A transfusion of packed red blood cells (PRBCs) has been infusing for 5 minutes when the patient becomes flushes and tachypneic and says, "I'm having chills. Please get me a blanket." Which action should the nurse take first?

Stop the transfusion

Administer oxygen

Obtain a blanket from the warmer

Check the patient's oral temperature

Answer and Explanation

The Correct Answer is A

A.   This is the first and most critical action to take. The patient's symptoms suggest a possible transfusion reaction, which can be life-threatening. Stopping the transfusion immediately prevents further exposure to potentially harmful blood components.
B.   Administering oxygen may be necessary if the patient exhibits signs of respiratory distress or hypoxia. However, this action should come after ensuring that the transfusion is stopped and the patient is stabilized, as continuing the transfusion could exacerbate the reaction.
C.   While providing warmth can help alleviate chills, it is not the priority action. The patient's safety is more important, and symptoms of a transfusion reaction must be addressed first.
D.   Checking the temperature can provide useful information about the patient's condition, especially if a fever is present, but it is not an immediate priority. The focus should be on stopping the transfusion and managing the acute symptoms.

Nursing Test Bank

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Correct Answer is C

Explanation

A. Epoetin Alfa is typically used to treat anemia, and it is often indicated when hemoglobin (Hgb) levels are below 11 g/dL. Therefore, if the Hgb is less than 11, it would be appropriate to administer the medication to help increase red blood cell production.
B. Do not hold. An activated partial thromboplastin time (aPTT) of 120 seconds indicates a prolonged coagulation time, which increases the risk of bleeding. However, Epoetin Alfa does not have a direct impact on coagulation, so this value alone would not warrant holding the medication.
C. Epoetin Alfa is generally not indicated if the Hgb level is already above 11 g/dL, particularly if there’s a risk of increasing the Hgb above the recommended therapeutic range (often above 12 g/dL). If the Hgb exceeds this level, the medication should be held to prevent complications such as thromboembolic events.
D. A PT/INR of 3.5 indicates a significantly prolonged prothrombin time, suggesting a high risk of bleeding. However, Epoetin Alfa does not directly cause bleeding.

A. They will be treated with medications for 2 years B. They will always test negative on a Mantoux test C. They can spread it to others until they have 3 negative sputum tests D. They can't spread it to others

Correct Answer is D

Explanation

A. While patients with latent TB may be treated to prevent progression to active TB, the treatment duration is generally shorter—typically around 3 to 9 months, depending on the medication regimen (e.g., isoniazid for 9 months or rifampin for 4 months).
B. Individuals with latent TB will usually test positive on a Mantoux test (also known as a tuberculin skin test), indicating they have been exposed to the TB bacteria. However, those with latent TB do not have active disease and may not have symptoms.
C. Individuals with latent TB do not spread the bacteria to others because the infection is contained and does not cause active disease. Only those with active TB can transmit the bacteria, regardless of sputum test results.
D. Patients with latent TB are not contagious and cannot spread the bacteria to others. The bacteria remain inactive in the body, and only a small percentage of these individuals may develop active TB in the future.

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A transfusion of packed red blood cells (PRBCs) has been infusing for 5 minutes when the patient becomes flushes and tachypneic and says, "I'm having chills. Please get me a blanket." Which action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Your cancer patient has bone marrow suppression from their chemotherapy treatments, and is scheduled to receive Epoetin Alfa shots 3 times per week. Which of the following lab values would cause you to hold the administration of the medication for safety concerns?

Correct Answer is C

Explanation

As a nurse, you understand that when patients have latent TB:

Correct Answer is D

Explanation

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