A nurse is preparing to administer blood to a client. Which of the following actions should the nurse take to identify the client? (Select All that Apply.)
Confirm that the room number matches the medical record.
Compare the client identification number to the blood component tag number.
Verify the provider's prescription with another RN.
Ask the client to verbalize if the blood type is Rh-negative or positive.
Scan the barcode on the client's identification band.
Correct Answer : B,E
A. Confirm that the room number matches the medical record. Room numbers should never be used as a sole method to identify a client. Room assignments can change, and relying on them could lead to errors.
B. Compare the client identification number to the blood component tag number. Matching the client identification number to the blood component tag ensures the blood is being administered to the correct client. This is a key step in preventing transfusion errors.
C. Verify the provider's prescription with another RN. While this is an important step in the blood administration process, it is not specifically related to identifying the client.
D. Ask the client to verbalize if the blood type is Rh-negative or positive. Clients may not know their blood type, and relying on their verbal confirmation is unsafe. The blood type must be confirmed through laboratory testing and matched with the blood being administered.
E. Scan the barcode on the client's identification band. Scanning the barcode on the client’s identification band is a reliable and commonly used method for verifying the client’s identity in modern healthcare settings. This ensures that the blood is administered to the correct client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "Hypertension is the leading cause of death in people your age.": While hypertension is a significant risk factor for cardiovascular events and mortality, stating it as the leading cause of death without specific context or statistical data may not provide the most informative response to the client's question.
B. "Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group.": Hypertension is primarily associated with cardiovascular risks such as stroke, heart disease, and kidney disease. While it can contribute to overall health risks, it is not typically linked directly to type 1 diabetes or cancer in the context of this client's question.
C. "Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs.": While hypertension can contribute to cardiovascular complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE), these are not the primary risks that are typically emphasized when discussing the importance of treating hypertension.
D. "Hypertension greatly increases your risk of stroke and heart disease.": This response is the most relevant and specific to the client's question. Hypertension is a major risk factor for stroke, heart disease (including heart attack and heart failure), and other cardiovascular complications. By treating hypertension and controlling blood pressure within recommended targets, the client can significantly reduce the risk of these serious and potentially life-threatening conditions.
Correct Answer is C
Explanation
A. "I have a difficult time falling asleep at night":
Difficulty falling asleep at night is not typically a direct symptom of iron-deficiency anemia. While anemia can lead to fatigue and general tiredness, which might affect sleep quality, insomnia or difficulty falling asleep may have various causes unrelated to anemia. These causes can include stress, anxiety, poor sleep hygiene, or other underlying medical conditions.
B. "I have an increase in my appetite":
This choice is not directly related to iron-deficiency anemia. While some individuals with anemia may experience changes in appetite, such as increased hunger, this symptom is not specific to iron-deficiency anemia alone. An increase in appetite can have various causes, including hormonal changes, dietary changes, medications, or psychological factors.
C. "I have difficulty breathing when walking 30 feet":
This choice is the correct answer. Difficulty breathing, especially during exertion like walking, is a hallmark symptom of iron-deficiency anemia. Anemia reduces the oxygen-carrying capacity of the blood, leading to inadequate oxygen delivery to tissues, which can result in shortness of breath, fatigue, and difficulty with physical activities.
D. "I feel hot all of the time":
Feeling hot all the time is not a specific symptom of iron-deficiency anemia. While anemia can cause symptoms such as fatigue, weakness, pale skin, and shortness of breath, it does not directly lead to a constant feeling of heat or warmth throughout the body. Feeling hot or experiencing excessive sweating could be due to other factors such as hormonal changes, fever, hyperthyroidism, or environmental conditions.
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