A nurse is caring for a client with an order for one unit of packed red blood cells (PRBCs). The nurse should anticipate to remain ate client's bedside during which time period of the infusion?
The first 2 min
The final 15 min
The first 15 min
The final 2 min
The Correct Answer is C
A) The first 2 min: While it is essential to monitor the client closely during the first few minutes of a PRBC infusion, a two-minute observation period is insufficient to detect most acute transfusion reactions. Many reactions, such as fever, chills, and allergic responses, can take longer to manifest.
B) The final 15 min: Monitoring during the final 15 minutes is important to ensure the infusion is completed without complications. However, the most critical time for monitoring is at the beginning of the infusion, as acute reactions are more likely to occur early on.
C) The first 15 min: The first 15 minutes of a PRBC transfusion are crucial because most acute transfusion reactions, such as allergic reactions, febrile non-hemolytic reactions, and hemolytic reactions, occur within this time frame. The nurse should remain at the bedside to promptly identify and manage any adverse reactions, ensuring the client's safety.
D) The final 2 min: Monitoring during the final two minutes of the infusion is also important, but it is not the critical time frame for detecting most transfusion reactions. Observing the client closely during the initial phase of the transfusion is essential to address any immediate complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. 8 hr - Infusing one unit of packed red blood cells (PRBCs) over 8 hours is too long. Typically, PRBCs are infused over a shorter period to avoid complications.
B. 4 hr - Infusing PRBCs over 4 hours is still within acceptable limits, but the standard time for PRBC transfusion is usually shorter.
C. 6 hr - Infusing PRBCs over 6 hours is longer than usual. The recommended duration for infusing one unit of PRBCs is generally shorter.
D. 2 hr - The standard time to infuse one unit of PRBCs is typically between 1.5 to 2 hours. This duration helps ensure the effective delivery of red blood cells while minimizing the risk of transfusion reactions.
Correct Answer is B
Explanation
A) "Your daily intake of fats should be limited to no more than 35% of your daily caloric intake":
Current dietary guidelines typically recommend limiting fat intake to less than 30% of total daily calories, not 35%, for optimal heart health. This recommendation is slightly higher than what is generally advised for managing high cholesterol.
B) "You should avoid trans-fat as much as possible":
Trans fats significantly increase LDL cholesterol (bad cholesterol) levels and decrease HDL cholesterol (good cholesterol). Avoiding trans fats is crucial in managing high cholesterol and reducing cardiovascular risk, making this the most important recommendation.
C) "Your main sources of protein should be red meat":
Red meat, particularly processed red meat, is associated with higher cholesterol levels and cardiovascular risk. It is generally recommended to choose lean proteins, such as fish, poultry, and plant-based sources, over red meat.
D) "Fats provide the highest amount of energy per gram":
While fats do provide more energy per gram than carbohydrates or proteins, this statement does not directly address the management of cholesterol levels. The focus should be on the type of fats consumed rather than their energy content.
E) "Your intake of fats should be unsaturated fats":
While consuming unsaturated fats is beneficial, avoiding trans fats specifically addresses a more immediate concern for those with high cholesterol. Option B emphasizes the importance of eliminating harmful fats.
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