ATI Pharmacology End of Chapter 27

6. A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for an older adult client who has a GI bleed and an Hgb of 6.0 g/dL. a. Therapeutic Procedure - evaluation:

A client who lost blood from a GI bleed may need a unit of PRBCs if his Hgb is below 10 g/dL and he is demonstrating clinical manifestations of hypovolemia (increase in pulse and respiration rate; decrease in blood pressure; a low oxygen saturation; cool and pale or cyanotic; decreased capillary refill time; decreased urinary output). If hypoxic, the client will exhibit decreased level of consciousness and confusion. PRBCs restore red blood cells and improve oxygenation. If the client has lost a large amount of fluid volume, whole blood, rather than PRBCs, may be indicated.

3. A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? a. Whole blood b. Platelets c. Fresh frozen plasma d. Packed red blood cells

Answer is C (Fresh frozen plasma is indicated for a client who has an elevated aPTTT because it replaces coagulation factors and can help prevent bleeding.

1. A nurse is preparing to administer an infusion of 300 mL of platelet concentrate. The nurse should plan to administer the infusion over which of the following time frames? a. Within 30 minutes/unit b. Within 60 minutes/unit c. Within 2 hours/unit d. Within 4 hours/unit

Answer is A (Platelets are fragile and should be administered quickly to reduce the risk of clumping. The nurse should administer the platelets concentrate within 15 to 30 minutes/unit.

5. A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2 degrees F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply) a. Stop the transfusion b. Place the client in an upright position with feet down c. Remove the blood bag and tubing from the client's IV catheter d. Obtain a urine specimen from the client e. Infuse dextrose 5% in water through the client's IV

Answer is A (The nurse should stop the transfusion for a rise in temperature of 2 degrees F and reports chills and fever. The client may be having a hemolytic reaction to the blood or a febrile reaction) C (The nurse should avoid infusing more PRBCs into the client's vein, and should remove the blood bag and tubing from the client's IV catheter) D (Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusion)

2. A nurse is preparing to transfuse a unit of PRBCs for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? a. Ensure that the client has a patient IV line before obtaining blood product from the refrigerator. b. Obtain help from another nurse to confirm the correct client and blood product. c. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. d. Stay with the client for the first 15 to 30 minutes of the transfusion.

Answer is B (Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility.

4. A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? a. Epinephrine b. Lorazepam c. Furosemide d. Diphenhydramine

Answer is C (Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload)