blood

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The nurse, listening to the morning report, learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which daily serum laboratory studies to assess the effectiveness of the transfusion?

WBC

The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. Approximately how long will the nurse need to stay with the client to ensure that a transfusion reaction is not occurring?

15 mins .. you have 30 mins to give the blood !

The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse should ask which initial question?

"Have you ever had a transfusion before?"

A nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells (PRBCs). Before leaving the room, the nurse tells the client that it is most important to immediately report which symptoms of a transfusion reaction? Select all that apply.

1. Chills 4. Chest pain 5. Low back pain 6. Difficulty breathing

The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussions with the client?

4. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees.

Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6° F orally. Which action should the nurse take?

Delay hanging the blood and notify the health care provider (HCP).

A nurse is monitoring a client who is receiving a blood transfusion. After 30 minutes of the infusion, the client begins to have chills and back pain. His temperature is 100.1° F (37.8° C). What action should the nurse take first?

Discontinue the infusion and start an infusion of normal saline using new tubing.

A postoperative client asks the nurse why it is so important to deep-breathe and cough after surgery. When formulating a response, the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to which condition?

pneumonia

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse should assess which priority item?

vital signs

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy?

circularly overload

The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which item is important to check regarding the age of blood cells before the transfusion is begun?

expiration date

The nurse enters a client's room who began receiving a blood transfusion 45 minutes earlier to check on the client. The client is dyspneic and has a bounding pulse. The nurse listens to the client's lung sounds and notes the presence of crackles in the lung bases. Which complication of blood transfusion therapy should the nurse determine that this client is most likely experiencing?

fluid overload

The nurse is monitoring the status of a postoperative client. The nurse would become most concerned with which sign that could indicate an evolving complication?

increasing restlessness


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