A nurse is preparing to administer an autologous blood product to a client. Which of the following actions should the nurse take to identify the client?
Match the client's blood type with the type and cross match specimen.
Confirm the provider's prescription matches the number on the blood component.
Ask the client to state his blood type and the date of the blood donation.
Ensure that the client's identification band matches the number on the blood unit.
The Correct Answer is D
A. Match the client's blood type with the type and cross match specimen. While type and crossmatch are important for allogeneic transfusions, an autologous transfusion uses the client’s own previously donated blood, so this is not the primary method for identification.
B. Confirm the provider's prescription matches the number on the blood component. Although important, this step alone does not verify the client’s identity. The nurse must also confirm the blood unit matches the correct client.
C. Ask the client to state his blood type and the date of the blood donation. Client recall is not a reliable form of identification for transfusion safety, as it is prone to error or misunderstanding.
D. Ensure that the client's identification band matches the number on the blood unit. This is the correct and safest method to confirm identity before administering an autologous blood product. It ensures the blood product is matched to the correct patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Have the client store smaller tanks under his bed. Oxygen tanks should never be stored in enclosed or confined spaces such as under a bed due to the risk of fire and poor ventilation, which can increase the danger of oxygen accumulation.
B. Place the oxygen tank away from curtains or drapes. This is essential to reduce the risk of fire. Oxygen supports combustion, so keeping the tank away from flammable materials like curtains helps ensure a safe home environment.
C. Store the oxygen tank wrench in a locked cabinet. The wrench should be kept accessible, not locked away, to allow quick adjustments or shut-off in case of emergency. Immediate access is a priority in safe oxygen use.
D. Ensure that the client checks the gauge weekly. The oxygen tank gauge should be monitored more frequently than once a week to avoid running out of oxygen unexpectedly, especially in clients with chronic respiratory conditions like COPD.
Correct Answer is C
Explanation
A. Administer packed RBCs. While blood transfusion may be urgently needed for hemorrhagic shock, it cannot be initiated until vascular access is established. It is important, but not the first step.
B. Obtain a specimen for ABG analysis. Arterial blood gases can provide valuable information about respiratory and metabolic status, but they are not the top priority in an unstable trauma patient.
C. Place a large-bore IV catheter in an upper extremity. Establishing IV access is the priority in trauma care, as it allows for rapid fluid resuscitation and medication administration. This intervention supports all subsequent emergency treatments.
D. Insert an indwelling urinary catheter. A catheter may be necessary for monitoring urine output as a sign of perfusion, but this is not the first action in a trauma situation where immediate stabilization is the priority.
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