A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the healthcare provider?
Lower back pain and hypotension.
Delayed painful rash with urticaria.
Acute rhinitis and nasal stuffiness.
Arthritic joint changes and chronic pain.
The Correct Answer is A
Lower back pain and hypotension are symptoms of an ABO incompatibility reaction, which is a serious complication of blood transfusion. This reaction occurs when the client receives a blood type that is incompatible with their own. It can cause a rapid and severe response, including back pain, hypotension, fever, and chills. This should be reported immediately to the healthcare provider.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Antibiotics are typically used to treat bacterial infections, not fungal infections like athlete’s foot. Therefore, using antibiotics would not be effective in this case.
Choice B rationale
While it’s important to use treatments for the full recommended duration to ensure the infection is completely eradicated, using an antibiotic ointment for a fungal infection like athlete’s foot would not be effective.
Choice C rationale
While it’s true that applying too much ointment can deter its effectiveness, the main issue here is that an antibiotic ointment is not the correct treatment for a fungal infection like athlete’s foot.
Choice D rationale
Athlete’s foot is a fungal infection that thrives in warm, moist environments. Therefore, keeping the feet dry and clean is an important part of managing and preventing athlete’s foot. This includes wearing clean socks and allowing the feet to dry completely before putting on shoes.
Correct Answer is ["A","B","E"]
Explanation
Choice A rationale
Checking the fingerstick glucose level is an immediate action that the nurse should take when a patient with type 2 diabetes reports feeling weak and jittery. These symptoms could indicate hypoglycemia, a condition characterized by low blood sugar levels.
Choice B rationale
Assessing skin temperature and moisture can help the nurse determine if the patient is sweating, a common symptom of hypoglycemia.
Choice C rationale
Administering a PRN dose of regular insulin is not the appropriate action if the patient is experiencing symptoms of hypoglycemia. Insulin would further lower the patient’s blood sugar levels, potentially worsening their condition.
Choice D rationale
Documenting anxiety on the surgical checklist may not be immediately helpful in addressing the patient’s current symptoms. While it’s important to document all relevant information, the nurse’s immediate focus should be on assessing and managing the patient’s symptoms.
Choice E rationale
Measuring pulse and blood pressure can provide important information about the patient’s cardiovascular status. Hypoglycemia can cause tachycardia and potentially hypotension, so these vital signs should be monitored.
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