A nurse is assisting with the care of a client who is receiving a blood transfusion. The nurse should monitor for which of the following findings as an indication the client is having an acute hemolytic reaction?
Vomiting
Urticaria
Low back pain
Pulmonary congestion
The Correct Answer is C
Choice A reason: Vomiting can be a sign of a transfusion reaction, but it is not as specific as low back pain for an acute hemolytic reaction.
Choice B reason: Urticaria, or hives, may indicate an allergic reaction but is not specific to an acute hemolytic reaction.
Choice C reason: Low back pain is a classic symptom of an acute hemolytic reaction, which is a serious and potentially life-threatening condition that requires immediate attention.
Choice D reason: Pulmonary congestion may occur in various conditions and is not the most specific indicator of an acute hemolytic reaction.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Phobia is an anxiety disorder characterized by an excessive and irrational fear of specific objects, situations, or activities, which does not align with Ms. T's symptoms.
Choice B reason: PTSD is a disorder that can occur after a person has been through a traumatic event, which is not indicated in Ms. T's case.
Choice C reason: SSD is characterized by an extreme focus on physical symptoms, such as pain, that causes major emotional distress and problems functioning, which matches Ms. T's experience.
Choice D reason: GAD involves persistent and excessive worry about various things, not just physical symptoms, so it is less likely than SSD in this scenario.
Correct Answer is D
Explanation
Choice A reason: Legs in adduction can increase the risk of dislocation after hip replacement surgery.
Choice B reason: Flexing the hip more than 90 degrees can also increase the risk of dislocation.
Choice C reason: Internal rotation of the leg can lead to dislocation of the new hip joint.
Choice D reason: Maintaining the legs in abduction helps to stabilize the hip and prevent dislocation.
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