LPN ATI fundamental exam
LPN ATI fundamental exam ( 53 Questions)
A nurse is assisting with the care of a client who is receiving a unit of packed RBCs.
Vital Signs 0800:
Blood pressure 112/64 mm Hg Heart rate 80/min
Respiratory rate 18/min
Temperature 37.1° C (98.8" F Oxygen saturation 97% on room air 08151
Blood pressure 106/54 mm Hg Heart rate 100/min Respiratory rate 22/min Temperature 37° C (98,6°F) Oxygen saturation 95% on room air
Complete the following sentence by using the lists of options.
Complete the following sentence by using the lists of options. The client has manifestations of an _______as evidenced by the _________
Allergic reaction: The client is at risk of blood transfusion reaction as evidenced by an increase in respiratory rate to 22 and an increase in heart rate from 88 to 100.
Itching: itching is an immediate symptom of type 1 hypersensitivity reactions that are common with blood transfusion.