A nurse is caring for a client who is experiencing chills and back pain during a blood transfusion. What should be the nurse’s priority action?
Assess the client’s skin for a rash.
Notify the provider.
Cover the client with a blanket.
Stop the transfusion.
The Correct Answer is D
Choice A rationale
While assessing the client’s skin for a rash could be part of the overall assessment of the client’s condition, it is not the priority action when a client is experiencing chills and back pain during a blood transfusion.
Choice B rationale
Notifying the provider is an important step when a client is experiencing a reaction to a blood transfusion, but it is not the first action that should be taken.
Choice C rationale
Covering the client with a blanket may provide comfort to the client, but it does not address the underlying issue of a potential transfusion reaction.
Choice D rationale
The priority action when a client is experiencing chills and back pain during a blood transfusion is to stop the transfusion. This is because these symptoms could indicate a transfusion reaction, which can be serious.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Auscultation of a bruit over the pedal pulse is not a typical symptom of DVT. A bruit is a sound heard over an artery due to turbulent blood flow. While it may indicate vascular disease, it is not a symptom of DVT121314.
Choice B rationale
Groin tenderness can be a symptom of DVT. DVT often causes pain or tenderness in the affected area, which can include the groin.
Choice C rationale
Pallor in the affected extremity is not a typical symptom of DVT. DVT can cause swelling and warmth in the affected area, but it does not typically cause pallor.
Choice D rationale
Cramping pain in one foot is not a typical symptom of DVT. DVT often causes pain or swelling in the affected leg, but the pain is not typically limited to the foot.
Correct Answer is A
Explanation
Choice A rationale
Rice is a safe food choice for a child diagnosed with celiac disease. Celiac disease is a chronic immune disorder triggered by the consumption of gluten, a protein naturally present in wheat, barley, and rye. When people with celiac disease eat foods with gluten, the immune system attacks the small intestine, causing inflammation and damage that affects digestion, absorption, and nutrition. Rice is naturally gluten-free and can be included in the diet of a person with celiac disease.
Choice B rationale
Rye is not a safe food choice for a child diagnosed with celiac disease. Rye contains gluten, which triggers an immune response in people with celiac disease. This immune response can cause damage to the small intestine and lead to various health problems.
Choice C rationale
Wheat is not a safe food choice for a child diagnosed with celiac disease. Wheat contains gluten, which triggers an immune response in people with celiac disease. This immune response can cause damage to the small intestine and lead to various health problems.
Choice D rationale
Barley is not a safe food choice for a child diagnosed with celiac disease. Barley contains gluten, which triggers an immune response in people with celiac disease. This immune response can cause damage to the small intestine and lead to various health problems.
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