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.
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
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This is the most appropriate response. Clients with COPD often have chronically elevated carbon dioxide levels, which can lead to a compensatory decrease in the oxygen saturation level. A reading of 91% may be within their normal range.
Correct Answer is B
Explanation
Hemoglobin is a protein found in red blood cells that plays a crucial role in transporting oxygen from the lungs to the body's tissues and organs. When oxygen is breathed in, it binds to the hemoglobin in red blood cells, forming oxyhemoglobin. This oxyhemoglobin is then transported throughout the body via the circulatory system, delivering oxygen to the cells that need it
.
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