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Which of the following actions should a nurse take during the administration of a blood transfusion to ensure patient safety? Select all that apply.

Perform safety checks to ensure the correct blood product is administered.

Use a 24-gauge catheter for blood transfusion.

Verify the client's blood type and match with the donor's blood.

Start the transfusion immediately without checking the infusion site.

Administer blood products with dextrose 5% in 0.9% sodium chloride.

Obtain the signed consent from the client prior to starting the transfusion.

Answer and Explanation

Correct Answer : A,C,F

Rationale:

A. This is a critical safety step. The nurse must verify the right patient, blood type, Rh factor, unit number, and expiration date with another qualified professional. This helps prevent life-threatening transfusion reactions, making this correct.

B. A 24-gauge catheter is too small for safe blood transfusion in most cases, especially for adults. Blood is typically administered through a larger bore IV (18–20 gauge) to prevent hemolysis and allow adequate flow. Therefore, this is incorrect.

C. This is one of the most essential steps in preventing hemolytic transfusion reactions, which can be fatal. Proper compatibility verification is mandatory before starting the transfusion. Therefore, this is correct.

D. The nurse must assess IV patency and site condition before initiating the transfusion. Starting without checking may result in infiltration or complications. This is unsafe and incorrect.

E. Blood should only be administered with 0.9% normal saline. Dextrose-containing solutions can cause hemolysis or clotting of blood products. Therefore, this is incorrect.

F. Informed consent is a legal and ethical requirement before administering blood products. The nurse must ensure that consent has been obtained and documented. Therefore, this is correct.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Rationale:

A. Gastrointestinal distress caused by NSAIDs like ketorolac is primarily due to gastric mucosal irritation, not potassium deficiency. A diet high in potassium does not prevent NSAID-related GI complications. Protective strategies include taking the medication with food or using gastroprotective agents if needed.

B. Ketorolac is a potent NSAID with a high risk of renal toxicity, gastrointestinal bleeding, and cardiovascular effects. It is generally not recommended for long-term or repeated use, and overlapping NSAIDs can increase the risk of adverse effects. The nurse should avoid concurrent NSAIDs unless explicitly prescribed.

C. Ketorolac can cause acute kidney injury, fluid retention, and electrolyte imbalances, even in patients without prior renal issues. Monitoring serum creatinine, BUN, and intake/output is essential to detect early renal compromise. This is especially important in patients with rheumatoid arthritis who may already be at risk due to chronic inflammation or other medications.

D. Taking ketorolac on an empty stomach increases the risk of gastric irritation and ulcers. NSAIDs should typically be taken with food or milk to minimize gastrointestinal adverse effects.

A. You can take an additional dose of ibuprofen if the headache does not subside within 30 minutes. B. You can safely combine ibuprofen with other NSAIDs or aspirin for more effective pain relief. C. Take ibuprofen with food or milk to minimize gastrointestinal upset. D. Acetaminophen does not increase bleeding time and has a low incidence of gastrointestinal (GI) adverse effects. E. Do not exceed a total daily dose of 1.200 mg to avoid toxicity of acetaminophen, F. Monitor for signs of gastrointestinal bleeding, such as black or tarry stools.

Correct Answer is ["C","D","F"]

Explanation

Rationale:

A. Ibuprofen should not be redosed this quickly. The typical dosing interval is every 6–8 hours, depending on the formulation. Taking an additional dose too soon increases the risk of gastrointestinal, renal, and cardiovascular adverse effects.

B. Combining NSAIDs (e.g., ibuprofen with naproxen or aspirin) increases the risk of GI bleeding, kidney injury, and other adverse effects. NSAIDs should not be combined unless specifically directed by a healthcare provider.

C. Ibuprofen is an NSAID, which can irritate the stomach lining and increase the risk of gastritis or ulcers. Taking it with food, milk, or antacids helps reduce GI irritation.

D. Acetaminophen is not an NSAID and does not affect platelet function or the GI mucosa. It is generally safer for patients at risk of GI bleeding or those who require normal coagulation.

E. Incorrect for typical adult dosing. The maximum recommended daily dose for healthy adults is 3,000–4,000 mg, depending on guidelines and liver function. 1,200 mg is usually a limit for over-the-counter preparations or special populations, but education should reflect safe adult dosing and emphasize not exceeding the recommended maximum.

F. NSAIDs like ibuprofen can cause GI bleeding, so patients should be instructed to report symptoms such as dark/tarry stools, vomiting blood, or abdominal pain.

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Which of the following actions should a nurse take during the administration of a blood transfusion to ensure patient safety? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A 45-year-old patient with rheumatoid arthritis is prescribed ketorolac for pain management. Which of the following nursing considerations should be prioritized when administering this medication?

Correct Answer is C

Explanation

Which of the following client education points about ibuprofen and acetaminophen should the nurse include? Select all that apply.

Correct Answer is ["C","D","F"]

Explanation

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