A nurse is assessing a client who received hydromorphone 4 mg IV 15 min ago.
The client has a respiratory rate of 10/min.
The nurse should prepare to administer which of the following medications? .

Choice A rationale:

Weight gain is a common side effect of many antipsychotic medications, including haloperidol. While it is important to monitor for this adverse effect, it is not specifically related to the extrapyramidal symptoms associated with haloperidol use.

Choice B rationale:

Dry mouth is a common anticholinergic side effect of antipsychotic medications like haloperidol. Although it is important to monitor for this adverse effect, it is not specifically related to the extrapyramidal symptoms, such as parkinsonism, associated with haloperidol use.

Choice C rationale:

This is the correct answer. Shuffling gait, or parkinsonism, is an extrapyramidal symptom associated with the use of antipsychotic medications like haloperidol. It is a movement disorder characterized by a shuffling walk, rigidity, and tremors. Recognizing and reporting this symptom promptly is crucial, as it may indicate the development of a serious neurological condition called tardive dyskinesia.

Choice D rationale:

Sedation is a common side effect of haloperidol and other antipsychotic medications. While it is important to monitor for sedation, it is not specifically related to the extrapyramidal symptoms associated with haloperidol use, as described in choice C.

The correct answer is D. Use a solution of 0.9% sodium chloride to flush the transfusion tubing.

Choice A reason: Storing a unit of blood at room temperature for 1 hour prior to the infusion is not recommended. Blood products should be kept refrigerated until just before the transfusion to minimize the risk of bacterial contamination. The recommended storage temperature for packed RBCs is 1-6°C. If blood is left at room temperature, it should be infused within 30 minutes to ensure safety.

Choice B reason: Ensuring that the transfusion is completed within 6 hours is not correct. The standard practice is to complete a blood transfusion over 2 to 4 hours, depending on the volume and the patient’s condition. This is to reduce the risk of bacterial growth and transfusion reactions. Prolonging the transfusion time beyond 4 hours increases the risk of bacterial contamination and can compromise the efficacy of the transfused red blood cells.

Choice C reason: Obtaining venous access using a 22-gauge needle is not ideal for a transfusion of packed RBCs. A larger bore needle, typically an 18-gauge or 20-gauge, is preferred to ensure adequate flow of the viscous packed RBCs and to prevent hemolysis. The smaller the gauge number, the larger the needle diameter, so a 22-gauge needle might be too small and could damage the red blood cells during the transfusion.

Choice D reason: Using a solution of 0.9% sodium chloride to flush the transfusion tubing is the correct action. Normal saline is isotonic and is the only fluid compatible with packed RBCs. It is used to prime the transfusion set and to flush the line before and after the transfusion to prevent hemolysis and clotting within the tubing.