A nurse is planning to administer a unit of PRBCS for a client. Which of the following actions should the nurse plan to take?
Stay with the client for the first 10 min after starting the transfusion.
Flush the transfusion tubing with 5% dextrose in water.
Ensure 2 nurses check the label on the unit of blood.
Administer the blood transfusion over 1 hr.
The Correct Answer is C
A. The correct actions to take include staying with the client for the first 15-30 minutes after starting the transfusion, not just the first 10 minutes, to monitor for any adverse reactions.
B. It is also crucial to use 0.9% sodium chloride solution, not 5% dextrose in water, to flush the transfusion tubing.
C. It is a standard practice to have two nurses check the blood unit label to verify the correct blood type and compatibility before administration.
D. The transfusion should not be rushed over 1 hour; instead, it should be administered over a period of 2-4 hours, depending on the patient's condition and the volume of PRBCs to be transfused.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Rinsing the client's mouth helps to remove oral contaminants, ensuring that the sputum specimen is representative of the respiratory secretions.
B. Obtaining the specimen in the evening is not a specific requirement; the best time to collect the specimen is when the client has the most productive cough.
C. Saving the sputum specimen in a clean container is essential to prevent contamination. However, a sterile container is usually required.
D. Collecting the sputum specimen after a meal might induce coughing but can also contaminate the specimen with food particles.
Correct Answer is ["100"]
Explanation
To calculate the rate at which the IV pump should be set to deliver the medication, you would use the formula:
(Total Volume in mL / Time in hours) = mL/hr.
The total volume of the IV bag is 50 mL and the time frame is 0.5 hours (since 30 minutes is half an hour). So, the calculation would be 50 mL / 0.5 hours = 100 mL/hr.
Therefore, the nurse should set the IV pump to deliver 100 mL/hr to administer 500 mg of ampicillin over 30 minutes.
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