The nurse is making rounds on a medical/surgical floor. Which client should the nurse see first?

Question

Quizplus · Accepted Answer

Acute transfusion reaction is a priority as it can be life-threatening if not immediately stopped and supportive care initiated. If untreated, hypotension, vascular collapse, respiratory distress, and disseminated intravascular coagulation ensue quickly. (Option A) Opioid withdrawal can be quite painful but usually is not life-threatening. (Option C) Pyelonephritis (kidney infection) is also serious and requires an IV antibiotic as soon as possible. However, it is not immediately life-threatening as complications do not usually occur within minutes to hours. (Option D) Clients with hepatic encephalopathy need lactulose (takes hours to days to take effect). However, this condition is not immediately life-threatening. Educational objective: Acute hemolytic transfusion reactions can be life-threatening and therefore treatment must be prioritized.

The Nurse Is Making Rounds on a Medical/surgical Floor