A nurse is caring for a client in the medical-surgical unit.

Exhibits

Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client?
Select all that apply.

Use soap and water to provide perineal care.

Change the indwelling urinary catheter tubing every 3 days

Encourage the client to drink 3000 ml of fluid daily.

Review the need for the indwelling urinary catheter daily

Place the drainage beg on the bed when transporting the client

Answer and Explanation

Correct Answer : A,D,E

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Correct Answer is C

Explanation

Choice A rationale:

Allergic transfusion reactions are characterized by symptoms such as hives, itching, and shortness of breath. While allergic reactions can cause discomfort, they do not typically present with the symptoms described in the scenario, such as chills, headache, low-back pain, and chest tightness.

Choice B rationale:

Febrile nonhemolytic transfusion reactions are characterized by fever and chills, but they do not usually cause headache, low-back pain, or chest tightness. These reactions occur due to antibodies against donor leukocytes or platelets.

Choice C rationale:

Acute hemolytic transfusion reactions occur when there is a mismatch in blood type between the donor and recipient, leading to rapid destruction of transfused red blood cells. This reaction can cause symptoms such as chills, fever, low-back pain, chest tightness, and hemoglobinuria (presence of hemoglobin in the urine) It is a medical emergency that requires immediate cessation of the transfusion, supportive care, and treatment for potential complications such as acute kidney injury.

Choice D rationale:

Bacterial transfusion reactions occur due to bacterial contamination of the blood product. These reactions can cause symptoms such as fever, chills, hypotension, and shock. While bacterial transfusion reactions can be serious, the symptoms described in the scenario, including headache and low-back pain, are not typically associated with this type of reaction.

A. Suspicious of others B. Ritualistic behavior C. Preoccupied with aging D. Exhibits separation anxiety

Correct Answer is C

Explanation

A. Incorrect. Being suspicious of others is more characteristic of paranoid personality disorder.
B. Incorrect. Ritualistic behavior is more characteristic of obsessive-compulsive personality disorder.
C. Correct. Preoccupation with aging and a fear of losing their physical attractiveness or power is a common trait in individuals with narcissistic personality disorder.
D. Incorrect. Exhibiting separation anxiety is not a defining characteristic of narcissistic personality disorder.

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A nurse is caring for a client in the medical-surgical unit. Exhibits Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client who is receiving a transfusion of packed RBCs.The client reports chills, headache, low-back pain, and a feeling of "tightness" in his chest.The nurse should identify that the client has developed which of the following types of transfusion reactions?

Correct Answer is C

Explanation

A nurse is completing an admission assessment for a client who has narcissistic personality disorder. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

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A nurse is caring for a client in the medical-surgical unit.

Exhibits

Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client?
Select all that apply.