A nurse is assessing a client before administering a unit of packed RBCs. The nurse should identify which of the following data as most important to obtain prior to the infusion?
Skin color
Hemoglobin level
Fluid intake
Temperature
The Correct Answer is B
Rationale:
A. While skin color may be an indicator of overall health, it is not the most crucial data point before administering packed RBCs.
B. The hemoglobin level is the most important data to assess before administering packed RBCs, as it provides direct information about the client’s need for the blood transfusion and helps evaluate the effectiveness of the intervention.
C. Fluid intake is important in overall client assessment but is not as immediately relevant as hemoglobin levels when preparing to administer packed RBCs.
D. Temperature should be monitored to check for any signs of infection, but it is not the primary concern when deciding to proceed with a blood transfusion.
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Correct Answer is A
Explanation
Rationale:
A. Negative stigmatization for mental illness is a well-documented issue that affects individuals with mental health conditions, leading to discrimination and social exclusion.
B. Bias is not isolated to inpatient settings but can occur in various healthcare contexts and beyond.
C. Bias is often unconscious and can be subtle, not necessarily a deliberate or conscious act.
D. Favoring clients based on their mental illness is not typically a form of bias; instead, it can be indicative of personal biases or misconceptions about mental health.
Correct Answer is D
Explanation
Rationale:
A. Seizures and tremors can occur with some antipsychotic medications but are not specifically indicative of tardive dyskinesia.
B. Hallucinations and delusions are symptoms of psychosis, not a side effect of anti-psychotic medications.
C. Nausea and vomiting can be side effects of anti-psychotic medications but are not characteristic of tardive dyskinesia.
D. Tardive dyskinesia is characterized by uncontrolled, repetitive movements, such as facial grimacing, tongue protrusion, and other involuntary movements.