A nurse is assessing a client who is receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain, and the client's blood pressure is 80/64 mm Hg. Which of the following actions should the nurse take first?

Stop the transfusion immediately.

Inform the provider.

Call the lab and ask if this is really a transfusion reaction.

Obtain a urine specimen.

Answer and Explanation

The Correct Answer is A

Choice A reason: Stopping the transfusion immediately is the first and most critical action in response to signs of a possible transfusion reaction, which can be life-threatening.

Choice B reason: While informing the provider is a necessary step, it should come after stopping the transfusion to prevent further harm to the patient.

Choice C reason: Calling the lab is an appropriate action but not the first priority. The immediate concern is the patient's safety.

Choice D reason: Obtaining a urine specimen may be part of the diagnostic process for a transfusion reaction, but it is not the first action to take.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason : Smoking tobacco is the most significant risk factor for developing emphysema. It damages the air sacs in the lungs and leads to the characteristic symptoms of emphysema.
Choice B reason : While pollution can contribute to respiratory problems, it is not the most common risk factor for emphysema compared to smoking tobacco.
Choice C reason : Age between 20 to 30 years is not a risk factor for emphysema. Emphysema typically develops after many years of smoking, often in older adults.
Choice D reason : Asthma is a diﬀerent respiratory condition and is not a risk factor for emphysema. However, individuals with asthma who smoke may have an increased risk of developing COPD, which includes emphysema.

A. Evaluating the eﬀectiveness of opioid analgesics B. Limiting the patient's intake of oral and IV ﬂuids C. Teaching the patient about high-protein, high-calorie foods D. Encouraging the patient to ambulate as much as tolerated

Correct Answer is A

Explanation

Choice A reason: Evaluating the eﬀectiveness of opioid analgesics is crucial as pain management is a primary concern for patients experiencing a sickle cell crisis.

Choice B reason: Limiting the patient's intake of oral and IV ﬂuids is not recommended as hydration is important for patients with sickle cell crisis to reduce blood viscosity and improve circulation.

Choice C reason: Teaching the patient about high-protein, high-calorie foods is beneficial for long-term management but is not the immediate nursing intervention during a crisis.

Choice D reason: Encouraging ambulation may be part of recovery but is not the primary intervention during an acute sickle cell crisis due to the risk of pain exacerbation.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is assessing a client who is receiving one unit of packed RBCs to treat intraoperative blood loss. The client reports chills and back pain, and the client's blood pressure is 80/64 mm Hg. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is the most common risk factor for emphysema?

Correct Answer is A

Explanation

Which nursing intervention is important when providing care for a patient with sickle cell crisis?

Correct Answer is A

Explanation

In planning care for the patient with acute myocardial infarction (AMI), the nurse identifies the highest priority goal of care as which of the following?

A nurse is prioritizing client care after receiving a change-of-shift report. Which of the following clients should the nurse plan to see first?

Vasoconstriction, sodium retention, and water reabsorption to increase circulating ﬂuid volume and cardiac output are the primary functions of:

A nurse is caring for a client who has cirrhosis of the liver and is having difficulty eliminating alcohol consumption because many of their friends drink alcohol socially. Which of the following steps should the nurse include to motivate the client to change?

What diagnostic test can be used to determine GFR as well as glomerular damage?

A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease?

A nurse is educating a client about the risk factors for GERD (gastroesophageal reﬂux disease). Which of the following statements should the nurse include?