A nurse is preparing to administer a blood transfusion to a client. Which of the following procedures should the nurse follow to ensure proper client identification?
Check the client's blood type and crossmatch it against the provider's orders
Ask the client to state their blood type prior to beginning blood administration
Compare information on the blood product to the informed consent form
Verify the client and blood product information with another licensed nurse
The Correct Answer is D
Verify the client and blood product information with another licensed nurse.
Rationale:
- A - This is not a correct procedure for client identification, but rather for blood compatibility. The nurse should check the client's blood type and crossmatch it against the blood product label, not the provider's orders.
- B - This is not a reliable method of client identification, as the client may not know or remember their blood type correctly. The nurse should use two identifiers, such as name and date of birth, to confirm the client's identity.
- C - This is not a relevant step for client identification, but rather for informed consent. The nurse should ensure that the client has signed an informed consent form before administering blood, but this does not verify that the blood product matches the client.
- D - This is the correct procedure for client identification, as it involves two licensed nurses who independently check and confirm the client's identity and the blood product information, such as blood type, Rh factor, expiration date, and serial number.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
- A. Instructing the client about the importance of regular medical appointments is important, but not the priority. The nurse should first ensure that the client knows how to manage their blood glucose levels and administer insulin at home.
- B. Encouraging the client to participate in daily exercise is beneficial, but not the priority. The nurse should first ensure that the client knows how to monitor their blood glucose levels and adjust their insulin dose accordingly.
- C. Explaining proper foot care techniques to the client is essential, but not the priority. The nurse should first ensure that the client knows how to prevent and treat hypoglycemia and hyperglycemia, which can have serious complications.
- D. Ensuring that the client understands the medication regimen is the priority. The nurse should teach the client about the types, actions, doses, and administration times of insulin, as well as how to store and dispose of it safely.
Correct Answer is A
Explanation
Choice A rationale:
The nurse should suggest, "Give your son a little gift from his new sister," as a strategy to help the preschool-age son adjust to having a new sibling. This approach involves a small token or gift given from the newborn to the older sibling. It helps create a positive association and fosters a sense of connection and acceptance between the siblings. The gift symbolizes the new baby's arrival and can help the older child feel special and valued during this transition.
Choice B rationale:
While spending alone time with the new sister is important, the statement, "Give your son plenty of 'alone time' with his sister," does not address the initial meeting concerns. Alone time is relevant once the siblings have established a bond, but the initial introduction requires a more structured approach to ensure a smooth transition.
Choice C rationale:
Planning for the son to meet his sister for the first time at home is not the most suitable strategy. Hospitals provide a controlled environment with healthcare professionals available, ensuring the safety and well-being of both the mother and the newborn. The initial meeting should occur in a setting where medical assistance is readily accessible in case of any unforeseen circumstances.
Choice D rationale:
Holding the daughter when the son first meets her is a common and natural practice but does not actively involve the son in the process. Providing a gift from the baby to the older sibling fosters a sense of participation and inclusion, making the older child feel more involved and excited about the new sibling's arrival.
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