A nurse is transcribing a client’s prescription for erythromycin 500mg four times per day. Which of the following information should the nurse clarify with the provider?

The nurse anticipates the client will likely require blood transfusion as evidenced by the client’s low hemoglobin and low hematocrit.

Rationale:

(i)

B. Blood transfusion: The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly low, suggesting anemia due to gastrointestinal blood loss. A blood transfusion may be necessary to restore adequate oxygen-carrying capacity and prevent further hemodynamic instability.

(ii)

C. Low hemoglobin: A hemoglobin level below normal indicates blood loss, likely from a bleeding peptic ulcer. This finding supports the need for intervention to prevent further complications such as hypoxia or shock.

F. Low hematocrit: A low hematocrit confirms anemia and blood volume depletion. This finding, along with the client's symptoms and history of dark, tarry stools, further supports the need for a blood transfusion.

Incorrect:

(i)

A. Proton pump inhibitor therapy: While PPIs are essential for ulcer management, they do not immediately address acute blood loss

C. Antibiotic therapy: Antibiotics are needed to eradicate H. pylori, but they are not the primary intervention for anemia.

D. Surgical intervention: Surgery is considered only if bleeding is severe and refractory to medical management.

E. Intravenous fluid resuscitation: IV fluids can help stabilize blood pressure but do not directly correct anemia.

(ii)

A. Elevated white blood cell count: The client’s WBC count is normal, making it irrelevant to this scenario.

B. Positive H. pylori test: While H. pylori is the likely cause of the ulcer, this result does not directly indicate the need for a blood transfusion.

D. Epigastric tenderness: This is a symptom of peptic ulcer disease but does not directly relate to the need for a blood transfusion.

E. Dark, tarry stools: While indicative of gastrointestinal bleeding, the direct lab evidence of anemia (low hemoglobin and hematocrit) is more critical in determining the need for transfusion.

Correct answers: C

Rationale:

A. Staff members using a class A fire extinguisher for an electrical fire is incorrect and dangerous. Class A extinguishers are for ordinary combustibles like paper and wood. Electrical fires require class C extinguishers to prevent the conduction of electricity.

B. Reviewing the locations of fire extinguishers every 2 to 3 years is insufficient for an effective safety plan. Regular fire safety drills and location reviews should occur at least annually. Frequent reinforcement ensures rapid response during a real fire emergency.

C. An evacuation order when fire extinguishers are ineffective indicates an effective safety plan and sound clinical judgment. The priority in the RACE acronym is to rescue and then evacuate if the fire is not contained. This protects life when suppression fails.

D. Fire alarms having the same sound as other alarms is a failure in safety design. Distinctive auditory signals are required to prevent confusion during an emergency. Unique alarms ensure that staff and patients immediately identify the specific nature of the threat.