A client diagnosed with severe anemia is to receive 2 U of packed red blood cells. Prior to starting the blood transfusion, the nurse must:

• A.Take a baseline set of vital signs
• B.Hang Ringer's lactate as the companion fluid
• C.Use microdrip tubing for the blood administration
• D.Have the registered nurse in charge assume responsibility for verifying the client and blood product information

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A pregnant client continues to visit the clinic regularly during her pregnancy. During one of her visits while lying supine on the examining table, she tells the RN that she is becoming light-headed. The RN notices that the client has pallor in her face and is perspiring profusely.
The first intervention the RN should initiate is to:

• A.Place the examining table in the Trendelenburg position
• B.Assess the client to see if she is having vaginal bleeding
• C.Obtain the client's vital signs immediately
• D.Help the client to a sitting position

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A 35-year-old client is receiving psychopharmacological treatment of his major depression with tranylcypromine sulfate (Parnate), a monoamine oxidase (MAO) inhibitor. The nurse teaches the client that while he is taking this type of antidepressant, he needs to restrict his dietary intake of:

• A.Potassium-rich foods
• B.Tryptophan
• C.Tyramine
• D.Saturated fats

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Following a fracture of the left femur, a client develops symptoms of osteomyelitis. During the acute phase of osteomyelitis, nursing care is directed toward:

• A.Moving or turning the client's left leg carefully to minimize pain and discomfort
• B.Allowing the client out of bed only in a wheelchair or gurney to minimize weight bearing on the left leg
• C.Providing the client with a high-protein, high-fiber diet to promote healing
• D.Instituting physical therapy to ensure restoration of optimal functioning of the leg

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A client with severe PIH receiving MgSO4 is placed in a quiet, darkened room. The nurse bases this action on the following understanding:

• A.The client is restless.
• B.The elevated blood pressure causes photophobia.
• C.Noise or bright lights may precipitate a convulsion.
• D.External stimuli are annoying to the client with PIH.

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