A client complains of a headache, nausea, and vomiting during a ...

[abern]

A client complains of a headache, nausea, and vomiting during a blood transfusion. Which one of the following actions should the nurse take immediately?
 
  1. Check the vital signs.
  2. Stop the blood transfusion.
  3. Slow down the rate of blood flow.
  4. Notify the health care provider and blood bank personnel.

Question 2

The nurse will be starting a new intravenous infusion and needs to select the site for the insertion. In selection of a site, the nurse should:
 
  1. Start with the most proximal site
  2. Look for hard, cordlike veins
  3. Use the dominant arm
  4. Avoid sites on the extremity away from a dialysis graft

[Missbam101]

Answer to Question 1

ANS: 2
If a blood reaction is suspected, the nurse stops the blood transfusion immediately. The nurse should take the client's vital signs, but the initial action should be to stop the blood transfusion. Once the transfusion is stopped, the nurse could notify the health care provider and blood bank personnel.

Answer to Question 2

ANS: 4
The nurse should avoid veins in an extremity with compromised circulation, such as a dialysis graft. The nurse should use the most distal site in the nondominant arm, if possible, and should avoid hardened cordlike veins.

[abern]

TYSM

[nyrave]

Excellent