A nurse is preparing to administer an autologous blood product to a client. Which of the following actions should the nurse take to identify the client?

Match the client's blood type with the type and cross match specimen.

Confirm the provider's prescription matches the number on the blood component.

Ask the client to state his blood type and the date of the blood donation.

Ensure that the client's identification band matches the number on the blood unit.

Answer and Explanation

The Correct Answer is D

A. Match the client's blood type with the type and cross match specimen. While type and crossmatch are important for allogeneic transfusions, an autologous transfusion uses the client’s own previously donated blood, so this is not the primary method for identification.
B. Confirm the provider's prescription matches the number on the blood component. Although important, this step alone does not verify the client’s identity. The nurse must also confirm the blood unit matches the correct client.
C. Ask the client to state his blood type and the date of the blood donation. Client recall is not a reliable form of identification for transfusion safety, as it is prone to error or misunderstanding.
D. Ensure that the client's identification band matches the number on the blood unit. This is the correct and safest method to confirm identity before administering an autologous blood product. It ensures the blood product is matched to the correct patient.

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Correct Answer is D

Explanation

A. Explain long term consequences of the procedure to the child. This level of detail is not developmentally appropriate for a school-age child. It may increase anxiety without helping the child understand or cope with the immediate situation.
B. Remove the dressings while explaining the procedure to the child. While it is important to explain procedures, it should be done before starting to allow time for questions and emotional preparation. Explaining during may cause confusion or distraction.
C. Keep equipment out of the child's sight. Hiding equipment can actually increase fear and mistrust. School-age children benefit from open, age-appropriate communication and preparation about what to expect.
D. Allow the child to help remove the dressings. This is the most appropriate action. Allowing the child to participate in their care provides a sense of control, reduces anxiety, and helps build trust. It also aligns with the developmental need of school-age children to take on increasing responsibility and be involved in decision-making.

A. "Blurred vision is an expected adverse effect of this medication," B. "This medication can cause weight gain." C. "This medication can cause nausea and drowsiness." D. "It will take at least a week before this medication reaches a therapeutic level." E. "You will be placed on a low-sodium diet while taking this medication."

Correct Answer is ["B","C","D"]

Explanation

A. "Blurred vision is an expected adverse effect of this medication." Blurred vision is not a common or expected adverse effect of lithium. If this occurs, it may indicate toxicity or another underlying issue and should be reported. It is not part of routine education for expected side effects.
B. "This medication can cause weight gain." This is true. Weight gain is a known long-term adverse effect of lithium therapy and should be discussed with the client and family as part of monitoring and lifestyle considerations during treatment.
C. "This medication can cause nausea and drowsiness." These are common initial side effects when starting lithium and usually subside over time. Clients should be aware of these effects so they can differentiate between expected reactions and signs of toxicity.
D. "It will take at least a week before this medication reaches a therapeutic level." Correct. Lithium takes 7–14 days to reach therapeutic plasma levels, so clients may not experience symptom relief immediately. During this period, supportive care and safety monitoring are essential.
E. "You will be placed on a low-sodium diet while taking this medication." This is incorrect. Lithium has a narrow therapeutic index, and sodium levels affect lithium levels. A low-sodium diet can increase the risk of lithium toxicity, so clients should maintain a consistent sodium intake, not reduce it.

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A nurse is preparing to administer an autologous blood product to a client. Which of the following actions should the nurse take to identify the client?

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Naxlex Comprehensive Predictor Exams

A nurse is planning to change the dressings on a school-age child who has sustained multiple burns. Which of the following actions should the nurse plan to take?

Correct Answer is D

Explanation

The nurse is continuing to care for the client. Exhibits The nurse is providing teaching about lithium to the client and the client's adult child. Select the 3 statements the nurse should include.

Correct Answer is ["B","C","D"]

Explanation

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