Saudi Prometric Nursing Medical-Surgical Nursing 3 — Questions and Answers
Question 1: A patient is receiving a blood transfusion and develops fever, chills, and back pain 15 minutes after the transfusion begins. What is the priority nursing action?
- Stop the transfusion immediately and maintain IV access with normal saline (Correct answer)
- Slow the transfusion rate and reassess in 30 minutes
- Administer antipyretics and continue the transfusion
- Notify the blood bank before stopping the transfusion
Correct answer: Stop the transfusion immediately and maintain IV access with normal saline
These symptoms suggest an acute hemolytic transfusion reaction, a potentially fatal immune response. The priority is to stop the transfusion immediately while maintaining IV access with normal saline to prevent hemoglobin from precipitating in the renal tubules.
Question 2: A patient with heart failure is prescribed furosemide. Which electrolyte level requires monitoring?
- Potassium (Correct answer)
- Calcium
- Sodium
- Magnesium
Correct answer: Potassium
Furosemide (a loop diuretic) causes potassium wasting through increased urinary excretion. Hypokalemia is the most significant electrolyte imbalance, increasing the risk of dangerous arrhythmias and digoxin toxicity if the patient is also on digoxin.
Question 3: The nurse is educating a patient with peptic ulcer disease about diet. Which food should the patient avoid?
- Coffee and alcohol (Correct answer)
- Bananas
- Low-fat milk
- Cooked vegetables
Correct answer: Coffee and alcohol
Coffee (even decaffeinated) and alcohol stimulate gastric acid secretion and damage the gastric mucosal barrier, worsening peptic ulcer disease. Patients should avoid these along with spicy foods, NSAIDs, and smoking.
Question 4: A patient with asthma is using a peak flow meter. The reading falls in the yellow zone (50–79% of personal best). What should the nurse instruct the patient to do?
- Take rescue bronchodilator and reassess; contact provider if no improvement (Correct answer)
- Continue usual activities with no change
- Use the rescue inhaler only if symptoms worsen
- Call emergency services immediately
Correct answer: Take rescue bronchodilator and reassess; contact provider if no improvement
The yellow zone (50–79% of personal best) indicates caution — airways are narrowing. The patient should take their rescue bronchodilator and reassess. If the reading does not improve or falls to the red zone, they should contact their healthcare provider.
Question 5: A patient develops sudden onset of severe 'thunderclap' headache described as 'the worst headache of my life.' The nurse should prioritize:
- Immediate CT scan of the head to rule out subarachnoid hemorrhage (Correct answer)
- Administration of analgesics and reassessment in 1 hour
- Blood pressure measurement and antihypertensive therapy
- Reassurance that tension headaches are common
Correct answer: Immediate CT scan of the head to rule out subarachnoid hemorrhage
A sudden, severe 'thunderclap' headache — described as the worst ever — is the classic presentation of subarachnoid hemorrhage (SAH) until proven otherwise. Immediate CT scan is required to diagnose or exclude SAH, a medical emergency.
Question 6: A patient with chronic kidney disease (CKD) asks why they have been prescribed erythropoietin. The nurse explains that this medication:
- Stimulates red blood cell production to treat anemia of CKD (Correct answer)
- Reduces phosphate levels in the blood
- Prevents calcium loss from bones
- Lowers blood pressure by reducing fluid volume
Correct answer: Stimulates red blood cell production to treat anemia of CKD
In CKD, the kidneys produce inadequate erythropoietin, leading to anemia. Exogenous erythropoietin (e.g., epoetin alfa) stimulates the bone marrow to produce more red blood cells, correcting the anemia of chronic kidney disease.
Saudi Prometric Nursing Medical-Surgical Nursing 3
A patient is receiving a blood transfusion and develops fever, chills, and back pain 15 minutes after the transfusion begins.
What is the priority nursing action?