You are caring for a patient with a positive TB skin test (15 mm), productive cough for two months, and unintentional weight loss. Which of the following orders will assist with the diagnosis of active tuberculosis? (Select all that apply)

Choice A reason: Checking the client’s temperature hourly monitors for transfusion reactions but does not prevent them. Fever may indicate a reaction, but prevention relies on ensuring blood compatibility and proper administration. Monitoring is a reactive measure, not a proactive step to avoid mismatches or errors causing hemolytic or febrile reactions.

Choice B reason: Verifying the client’s identity and blood type with another nurse is critical to prevent transfusion reactions. Mismatched blood types cause hemolytic reactions due to antibody-mediated destruction of donor red cells. Double-checking ensures the correct blood unit is administered, preventing life-threatening immunological responses and ensuring patient safety during transfusion.

Choice C reason: Administering diphenhydramine may prevent mild allergic reactions to blood transfusions, such as hives, but it does not address severe hemolytic reactions caused by ABO incompatibility. It is not routinely given prophylactically unless the client has a history of allergic reactions, making it less critical than verifying blood compatibility.

Choice D reason: Infusing blood over 6 hours increases the risk of bacterial growth and hemolysis in the blood unit, as transfusions should typically be completed within 4 hours. Prolonged infusion does not prevent reactions and may cause complications, making it an incorrect action for ensuring safe transfusion practices.

Choice A reason: Frequent bowel movements are not typical in peritonitis. Inflammation of the peritoneal cavity causes ileus, reducing bowel motility and leading to constipation or obstipation. Peristalsis slows due to irritation, and the body diverts energy to combat infection, making diarrhea unlikely unless another condition, like gastroenteritis, is present, which is not indicated here.

Choice B reason: A rigid abdomen is a classic sign of peritonitis due to peritoneal inflammation causing muscle guarding and rigidity. The peritoneal irritation from infection or chemical irritants (e.g., bile, gastric contents) triggers involuntary abdominal wall contraction to protect inflamed tissues, resulting in a board-like abdomen, often with severe pain.

Choice C reason: Decreased urinary output occurs in peritonitis due to systemic inflammation and potential hypovolemia from fluid shifts into the peritoneal cavity (third-spacing). The kidneys receive reduced perfusion, activating the renin-angiotensin-aldosterone system, leading to oliguria. This reflects the body’s attempt to conserve fluid in response to systemic stress and inflammation.

Choice D reason: Inability to pass stools is expected in peritonitis due to paralytic ileus, where intestinal motility ceases from inflammation. Peritoneal irritation disrupts normal peristalsis, causing bowel obstruction symptoms like constipation or obstipation. This results from the body’s inflammatory response inhibiting gastrointestinal function, leading to stool retention.

Choice E reason: Hyperactive bowel sounds are not typical in peritonitis. The condition causes paralytic ileus, reducing or absent bowel sounds due to decreased peristalsis from peritoneal inflammation. Hyperactive sounds may occur in early mechanical obstruction but not in peritonitis, where inflammation halts bowel motility, leading to hypoactive or absent sounds.