdrawal.

A. "Eat three large meals each day." B. "Keep your environment well ventilated." C. "Restrict intake of high-carbohydrate foods." D. "Brush your teeth immediately after eating."

Correct Answer is B

Explanation

A. "Eat three large meals each day."
Small, frequent meals are better tolerated during early pregnancy.

B. "Keep your environment well ventilated."
Fresh air and avoiding strong odors help reduce nausea during early pregnancy.

C. "Restrict intake of high-carbohydrate foods."
Complex carbohydrates are often helpful in reducing nausea.

D. "Brush your teeth immediately after eating."
This may worsen nausea due to gag reflex—it's best to wait.

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Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has recently stopped smoking. Which of the following findings should the nurse recognize as a manifestation of acute nicotine withdrawal?

Correct Answer is D

Explanation

A nurse is caring for a client who is at 10 weeks of gestation and reports nausea and vomiting on most days. Which of the following recommendations should the nurse make?

Correct Answer is B

Explanation

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