While receiving a unit of packed red blood cells, the patient begins to experience hives around the neck and upper chest. What actions should the nurse perform because of this reaction? (Select all that apply.)
a. Stop the transfusion.
b. Notify the health care provider (HCP).
c. Return the blood to the blood bank.
d. Administer prescribed antihistamines.
e. Restart the infusion and carefully monitor.
ANS: A, B, D, E
On discovery of a urticarial reaction, the nurse should stop the transfusion and notify the HCP immediately. Expect that the patient will be given a dose of an antihistamine, such as diphenhydramine (Benadryl). If the transfusion is restarted, continue to monitor the patient closely. C. The blood will most likely not be returned to the blood bank but transfused into the patient.
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A newly diagnosed type I, insulin-dependent diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:
1. "Your baby may be smaller than average at birth." 2. "Your baby will probably be larger than average at birth." 3. "As long as you control your blood sugar, your baby will not be affected at all." 4. "Your baby might have high blood sugar for several days."
The director of nursing at a skilled facility is implementing knowledge, skills, and attitudes to improve the quality of care of the older residents. Which criteria will be implemented? Standard Text: Select all that apply
1. Safety 2. Teamwork 3. Staff incentives 4. Patient-centered care 5. Quality improvement
A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present?
A) Myocardial muscle tissue B) All body fluids C) Cerebral tissue D) Renal cells
A client is prescribed a fluoroquinolone to be taken for 10 days. What should the nurse instruct the client to avoid while taking this medication?
a. Gluten b. Dairy products c. High-sodium foods d. Soda with citrus juice