Nokea
A client has been admitted with active rectal bleeding. He has been typed and cross-matched for 2 units of packed red blood cells (RBCs). Within 10 minutes of admission the client faints when getting up to go to the bedside commode. The nurse notifies the health care provider, who orders a unit of blood immediately. The nurse should expect which type of packed RBCs will be used for immediate transfusion?
- A. A negative.
- B. B negative.
- C. AB negative.
- D. O negative.
Correct Answer: D
Rationale: In an emergency situation requiring immediate transfusion, such as when a client with active bleeding faints, O negative blood is used because it is the universal donor type. O negative blood can be safely transfused to any patient regardless of their blood type, minimizing the risk of a transfusion reaction when there is no time for type and cross-match verification.
You may also like to solve these questions
Several clients have come to the emergency department after a possible bioterrorist act of arsenic overexposure. The nurse should assess these clients for which signs or symptoms immediately following the poisoning? Select all that apply.
- A. Violent vomiting.
- B. Severe diarrhea.
- C. Abdominal pain.
- D. Sensory neuropathy.
- E. Persistent cough.
Correct Answer: A,B,C
Rationale: Arsenic poisoning typically presents with acute gastrointestinal symptoms such as violent vomiting, severe diarrhea, and abdominal pain due to its toxic effects on the digestive system. Sensory neuropathy and persistent cough are less common immediate symptoms.
A client post-cystoscopy is discharged. The nurse should instruct to:
- A. Resume normal activity.
- B. Avoid fluids for 24 hours.
- C. Expect blue urine.
- D. Take antibiotics for a week.
Correct Answer: A
Rationale: Normal activity can resume post-cystoscopy unless complications arise.
The nurse develops a teaching plan for a client scheduled for a spinal fusion. Which of the following should the nurse expect to include?
- A. The client typically experiences more pain at the donor site than at the fusion site.
- B. The surgeon will apply a simple gauze dressing to the donor site.
- C. Neurovascular checks are unnecessary if the fibula is the donor site.
- D. The client's level of activity restriction is determined by the amount of pain.
Correct Answer: A
Rationale: The donor site (e.g., iliac crest) often causes more pain than the fusion site due to tissue trauma.
Which of the following diets would be most appropriate in the chronic obstructive pulmonary disease (COPD)?
- A. Low-fat, low-cholesterol diet.
- B. Bland, soft diet.
- C. Low-sodium diet.
- D. High-calorie, high-protein diet.
Correct Answer: D
Rationale: A high-calorie, high-protein diet supports nutritional needs in COPD, where energy expenditure is high and appetite may be low. Other diets are less specific to COPD requirements.
A 49-year-old male with a tracheostomy tube confides to the nurse during a clinic visit that he is beginning to avoid sexual activity because of the increased tracheostomy secretions. Which of the following statements by the nurse will be most helpful to the client?
- A. I have a special medication to decrease secretions.
- B. Avoid fluid intake 2 hours before sexual activity.
- C. Place a thin piece of gauze over the tracheostomy.
- D. Wash the tracheostomy area with deodorizing antibacterial soap before sexual activity.
Correct Answer: C
Rationale: Placing a thin gauze over the tracheostomy can absorb secretions, reducing embarrassment and enabling the client to engage in sexual activity comfortably.