Which nursing interventions are appropriate for a nurse administering a blood transfusion? Select All That Apply
Hang a bag of 0.9% normal saline with 5% dextrose at the bedside (D5%NS)
Verify the client's name and blood type with a second nurse
Infuse the unit of blood within 4 hours.
Obtain baseline vital signs prior to starting the transfusion
Continuously monitor the client during the first 15 minutes of the transfusion
Insert an 18-gauge intravenous catheter
Insert a 22-gauge intravenous catheter
Correct Answer : B,C,D,E,F
A. Hanging a bag of 0.9% normal saline with 5% dextrose (D5%NS) is incorrect; only normal saline (0.9% NS) should be used to prime the blood transfusion line to avoid hemolysis.
B. Verifying the client's name and blood type with a second nurse is a critical safety measure to prevent transfusion reactions and ensure the correct blood product is given.
C. Infusing the unit of blood within 4 hours is essential to reduce the risk of bacterial growth in the blood product.
D. Obtaining baseline vital signs prior to starting the transfusion is important to assess the client's condition and monitor for any changes during the transfusion.
E. Continuously monitoring the client during the first 15 minutes of the transfusion is vital for detecting any signs of a transfusion reaction promptly.
F. Inserting an 18-gauge intravenous catheter is recommended for blood transfusions as it provides a sufficient lumen to accommodate the blood flow.
G. Inserting a 22-gauge intravenous catheter is acceptable for some transfusions, but an 18-gauge is preferred for larger blood products.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E","F"]
Explanation
A. Hanging a bag of 0.9% normal saline with 5% dextrose (D5%NS) is incorrect; only normal saline (0.9% NS) should be used to prime the blood transfusion line to avoid hemolysis.
B. Verifying the client's name and blood type with a second nurse is a critical safety measure to prevent transfusion reactions and ensure the correct blood product is given.
C. Infusing the unit of blood within 4 hours is essential to reduce the risk of bacterial growth in the blood product.
D. Obtaining baseline vital signs prior to starting the transfusion is important to assess the client's condition and monitor for any changes during the transfusion.
E. Continuously monitoring the client during the first 15 minutes of the transfusion is vital for detecting any signs of a transfusion reaction promptly.
F. Inserting an 18-gauge intravenous catheter is recommended for blood transfusions as it provides a sufficient lumen to accommodate the blood flow.
G. Inserting a 22-gauge intravenous catheter is acceptable for some transfusions, but an 18-gauge is preferred for larger blood products.
Correct Answer is ["B","E","F"]
Explanation
A. Bananas are not a significant source of vitamin B12.
B. Eggs are a good source of vitamin B12 and should be included in the diet of someone with a deficiency.
C. Spinach contains folate but is not a reliable source of vitamin B12.
D. Carrots are not a source of vitamin B12.
E. Beef is an excellent source of vitamin B12 and should be consumed to help correct the deficiency.
F. Milk is a good source of vitamin B12 and can help increase intake for clients with a deficiency.
G. Quinoa does not contain vitamin B12 and should not be relied upon for addressing this deficiency.
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