A nurse is assisting with the care of a client who is receiving a blood transfusion. The nurse should monitor for which of the following findings as an indication the client is having an acute hemolytic reaction?

Vomiting

Urticaria

Low back pain

Pulmonary congestion

Answer and Explanation

The Correct Answer is C

Choice A reason: Vomiting can be a sign of a transfusion reaction, but it is not as specific as low back pain for an acute hemolytic reaction.

Choice B reason: Urticaria, or hives, may indicate an allergic reaction but is not specific to an acute hemolytic reaction.

Choice C reason: Low back pain is a classic symptom of an acute hemolytic reaction, which is a serious and potentially life-threatening condition that requires immediate attention.

Choice D reason: Pulmonary congestion may occur in various conditions and is not the most specific indicator of an acute hemolytic reaction.

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Correct Answer is C

Explanation

Choice A reason: Regression involves reverting to an earlier stage of development when faced with stress, which is not what Marie is doing.

Choice B reason: Repression involves unconsciously blocking out painful thoughts or feelings, which is different from Marie's conscious rationalization of her failure.

Choice C reason: Rationalization is a defense mechanism where an individual justifies an unacceptable behavior or feeling with a logical reason, avoiding the true explanation for the behavior. Marie is rationalizing her failure by blaming the instructor rather than accepting her own role in the outcome.

Choice D reason: Reaction formation involves behaving in a way that is opposite to what one truly feels, which is not applicable in Marie's case.

A. Forms new relationships easily B. Chemical dependency C. Feelings of low self-esteem D. Social integration E. Flashbacks F. Irritability

Correct Answer is ["B","C","E","F"]

Explanation

Choice A reason: Forming new relationships easily is not typically associated with PTSD.

Choice B reason: Chemical dependency can be a coping mechanism for those with PTSD.

Choice C reason: Feelings of low self-esteem are common in individuals with PTSD.

Choice D reason: Social integration is not a symptom of PTSD; rather, individuals may struggle with social interactions.

Choice E reason: Flashbacks are a hallmark symptom of PTSD, where individuals relive the traumatic event.

Choice F reason: Irritability is a common symptom of PTSD, often due to heightened arousal and anxiety.

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A nurse is assisting with the care of a client who is receiving a blood transfusion. The nurse should monitor for which of the following findings as an indication the client is having an acute hemolytic reaction?

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Naxlex Comprehensive Predictor Exams

Marie has just learned that she has failed her mental health nursing class. She tells her friends, "I knew that instructor was going to fail me. She has never liked me and has just been looking for an excuse to fail me all along." Marie's behavior is an example of which defense mechanism?

Correct Answer is C

Explanation

Symptoms of Post-Traumatic Stress Disorder include: (select all that apply)

Correct Answer is ["B","C","E","F"]

Explanation

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