A nurse is administering a blood transfusion to a client. After 15 minutes, the client reports difficulty breathing. What is the first action by the nurse?

Stop the transfusion.

Notify the health care provider of the client s response.

Check the client s vital signs.

Document the findings.

Answer and Explanation

The Correct Answer is A

Difficulty breathing is a sign of a potential transfusion reaction. When a client reports difficulty breathing during a blood transfusion, the nurse should stop the transfusion immediately to prevent the reaction from worsening. Once the transfusion is stopped, the nurse can then assess the client's vital signs and notify the healthcare provider of the client's response. Documentation of the findings should also be completed after the client's condition has stabilized. However, stopping the transfusion takes priority over documenting the findings.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Renal failure can cause a buildup of ﬂuid in the body. When kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood’s chemical makeup may get out of balance. This can lead to ﬂuid retention, causing swelling in your legs, ankles or feet.

A. Midline catheter B. Tunneled catheter C. Non-Tunneled catheter D. Peripheral IV E. PlCC Line

Correct Answer is ["B","C","E"]

Explanation

Explanation: Central venous catheters are catheters that are inserted through a vein in the chest, neck, or groin and then threaded through to a large vein near the heart. These types of catheters are used for long- term treatment and monitoring of critically ill patients.

A midline catheter is a type of peripheral IV catheter that is longer and extends into the upper arm, but it does not reach a central vein and is not considered a central line. Therefore, option a. is incorrect.

A peripheral IV catheter is inserted into a peripheral vein (e.g., hand, arm), and it does not reach a central vein, making it a peripheral line. Therefore, option d. is incorrect.

A tunneled catheter is a type of central venous catheter that is inserted through a small incision in the chest and then tunneled under the skin to a central vein. It is typically used for long-term treatment and is less likely to become infected than a non-tunneled catheter. Therefore, option b. is correct.

A non-tunneled catheter is a type of central venous catheter that is inserted directly into a central vein in the chest, neck, or groin. It is typically used for short-term treatment and is more likely to become infected than a tunneled catheter. Therefore, option c. is correct.

A PICC line (peripherally inserted central catheter) is a type of central venous catheter that is inserted through a vein in the arm and then threaded through to a central vein near the heart. It is typically used for long-term treatment and is less invasive than other types of central lines. Therefore, option e. is correct.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is administering a blood transfusion to a client. After 15 minutes, the client reports difficulty breathing. What is the first action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A dialysis unit nurse caring for a client with renal failure will expect the client to exhibit which ﬂuid imbalance?

Correct Answer is B

Explanation

The nurse is working on a cardiac unit with several patients who have intravenous access lines. The nurse identifies the following are considered central venous catheters: (Select All That Apply)

Correct Answer is ["B","C","E"]

Explanation

The Practical Nurse (PN) assessing a client for the nursing diagnosis of Impaired Verbal Communication is aware that the least number of defining characteristics for this diagnosis is:

A client with renal disease requires IV ﬂuids. It is important for the nurse to:

A nurse is administering a blood transfusion to a client. After 15 minutes, the client reports difficulty breathing. What is the first action by the nurse?

A patient who is ordered a ﬂuid restriction of 1000ml ﬂuid restriction. He is on the list for a kidney transplant due to kidney failure. His mouth feels dry during the day. and he wants to know how he can moisten his mouth without going over his restriction:

MK is admited with COPD exacerbation. Your nursing care plan reads Impaired Gas Exchange, related to smoking 1 PPD of cigaretes. AED pursed lip breathing shortness of breath. Which is the best expected outcome for this diagnosis.

The nurse scaring for a patient who will be needing a blood transfusion. The nurse knows that the universal recipient of blood would be considered blood type:

The nurse is caring for a client with respiratory alkalosis. Which arterial blood gas data does the nurse anticipate finding?

A patient with congestive heart failure is at risk of excess ﬂuid volume. Which intervention will best determine if the patient is beginning to have excess ﬂuid volume?