A nurse is caring for a client who is recovering from a cerebrovascular accident in a rehabilitation facility. The client tells the nurse. "I am sick of being in here, and I want to go home." Which of the following responses should the nurse make?

A. Packed red blood cells (PRBCs) should be infused within 2–4 hours, but in older adults and clients at risk for fluid overload, the infusion is often run more cautiously and typically completed within 2–3 hours per unit when possible. However, the key issue is that exceeding 4 hours increases the risk of bacterial contamination and transfusion-related complications. Therefore, while 4 hours is the absolute maximum, it is not always the safest planned rate for two consecutive units in an older adult.

B. Sterile gloves are not required for blood administration setup. Aseptic (clean) technique is used when preparing and handling blood products and IV equipment. Sterile gloves are not necessary because the system is closed once blood is spiked and administered using standard blood tubing.

C. Independent double-checking by two licensed nurses (or per facility policy) is required to ensure correct patient identification, blood type compatibility, unit number, and expiration date. This is a critical safety step to prevent hemolytic transfusion reactions, which can be life-threatening.

D. Baseline respiratory assessment is essential, especially in older adults who are at increased risk for transfusion-associated circulatory overload (TACO). Documenting lung sounds before transfusion allows comparison if the client develops symptoms such as crackles, dyspnea, or hypoxia during or after the transfusion.

E. Only 0.9% normal saline (0.9% sodium chloride) is compatible with blood products. Hypotonic solutions like 0.45% sodium chloride can cause hemolysis of red blood cells and are therefore contraindicated in blood administration.

Rationale:
A. Clients experiencing anorexia, especially related to radiation therapy, are often more fatigued in the evening and may have a decreased appetite later in the day. It is generally more effective to encourage the largest meal earlier in the day when energy levels and appetite may be higher.

B. Clients undergoing radiation therapy require adequate protein intake to promote tissue repair and maintain strength. Low-protein supplements would not meet the increased metabolic and healing needs associated with cancer treatment and its side effects.

C. Radiation therapy, especially when affecting the head, neck, or gastrointestinal tract, can alter taste perception and increase nausea. Cold or room-temperature foods tend to have less odor and are often better tolerated, which can help improve appetite and reduce food aversions in clients experiencing anorexia.

D. Drinking large amounts of fluids with meals can create a sense of fullness and further reduce food intake, worsening anorexia. Instead, fluids are often encouraged between meals to help maintain hydration without interfering with caloric intake.