Which gauge IV cannula should the nurse choose when preparing to initiate a blood transfusion?

Correct Answer: A

Rationale: An 18-gauge IV cannula is the most appropriate choice when preparing to initiate a blood transfusion. This larger size allows for the rapid administration of blood products, which is important to prevent clotting and ensure a stable flow of the transfusion. Smaller gauge sizes, such as 22, 24, or 28, may be too slow for transfusion purposes and could potentially lead to delays or complications during the procedure. Therefore, the optimal choice for initiating a blood transfusion is an 18-gauge IV cannula.

Correct Answer: C

Rationale: As the man's blood type is AB, he can only receive blood from donors with type AB blood. This is because individuals with type AB blood are universal recipients, meaning they can safely receive blood from any blood type without risking complications. Blood types A, B, and O all contain antigens that could cause a reaction if transfused into someone with type AB blood. Therefore, to prevent any complications of blood incompatibility, the client in this case should only receive blood with type AB.

Correct Answer: C

Rationale: In pediatric patients with Hodgkin's disease, maintaining a clean environment is crucial to prevent infections due to their compromised immune system. The correct answer, option C, to practice conscientious hand washing is essential as it helps to minimize the transmission of pathogens that could lead to infections. Hand washing is a fundamental nursing intervention that significantly reduces the risk of spreading infections in healthcare settings. Options A and B, applying ice to the skin and providing cool sponge baths, do not directly relate to infection prevention in a client with Hodgkin's disease. While these interventions may offer comfort or symptom relief, they do not address the primary concern of infection control. Option D, using cotton gloves and restricting visitors or personnel with infections from contact with the client, is also important in infection control. However, hand washing (option C) is a more direct and universal measure that all healthcare providers and visitors can easily implement to reduce the risk of infections in pediatric patients with compromised immune systems. Educationally, this question emphasizes the significance of basic infection control practices in pediatric oncology care. It highlights the need for healthcare providers to be diligent in hand hygiene to protect vulnerable patients from potential infections, showcasing the importance of evidence-based nursing interventions in maintaining patient safety and well-being.

Correct Answer: D

Rationale: Obtaining baseline vital signs before administering the first dose is appropriate for the nurse caring for a client in severe pain receiving a continuous I.V. infusion of morphine. Monitoring vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, is essential to assess the client's response to opioid therapy. Baseline vital signs provide a comparison for evaluating changes in the client's physical status and help identify any adverse effects or complications related to morphine administration. This proactive approach allows the nurse to detect and address any abnormalities promptly, ensuring the client's safety and optimal pain management.

Correct Answer: A

Rationale: The usual treatment for vaginal cancer typically involves surgery. The specific type of surgery can vary depending on the stage and type of cancer, but it often includes removal of the tumor or affected tissue. In some cases, surgery may be combined with other treatments such as radiation or chemotherapy to enhance the effectiveness of the treatment. Surgery is considered a primary treatment option for many cases of vaginal cancer, particularly in early stages where the goal is to remove the cancerous cells and prevent further spread.