A nurse is assessing a client who received 2 units of packed RBCs 48 hr ago. Which of the following findings should indicate to the nurse that the therapy has been effective?
Hemoglobin 14.9 g/dL
WBC count 12.000/mm
Potassium 48 mEq
BUN 18 mg/dL
The Correct Answer is A
- A. Correct. A hemoglobin level of 14.9 g/dL indicates that the client has an adequate amount of oxygen-carrying capacity in the blood, which is the goal of blood transfusion therapy.
- B. Incorrect. A WBC count of 12,000/mm3 is slightly elevated and may indicate an infection or inflammation, which are not related to blood transfusion therapy.
- C. Incorrect. A potassium level of 48 mEq/L is dangerously high and may cause cardiac arrhythmias, muscle weakness, or paralysis. This is not an expected outcome of blood transfusion therapy and may indicate hemolysis or renal impairment.
- D. Incorrect. A BUN level of 18 mg/dL is within the normal range and does not reflect the effectiveness of blood transfusion therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Suggesting that the client attend adult day care three times per week is incorrect. While social interaction is essential for the elderly, it does not address the specific needs of a client with type 2 diabetes mellitus. Moreover, attending adult day care may not necessarily promote diabetes management.
Choice B rationale:
Reviewing assisted living accommodations with the client is incorrect. Assisted living facilities might be suitable for some elderly individuals, but in this case, the client lives independently. There is no indication in the question stem that the client needs assisted living arrangements at this time.
Choice C rationale:
Discussing a long-term care referral for the client with the provider is incorrect. Long-term care facilities are designed for individuals who require extensive assistance with daily activities. There is no information in the question suggesting that the client's condition has deteriorated to the extent of needing long-term care.
Choice D rationale:
Instructing the client about the use of telehealth services is the correct intervention. Telehealth services, including remote monitoring of blood glucose levels, virtual consultations with healthcare providers, and medication management, can enhance diabetes management for elderly individuals living independently in rural areas. Telehealth provides access to healthcare professionals without the need for frequent travel, addressing the challenges faced by individuals residing in remote areas.
Correct Answer is ["13"]
Explanation
gtt/min = (mL/hr x gtt/mL) / 60
gtt/min = (50 x 15) / 60 gtt/min = 750 / 60 gtt/min = 12.5 Rounding to the nearest whole number, the answer is 13.
Therefore, the nurse should set the manual IV infusion to deliver 13 gtt/min.
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