A client expresses anxiety and fear about receiving a blood transfusion. What action should the nurse take to address the client's concerns?

Explain the blood transfusion procedure in detail to the client.

Offer the client a warm blanket to help them relax during the transfusion.

Ask the healthcare provider to order a sedative for the client before the transfusion.

Provide the client with information about the benefits and risks of the transfusion.

Answer and Explanation

The Correct Answer is D

A) Incorrect: While explaining the blood transfusion procedure is essential, doing so in excessive detail may increase the client's anxiety. The nurse should provide information in a clear and concise manner, addressing the client's specific concerns.

B) Incorrect: Offering a warm blanket is a comfort measure but may not be sufficient to address the client's anxiety and fear about the transfusion. The nurse should engage in therapeutic communication and provide emotional support.

C) Incorrect: Requesting a sedative for the client may not be the best course of action unless specifically prescribed by the healthcare provider. It is essential to explore other interventions to address the client's anxiety before resorting to medication.

D) Correct: Providing the client with information about the benefits and risks of the transfusion can help alleviate their anxiety and fear. The nurse should engage in patient education, discuss the purpose of the transfusion, potential benefits, and possible risks involved. This empowers the client with knowledge and helps them make informed decisions.

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Correct Answer is B

Explanation

A) Incorrect: Confirming the client's identity and blood type with the client's family member is not a reliable method for ensuring patient safety during a blood transfusion. The nurse should directly verify the client's identity and blood type with two unique identifiers, such as asking the client to state their full name and date of birth and comparing it to their identification band.

B) Correct: Obtaining informed consent from the client is a crucial step before initiating a blood transfusion. The nurse must ensure the client understands the risks and benefits of the transfusion and has willingly provided consent. A signed consent form is the formal documentation of this process.

C) Incorrect: Warming blood in a microwave oven is not an appropriate method for preventing hypothermia and can lead to hemolysis of the blood components. Blood should be warmed using an approved blood warmer designed for this purpose.

D) Incorrect: Administering a rapid bolus of normal saline is unnecessary and could lead to fluid overload in the client. The nurse should administer normal saline or another appropriate IV fluid at the prescribed rate if the client requires hydration before or after the transfusion, but not as a priming method.

A. "You may experience a mild fever and chills during the transfusion, which is normal." B. "If you develop any itching, rash, or facial swelling, please notify me immediately." C. "Expect a brief period of increased heart rate after the transfusion is completed." D. "It is common to have lower back pain after receiving a blood transfusion."

Correct Answer is B

Explanation

A) Incorrect: Fever and chills during a blood transfusion may be signs of a febrile transfusion reaction, not an allergic reaction. The nurse should provide information specific to preventing allergic reactions.

B) Correct: Itching, rash, and facial swelling are common signs of an allergic transfusion reaction. The nurse should instruct the client to notify the healthcare provider immediately if they experience these symptoms.

C) Incorrect: A brief period of increased heart rate after the transfusion may be normal, but it is not specific to preventing an allergic transfusion reaction. The nurse should focus on providing information about allergic reaction symptoms.

D) Incorrect: Lower back pain is not typically associated with allergic transfusion reactions. The nurse should provide information about symptoms that indicate an allergic reaction, such as itching, rash, and facial swelling.

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A client expresses anxiety and fear about receiving a blood transfusion. What action should the nurse take to address the client's concerns?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer a blood transfusion to a client. Which action should the nurse take before initiating the transfusion?

Correct Answer is B

Explanation

A nurse is caring for a client who is about to receive a blood transfusion. What information should the nurse provide to the client to prevent an allergic transfusion reaction?

Correct Answer is B

Explanation

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