The nurse is setting up to administer a unit of blood. Which is the most important nursing intervention during preparation for this procedure?
a. Prepare a normal saline solution.
b. Obtain a Y-tubing for administration.
c. Provide the patient with information.
d. Identify the blood product and patient.
D
Before administering blood, the nurse checks the identification of the patient and the blood product according to agency policy, which includes several patient identifiers. Accurate identifi-cation decreases the risk of patient injury, infection, or death from patient-blood mismatch. The nurse prepares the Y-tubing with normal saline before the blood transfusion is started. He or she takes time to teach the patient before beginning the transfusion. The instruction should include when the nurse should be notified; this instruction is given not to alarm the patient but to make the patient an active participant.
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The nurse receives a phone call from a 25-year-old woman experiencing breast tenderness in the week prior to her menses, with palpable breast nodularity, without nipple discharge. What is the best response by the nurse?
1. "Please make an appointment at the Breast Cancer center as soon as possible." 2. "How much salty food do you consume on a regular basis?" 3. "As long as you don't have nipple discharge, it isn't a serious condition." 4. "Eliminate caffeine and chocolate from your diet."
A woman in labor seems to be progressing more slowly than expected. Which action should the nurse perform first?
A. Administer oxygen by face mask. B. Assess the woman for a full bladder. C. Increase the rate of the IV fluids. D. Provide stimulants such as coffee.
A woman has been prescribed a daily iron supplement by her health care provider. She recently became constipated, most likely related to the iron supplement. Which of the following best de-scribes this response?
a. Therapeutic effect b. Adverse reaction c. Side effect d. Toxicity
Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not
making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by: a. QSEN. b. IHI. c. DNV/NIAHO. d. AHRQ.