A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses?
Hemolysis
Urticaria
Fever
Fluid overload
The Correct Answer is B
A. Hemolysis: This is a severe reaction to blood transfusion involving the destruction of red blood cells and requires different management strategies.
B. Urticaria: Diphenhydramine is used to prevent or treat urticaria (hives), which is a mild allergic reaction and can be managed with antihistamines.
C. Fever: This is typically managed with antipyretics or by addressing the underlying cause rather than antihistamines.
D. Fluid overload: This condition requires management with diuretics and careful monitoring of fluid intake rather than antihistamines.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The client waits 10 min between inhalations: Waiting 10 minutes between inhalations is unnecessary for a rescue inhaler like albuterol. Typically, it is sufficient to wait for 1 to 2 minutes if more doses are required.
B. The client holds his breath for 10 seconds after inhaling the medication: This is correct. Holding the breath for about 10 seconds after inhalation allows the medication to settle in the airways and enhances its effectiveness.
C. The client takes a quick inhalation while releasing the medication from the inhaler: This is incorrect. A slow, deep inhalation is recommended to ensure that the medication reaches the lower airways.
D. The client exhales as the medication is released from the inhaler: This is incorrect. The client should exhale fully before inhaling the medication to ensure that the medication can be inhaled deeply into the lungs.
Correct Answer is B
Explanation
A. Explain the risks and benefits of the procedure: This is the responsibility of the provider, not the nurse. The nurse can provide information but does not explain the risks and benefits.
B. Witness the client's signature: This is the correct action for the nurse regarding informed consent. The nurse's role is to witness the client’s signature after the provider has explained the procedure.
C. Obtain the client's consent: The nurse does not obtain consent; this is the provider's responsibility. The nurse’s role is to witness the signing of the consent form.
D. Explain the procedure to the client if they do not understand: This is the responsibility of the provider who has the expertise to explain the procedure. The nurse should ensure that the client has had the opportunity to ask questions and understands the information provided by the provider.
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