The nurse suspects the patient is having a blood transfusion reaction. What is the FIRST action the nurse should do?
Stop the transfusion
Call the blood bank to report the reaction
Administer oxygen
Call the physician
The Correct Answer is A
A. Stop the transfusion: The immediate priority is to halt the infusion to prevent further exposure to the offending blood product.
B. Call the blood bank to report the reaction: This is done after the transfusion is stopped and the patient is stabilized.
C. Administer oxygen: Oxygen administration may be required if the patient shows signs of respiratory distress but is not the immediate first action.
D. Call the physician: Notifying the physician is important but only after stopping the transfusion and assessing the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "These organs assist with vitamin absorption."These organs are not involved in nutrient absorption.
B. "These organs are used in digestion." The thymus, spleen, and lymph nodes are not part of the digestive system.
C. "These organs are for immunity." These organs play essential roles in the immune system, including lymphocyte production, pathogen filtration, and immune response regulation.
D. "These organs regulate electrolyte balance." Electrolyte regulation is managed by the kidneys and endocrine system.
Correct Answer is A
Explanation
A. Antigen-antibody complexes: These are involved in Type III hypersensitivity reactions, not in Hashimoto thyroiditis.
B. Autoantibodies: Hashimoto thyroiditis is an autoimmune disorder where autoantibodies target thyroid peroxidase (TPO) and thyroglobulin, leading to inflammation and destruction of thyroid cells.
C. Viral infection: Although some autoimmune conditions may have viral triggers, Hashimoto's is not directly caused by a viral infection.
D. Bacterial infection: Bacterial infections do not cause Hashimoto thyroiditis.
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