A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately?

Correct Answer: C

Rationale: The correct answer is option C: The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. This action is incorrect because blood products like PRBCs should only be infused using normal saline (0.9% sodium chloride) and never with dextrose solutions. Infusing blood products with dextrose can cause the red blood cells to hemolyze, leading to serious complications for the patient. Option A is not the best practice as there is no need to wait 20 minutes after obtaining PRBCs before starting the infusion. Timely administration is crucial for patients requiring blood transfusions. Option B is suboptimal because a larger gauge catheter (usually 18-20 gauge) is recommended for blood transfusions to prevent hemolysis and ensure a smooth flow of blood products. Option D is not ideal because it is important for the nurse to provide accurate and reassuring information to the patient about the transfusion process. Informing the patient about potential risks is part of informed consent and should be done in a supportive and educational manner. Educationally, this question highlights the importance of proper blood transfusion practices, including the choice of IV solution, catheter gauge selection, and patient education. Nurses must adhere to evidence-based guidelines to ensure patient safety and positive outcomes during blood transfusions.

Correct Answer: A

Rationale: The correct answer is A) The client with digoxin toxicity. When a client presents with pancytopenia, it indicates a decrease in all three blood cell types (red blood cells, white blood cells, and platelets). Digoxin toxicity can cause bone marrow suppression leading to pancytopenia. By rooming the new client with digoxin toxicity, you are pairing them with a peer who shares a common underlying cause for their condition, potentially facilitating understanding and support between the two individuals. The other options are incorrect because they do not have a direct correlation to pancytopenia. The client with viral pneumonia is experiencing a respiratory infection, the client with shingles has a viral skin rash, and the client with cellulitis has a bacterial skin infection. These conditions do not typically cause pancytopenia and would not provide the same level of shared experience and potential mutual support as the client with digoxin toxicity. In an educational context, this question highlights the importance of understanding the underlying causes of hematologic disorders and their potential implications for patient care and management. It also emphasizes the significance of creating supportive environments for clients with similar health conditions to foster empathy, shared experiences, and potentially better outcomes through peer support.

Correct Answer: B

Rationale: In this scenario, the most concerning statement made by the client is option B, "I take one aspirin every morning because of my history of angina." This statement is of utmost concern because aspirin, being a blood thinner, can exacerbate thrombocytopenia by further reducing the number of platelets in the blood, leading to an increased risk of bleeding. Option A, soft and dark brown bowel movements, could indicate gastrointestinal bleeding but is not as immediately concerning as the aspirin use in a thrombocytopenic patient. Option C, decreased appetite, is a common side effect of chemotherapy and may not directly impact the risk of bleeding in this context. Option D, increased bruising, is a common symptom of thrombocytopenia and, though relevant, is not as concerning as the client's aspirin use. Educationally, this question highlights the importance of understanding the potential interactions between medications and a patient's condition. It emphasizes the need for healthcare providers to be vigilant in assessing and addressing all aspects of a patient's history to provide safe and effective care, especially in oncology patients with complex treatment regimens.

Correct Answer: A

Rationale: The correct answer is option A) "I have started to eat more healthy foods like green salads and fruit." This statement indicates a potential lack of understanding about warfarin therapy because consuming large amounts of green, leafy vegetables rich in vitamin K can interfere with the effectiveness of warfarin. Vitamin K is essential for normal blood clotting, and warfarin works by inhibiting vitamin K-dependent clotting factors. Therefore, a sudden increase in vitamin K intake can reduce the anticoagulant effects of warfarin. Option B) "The doctor said that it is important to avoid becoming constipated" is incorrect because constipation, while it can affect medication absorption in some cases, is not directly related to warfarin therapy. Option C) "Coumadin makes me feel a little nauseated unless I take it with food" is incorrect because taking warfarin with food to reduce nausea is a common practice and does not necessarily indicate a need for additional teaching. Option D) "I will need to have some blood testing done once or twice a week" is incorrect because regular blood testing to monitor the International Normalized Ratio (INR) levels is a standard part of warfarin therapy and does not indicate a lack of understanding. In an educational context, it is crucial to emphasize to patients on warfarin therapy the importance of maintaining a consistent intake of vitamin K-rich foods to ensure the medication's effectiveness. This case highlights the need for clear and detailed patient education regarding dietary considerations when taking warfarin to prevent complications and ensure optimal therapeutic outcomes.

Correct Answer: C

Rationale: The most appropriate response in this scenario is option C: "Tell me a little bit more about your fear of dying." This response demonstrates active listening and empathy, allowing the patient to express their emotions and concerns freely. It opens up a channel for the patient to share their feelings, which can help in addressing their fears and providing appropriate support. Option A is incorrect because it does not directly address the patient's specific fear of dying, which may require further exploration. Option B is inappropriate as it immediately jumps to suggesting medication without fully understanding the source of the patient's fear. Option D, while providing some reassurance, does not acknowledge or validate the patient's feelings of fear. In an educational context, it is crucial for healthcare providers to develop strong communication skills to effectively address the emotional needs of patients, especially in oncology settings where patients may experience significant distress. By actively listening and encouraging patients to express their emotions, healthcare providers can build trust, provide holistic care, and support patients through their treatment journey.