MRCP UK EXAMINATIONS

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NEUROLOGY

SURGERY

Question [CLICK ON ANY CHOICE TO KNOW THE RIGHT ANSWER]
The nurse is administering two units of packed RBCs to an older adult patient with a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. Which action by the nurse is a priority? (Select all that apply.)
A
Continue the infusion but slow the rate down.
B
Place the patient in an upright position with the feet dependent.
C
Administer diuretics as prescribed.
D
Discontinue the transfusion.
E
Administer oxygen.
Explanation: 

Detailed explanation-1: –The nurse would first verify the physician’s order for the blood transfusion and ensure that the client has been informed about the procedure and has signed an informed consent. Once this has been done, the nurse would ensure that at least an 18-or 19-gauge intravenous needle is inserted into the client.

Detailed explanation-2: -The nurse should verify that the clients identification number is identical to the blood component tag number to ensure the client is receiving the correct blood component. A client must have a provider prescription to receive a blood transfusion.

Detailed explanation-3: -The nurse should identify the manifestations of flank pain and tachycardia as a hemolytic transfusion reaction. Other manifestations can include fever, chills, hypotension, apprehension, and reddish or brown urine.

There is 1 question to complete.
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