A nurse is monitoring a client who reports having chills and back pain during a blood transfusion. Which of the following actions is nurse's priority?

Stopping the transfusion

Covering the client with a blanket

Assessing the client's skin for a rash

Notifying the provider

Answer and Explanation

The Correct Answer is A

A.   Stopping the transfusion is the priority action if the client is experiencing symptoms of a transfusion reaction.
B.   Covering the client with a blanket may address chills but does not address the potential serious nature of the reaction.
C.   Assessing the client's skin for a rash is important but should not delay the immediate action of stopping the transfusion.
D.   Notifying the provider is important, but stopping the transfusion and addressing the immediate needs of the client take precedence.

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Correct Answer is A

Explanation

A. Hyponatremia (low sodium) can lead to neurological symptoms, including nausea and vomiting.
B. Extreme thirst is more commonly associated with hypernatremia (high sodium).
C. Flushed skin and fever are not typical manifestations of hyponatremia.
D. Fever is not a typical manifestation of hyponatremia.

A. Hyperactive bowel sounds B. Hyperactive deep tendon reflexes C. Prolonged ST segment D. Lethargy

Correct Answer is C

Explanation

A. Hyperactive bowel sounds are not typically associated with elevated calcium levels.
B. Hyperactive deep tendon reflexes are a potential sign of hypercalcemia, but cardiac manifestations are more critical.
C. Prolonged ST segments on cardiac monitoring can be indicative of hypercalcemia and may lead to cardiac arrhythmias.
D. Lethargy is a general symptom and may not be specific to hypercalcemia. Cardiac manifestations are a more immediate concern.

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A nurse is monitoring a client who reports having chills and back pain during a blood transfusion. Which of the following actions is nurse's priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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