Following a car accident, a client with a Medic-Alert bracelet indicating hemophilia A is admitted to the emergency department (ED). Which physician order should you implement first?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Transfuse Factor VII concentrate. The priority in a client with hemophilia A, a disorder where there is a deficiency in factor VIII, is to address the bleeding risk. Factor VII concentrate helps replace the deficient clotting factor, aiding in hemostasis and preventing further bleeding complications. This intervention is crucial in managing hemophilia-related bleeding, especially in the setting of a traumatic injury like a car accident. Option A) Transport to radiology for C-spine x-rays is not the priority as assessing the C-spine can wait until the bleeding risk is addressed. Option C) Type and cross-match for 4 units RBCs is not the priority as addressing the clotting factor deficiency takes precedence over potential blood transfusions. Option D) Infuse normal saline at 250 mL/hour is not the priority as it does not address the underlying issue of hemophilia and bleeding risk. Educationally, this question highlights the importance of prioritizing interventions based on the client's condition, emphasizing the critical nature of addressing the underlying pathophysiology in emergencies. Understanding the specific management strategies for clients with hemophilia is essential in providing safe and effective care in emergency situations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature. This client should be assessed first because neutropenia (low white blood cell count) puts them at high risk for infections, and an elevated temperature could indicate the presence of an infection, which is a medical emergency in this case. Option A, the 26-year-old with thalassemia major, is stable and scheduled for a blood transfusion, which is not an immediate concern. Option B, the 44-year-old with sickle cell crisis awaiting a CT scan, is also stable for the moment and can wait for assessment. Option C, the 50-year-old with non-Hodgkin's lymphoma expressing emotional distress, while important, does not present an immediate physiological threat that requires urgent assessment compared to the risk of infection in the neutropenic patient. Educationally, this question highlights the importance of prioritizing patient care based on the urgency of the situation and the potential risks involved. It reinforces the significance of recognizing signs of infection in immunocompromised patients and the need for prompt assessment and intervention in such cases to prevent further complications.

Correct Answer: C

Rationale: In this scenario, the correct action to take first is to stop the transfusion (Option C). This is because the client is experiencing signs of a transfusion reaction, specifically a febrile non-hemolytic reaction. This type of reaction is characterized by symptoms such as flushing, chills, fever, and tachypnea, which align with the client's presentation. Stopping the transfusion is crucial to prevent the reaction from worsening and to ensure the client's safety. By halting the transfusion, the healthcare provider can assess the client's condition, confirm the diagnosis of a transfusion reaction, and initiate appropriate interventions. Option A (Obtain a warm blanket for the client) may provide comfort but does not address the underlying cause of the client's symptoms. Checking the client's oral temperature (Option B) could be useful information but is not the priority when a transfusion reaction is suspected. Administering oxygen (Option D) may be necessary if the client develops respiratory distress, but stopping the transfusion takes precedence to prevent further complications. In an educational context, understanding the signs and management of transfusion reactions is essential for nurses and healthcare providers who administer blood products. Rapid recognition and appropriate intervention can mitigate the severity of a reaction and promote positive patient outcomes. It is vital to prioritize patient safety and well-being in these situations by taking prompt and effective actions.

Correct Answer: D

Rationale: In the context of a client admitted with multiple myeloma, the most immediate implication for the client's care is option D) The client is unable to plantarflex the feet. This finding indicates a potential complication of multiple myeloma known as spinal cord compression, which is a medical emergency requiring urgent intervention to prevent permanent neurological damage. Option A) The client complaining of chronic bone pain is a common symptom of multiple myeloma, but it does not indicate an immediate need for intervention. Option B) Elevated blood uric acid levels can occur in multiple myeloma due to increased cell turnover but do not pose an immediate threat. Option C) Bence-Jones protein in the urine is a hallmark of multiple myeloma, but its presence does not require immediate action compared to spinal cord compression. In an educational context, understanding the acute complications of multiple myeloma is crucial for nurses and healthcare providers to prioritize care and intervene promptly to prevent serious consequences for the patient. Recognizing signs of spinal cord compression, such as the inability to plantarflex the feet, can lead to timely assessment, imaging, and treatment to ensure the best outcomes for the client.

Correct Answer: C

Rationale: In this scenario, the best option to delegate to a newly graduated RN with a 6-week orientation to the unit is option C) Infusion of D5.45% normal saline at 125 mL/hour to the client. This task involves a routine and stable procedure that aligns with the RN's level of experience and training. Infusion of fluids is a common nursing responsibility that requires attention to detail but does not involve complex decision-making or critical thinking beyond the scope of a new RN's training. Options A, B, and D involve higher levels of complexity and critical thinking. Option A requires the administration of specific medications with potential side effects and interactions that need careful monitoring and assessment, which is beyond the scope of a newly graduated RN. Option B involves assessing a client for signs of infection, which requires a deeper understanding of GVHD and its complications. Option D requires educating the client about infection prevention, which involves communication skills and a comprehensive understanding of patient education strategies. In an educational context, it is crucial to teach new RNs how to prioritize tasks based on their level of experience and competence. Delegation is a vital skill in nursing that involves assigning appropriate tasks to team members based on their knowledge and skill level. By understanding the rationale behind task delegation, nurses can provide safe and efficient care while promoting professional growth and development.