A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

Correct Answer: D

Rationale: The correct answer is D. After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Washing hands and avoiding contact with individuals who are ill are crucial to reduce this risk. Choice A is incorrect because checking for swollen lymph nodes is not a priority after a splenectomy. Choice B is incorrect as while bleeding is a concern, it is more immediate post-operatively. Choice C is incorrect as iron supplements do not specifically relate to the risk of infection post-splenectomy.

Correct Answer: C

Rationale: The correct answer is C because administering subcutaneous medications falls within the education and scope of practice of an LPN/LVN. Assessing the patient for signs and symptoms of infection, teaching the patient, and developing a discharge plan are tasks that require an RN level of education and scope of practice. LPN/LVNs can assist in patient care, but tasks that involve assessment, teaching, and care planning are typically the responsibility of an RN.

Correct Answer: B

Rationale: The patient's young age and the presence of a nontender lump in the axilla raise concerns for possible lymphoma, which requires prompt evaluation and treatment. This patient should be seen first to rule out any serious underlying condition. Choice A is less urgent as yellowish eyes in sickle cell anemia may be due to jaundice but not necessarily an acute issue. Choice C, a 50-year-old with chronic fatigue related to early-stage chronic lymphocytic leukemia, is a known condition that can be managed on a routine basis. Choice D, a 19-year-old with hemophilia wanting to self-administer factor VII replacement, is important but less urgent compared to the potential lymphoma presentation in choice B.

Correct Answer: C

Rationale: In this scenario, the correct action for the nurse to take is to administer PRN acetaminophen (Tylenol) to the postoperative patient who is experiencing symptoms of a transfusion reaction. This choice is correct because the symptoms described (chills, fever, headache, and anxiety) are indicative of a febrile non-hemolytic transfusion reaction, which is a common type of transfusion reaction. Acetaminophen can help reduce fever and relieve headache and discomfort associated with the reaction. Option A, giving diphenhydramine, is incorrect because diphenhydramine is typically used to manage allergic reactions, such as urticaria or itching, rather than febrile reactions. Option B, sending a urine specimen to the laboratory, is not the priority in this situation as the patient is experiencing acute symptoms that need immediate attention. Option D, drawing blood for a new type and crossmatch, is not necessary at this point as the priority is managing the patient's symptoms and ensuring their safety. A new type and crossmatch may be needed if a more severe transfusion reaction is suspected, but it is not the immediate action to take in this case. Educationally, it is crucial for nurses to recognize and manage transfusion reactions promptly to prevent further complications. Understanding the signs and symptoms of different types of transfusion reactions, as well as appropriate interventions, is essential in providing safe and effective patient care in the medical-surgical setting.

Correct Answer: D

Rationale: The patient's symptoms, back pain, and difficulty breathing after the transfusion indicate a possible acute hemolytic reaction, a severe transfusion reaction. The priority action in this situation is to discontinue the transfusion immediately to prevent further complications. Infusing normal saline helps maintain the patient's intravascular volume and prevent renal damage. Administering oxygen or obtaining a urine specimen is not the most urgent action and could delay essential treatment. Notifying the healthcare provider is important but should come after ensuring the patient's safety by stopping the blood transfusion.