A nurse is caring for several clients in the morning prior to surgery. Which medications taken by the clients necessitate a consultation with the primary health care provider regarding their administration? (Select all that apply.)

Choice A rationale:
It is incorrect to state that the client will not be able to bathe with a central vascular access device.
While certain precautions are necessary to keep the device dry and clean during bathing, bathing is still possible and important for maintaining hygiene.
The nurse should provide specific instructions on how to protect the device during bathing, such as using a waterproof cover or avoiding direct water contact.
Choice B rationale:
It is inaccurate to claim that there is no risk of infection associated with a central vascular access device, even when sterile technique is used during insertion.
Infection is a serious potential complication, and it's crucial to emphasize ongoing infection prevention measures to the client.
The nurse should educate the client about signs and symptoms of infection to watch for and the importance of prompt reporting to healthcare providers.
Choice C rationale:
It is not always necessary to wear a sling on the arm with the central vascular access device.
The need for a sling may depend on the type of device, the client's condition, and the healthcare provider's recommendations.
If a sling is indicated, the nurse should provide instructions on proper use and care to maintain comfort and prevent complications.
Choice D rationale:
This is the correct statement to include in the client's teaching.
Thorough cleaning of the connections prior to accessing the device is essential for preventing infection.
The client should be empowered to advocate for themselves and ensure that all providers follow proper infection control procedures.

Choice A rationale:
Leukocyte-poor packed red blood cells (LP-PRBCs) have a significantly reduced number of white blood cells (WBCs), also known as leukocytes. This is crucial for pre-transplant patients like the one in the question for several reasons:
Prevention of Alloimmunization: WBCs in blood transfusions carry human leukocyte antigens (HLAs), which are proteins on the surface of cells that play a role in the immune system. Exposure to foreign HLAs can cause the recipient's immune system to develop antibodies against them, a process called alloimmunization. These antibodies can then attack and damage the transplanted kidney, leading to rejection. By reducing the number of WBCs in the transfusion, LP-PRBCs significantly lower the risk of alloimmunization.
Reduced Incidence of Febrile Non-Hemolytic Transfusion Reactions (FNHTRs): FNHTRs are the most common type of transfusion reaction, characterized by fever, chills, and occasionally other symptoms like nausea and vomiting. They are thought to be caused by cytokines released from WBCs in the transfused blood. LP-PRBCs, with their reduced WBC content, have been shown to lower the incidence of FNHTRs.
Potential Benefits for Graft Survival: Some studies have suggested that the use of LP-PRBCs for transfusions may improve long-term graft survival rates in kidney transplant patients, although more research is needed to confirm these findings.
Choice B rationale:
This statement is incorrect. While LP-PRBCs may have some advantages in terms of absorption or utilization, this is not the primary reason for their use in pre-transplant patients. The main goal is to reduce the risk of alloimmunization and other transfusion-related complications.
Choice C rationale:
This statement is partially correct. LP-PRBCs do tend to cause fewer blood reactions, particularly FNHTRs, as explained in the rationale for Choice A. However, this is not the most comprehensive or accurate explanation for their use in pre-transplant patients.
Choice D rationale:
This statement is not directly relevant to the use of LP-PRBCs in pre-transplant patients. While LP-PRBCs may have a lower risk of hemolysis, this is not the primary reason for their use in this specific context.