CH. 37: Transfusion Therapy/Red & White Blood Cell Disorders

Which type of unrelated transplant donor matches are most difficult to find for African-American patients? Organ Blood Bone marrow Blood products

Bone marrow African Americans are 10% to 20% less likely to find an unrelated bone marrow donor match, because statistically African Americans are less likely to register as donors. Because blood types are common among all racial groups, the same problem is not present for finding organ, blood, or blood product matches.

A patient who has undergone bone marrow transplantation 21 days prior is receiving growth factors. The patient's blood test reveals mixed chimerism with a greater percentage of donor cells than 1 week prior. How does the nurse interpret this result? 1Graft failure seems likely. 2Engraftment appears to be successful. 3The patient should have 100% donor cells. 4The patient will probably need an increased dose of growth factor.

2Engraftment appears to be successful. Patients who undergo bone marrow transplantation can expect engraftment to occur 12 to 28 days after the transplant. Progressive chimerism (presence of donor cells) indicates engraftment; graft failure would be indicated by regressive chimerism. It is not necessarily expected for the patient to have 100% donor cells this early after transplant, and there is no indication for increasing growth factor.

Which patient is at greatest risk for having a hemolytic transfusion reaction? 34-year-old patient with type O blood 42-year-old patient with allergies 58-year-old immune-suppressed patient 78-year-old patient

34-year-old patient with type O blood Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the patient's own antigens is infused, antigen-antibody complexes are formed in the patient's blood. Type O is considered the universal donor, but not the universal recipient. The patient with allergies would be most susceptible to an allergic transfusion reaction. The immune-suppressed patient would be most susceptible to a transfusion-associated graft-versus-host disease. The older adult patient would be most susceptible to circulatory overload.

What patient is an ideal candidate for plasma transfusion therapy? A patient with an albumin deficiency A patient with an electrolyte deficiency A patient with a hemoglobin deficiency A patient with a prothrombin deficiency

A patient with a prothrombin deficiency Plasma transfusion therapy is used to replace plasma volume and clotting factors. Patients with a prothrombin deficiency are most suitable for this therapy. Electrolyte deficiency is managed with electrolyte replacement therapy by infusing intravenous fluids. Hemoglobin deficiency is managed with red blood cell transfusion therapy. A deficiency of albumin is not managed by plasma transfusion therapy.

An older adult who is receiving rapid whole blood transfusion develops hypertension, bounding pulse, distended neck veins, and confusion. What could be the cause of the patient's condition? Circulating overload Febrile transfusion reaction Allergic transfusion reaction Hemolytic transfusion reaction

Circulating overload Circulating overload is manifested as hypertension, bounding pulse, distended neck veins, and confusion. Circulating overload can occur when the infusion rate is rapid, especially in older adults. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies and are manifested by chills, tachycardia, fever, hypotension, and tachypnea. Hemolytic transfusion reactions are characterized by fever, chills, disseminated intravascular coagulation, and circulatory collapse. Symptoms of allergic transfusion reactions include urticaria, itching, bronchospasm, or anaphylaxis.

Which symptom is a sign that the patient is experiencing circulatory overload when receiving a blood transfusion? Fever Confusion Tachycardia Hypotension

Confusion. Signs of transfusion-associated circulatory overload include confusion, a bounding pulse, distended jugular veins, dyspnea, and restlessness. Fever and tachycardia are signs of bacterial transfusion reactions, not circulatory overload. Hypertension, not hypotension, is a sign of circulatory overload.

What clinical manifestation is associated with hemolytic transfusion reactions? Anorexia Vomiting Low back pain Thrombocytopenia

Low back pain Low back pain is the clinical manifestation associated with hemolytic transfusion reactions. Anorexia, vomiting, and thrombocytopenia are associated with transfusion-associated graft-versus-host disease.

Which blood product may be administered to a patient diagnosed with thrombotic thrombocytopenic purpura? Albumin Platelets Fresh frozen plasma Packed red blood cells

Fresh frozen plasma. Fresh frozen plasma is administered to reduce clumping. Administering platelets would be contraindicated for a patient with thrombotic thrombocytopenic purpura. Albumin and red blood cells are not indicated.

A patient with neutropenia who is receiving amphotericin B therapy is prescribed white blood cell (WBC) transfusion therapy. Which intervention needs correction? Infusing the WBC products at a slow rate Placing a long filtered tubing for infusion Stricter monitoring of the patient for transfusion reactions Terminating the infusion of amphotericin B 4 to 6 hours before WBC transfusions

Placing a long filtered tubing for infusion Long filtered tubing equipment is used for infusing products such as platelets, plasma, and red blood cells (RBCs); it should not be used to infuse white blood cells (WBCs). WBC products should be infused slowly. Transfusion reactions are more common during WBC infusion; thus patients often require strict monitoring. Infusion of amphotericin B should be terminated 4 to 6 hours before WBC transfusions.

What clotting factor deficiencies cause hemophilia? Select all that apply. I II V VIII IX

VIII & IX Deficiency of clotting factor VIII is hemophilia A, and deficiency of clotting factor IX leads to hemophilia B. Clotting factor I is fibrinogen, clotting factor II is prothrombin, and clotting factor V is proaccelerin factor, none of which are associated with hemophilia.

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). What manifestations of this diagnosis should the patient be assessed for? SATA. 1Petechiae 2Ecchymosis 3Hypotension 4Abdominal pain 5Mucosal bleeding

1Petechiae 2Ecchymosis 5Mucosal bleeding Petechiae, ecchymosis, and mucosal bleeding are manifestations of idiopathic thrombocytopenic purpura (ITP). Hypotension and abdominal pain are not common findings in ITP.

What findings are consistent with a diagnosis of hemophilia? SATA. 1Renal failure 2Platelet clumping 3Long-term joint problems 4Tendency to bruise easily 5Excessive bleeding from minor cuts

3Long-term joint problems 4Tendency to bruise easily 5Excessive bleeding from minor cuts Patients with hemophilia have a tendency to bruise easily, have excessive bleeding from minor cuts, and may have long-term joint problems due to bleeding in the joint spaces. Renal failure and platelet clumping are not associated with hemophilia.

Which clotting factor is deficient in patients with hemophilia B? 1Thrombin 2Fibrinogen 3Prothrombin 4Plasma thromboplastin

4Plasma thromboplastin Plasma thromboplastin (factor IX) is deficient in patients with hemophilia B. Thrombin helps convert fibrinogen to fibrin strands and catalyzes other coagulated reactions. Fibrinogen (factor I) and prothrombin (factor II) are not deficient in cases of hemophilia B.

A patient who has had stem cell implantation after unsuccessful chemotherapy with an alkylating agent has had a sudden increase in weight. Which physical assessment does the nurse expect in this patient? Unusual skin lesions Abnormal breath sounds Bleeding of the mouth and gums Ascites with right upper quadrant pain

Ascites with right upper quadrant pain Patients who receive alkylating agents are at risk for liver damage; this can increase the risk of vasoocclusive disease after hematopoietic stem cell transplantation. Symptoms include weight gain, jaundice, right upper quadrant pain, liver enlargement, and ascites. The assessment of lung sounds may help detect signs of infection in neutropenic patients. Patients who have thrombocytopenia are at risk for bleeding. Unusual skin lesions occur with graft-versus-host disease.

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. Which major side effect should the nurse anticipate? Nausea Stomatitis Liver toxicity Bone marrow suppression

Bone marrow suppression. IV cytosine arabinoside and daunorubicin are a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The patient is even more at risk for infection than before treatment began. Liver toxicity, nausea, and stomatitis are not the major problem with this therapy.

The student nurse starts the infusion of packed red blood cells in a patient who is already on intravenous (IV) antibiotic therapy; the infusion goes through the same IV line. What complication would be expected? Allergy Clotting Hemolysis Fluid overload

Clotting When added to or infused along with blood products, drugs may cause blood clotting. Therefore, an additional intravenous site should be used in order for blood to be infused without any other medications. Allergies do not arise from a co-administration of drug and blood products. It is seen in patients with a history of other allergies, including asthma. Hemolysis occurs due to blood type or Rh factor incompatibilities. Fluid overload occurs due to rapid infusion of blood products, not due to the co-administration of drug and blood products.

The registered nurse is teaching a novice nurse about transfusion in older patients. Which statement by the novice nurse indicates effective learning? "Blood that is more than 1 week old should be used." "Large bore needles over 19 gauge should be used." "2 to 4 hours should be taken to administer one unit of blood." "Dextrose should be simultaneously administered while the transfusion is taking place."

"2 to 4 hours should be taken to administer one unit of blood." Administering the blood rapidly may lead to infusion reactions in older patients. Therefore 2 to 4 hours should be taken to administer one unit of blood. Using a blood sample from the blood bank that is more than 1 week old will lead to easy breakage of the cells, because the cell membranes of older patients are more fragile. Needles no larger than 19 gauge should be used in older patients. Dextrose should not be administered along with blood products, because it results in hemolysis.

The nurse educator is teaching a nursing student about the transfusion of blood products. Which statement made by the student nurse regarding the transfusion of red blood cells indicates effective learning? "Do not administer any other solution with the blood product." "Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." "Increasing the speed of administration during the first 15 minutes of the transfusion is necessary." "Once the blood product has been released from the blood bank, it should be immediately transfused into the recipient's body within a few seconds."

"Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." Red blood cell transfusions should be performed within 4 hours of after removal from the refrigeration. If the transfusion time extends longer than four hours, it may lead to infections in the recipient. Hemolytic reaction may occur if saline is not administered with the blood product. Increasing the rate of administration of the drug may lead to fluid overload. After the blood product is released from the blood bank, it must be transfused within 4 hours, not immediately.

A patient with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this patient's problem? "Ask your doctor to prescribe more medication." "I'll turn on some soothing classical music for you." "Would you like to try some relaxation techniques?" "It is too soon for additional medication to be given."

"Would you like to try some relaxation techniques?" Because most patients with multiple myeloma have local or generalized bone pain, analgesics and alternative approaches for pain management, such as relaxation techniques, are used for pain relief. This also offers the patient a choice. Before prescribing additional medication, other avenues should be explored to relieve this patient's pain. Even if it is too soon to give additional medication, telling that to the patient is not helpful because it dismisses the patient's pain concerns. Although music therapy can be helpful, this response does not give the patient a choice.

Which clotting disorder may be caused by X-linked inheritance? 1Hemophilia A 2Hemophilia C 3Von Willebrand disease 4Heparin-induced thrombocytopenia

1Hemophilia A Hemophilia A, a deficiency of factor IX, shows X-linked recessive pattern of inheritance. Hemophilia C is a deficiency of factor XI that is an autosomal pattern of inheritance involving lack of functional clotting factor XI. Von Willebrand disease is caused by the presence of an abnormal gene. Heparin-induced thrombocytopenia is a clotting disorder involving an unexplained drop in platelet count after heparin treatment.

A nurse is counseling a patient who wishes to donate blood for autologous use during surgery. The nurse advises the patient that the blood can be stored for how long? 30 days 40 days 50 days 60 days

40 days A patient who is donating blood for autologous use during or after surgery should be advised that this blood can be stored for up to 40 days. The blood is collected after multiple donations, divided into its component parts, and stored for later use. If the patient has a rare blood type, the blood can be frozen for up to 10 years. Discarding blood after 30 days is not appropriate because the blood can still be used for the patient. Blood cannot be used 50 or 60 days after donation.

The nurse is caring for a patient diagnosed with septic shock. The patient develops bleeding from puncture sites after a blood draw. What complications does the nurse suspect? 1Hemophilia A 2Hemophilia B 3Von Willebrand's disease 4Disseminated intravascular coagulation

4Disseminated intravascular coagulation Disseminated intravascular coagulation often occurs with septic shock and is identified by excessive bleeding. Hemophilias A and B and von Willebrand's disease are not commonly found in septic patients.

What disorder is classified by less than 150,000 platelets per microliter? 1Leukemia 2Hemophilia 3Leukocytopenia 4Thrombocytopenia

4Thrombocytopenia Thrombocytopenia is characterized by a platelet count of less than 150,000 platelets per microliter. Leukemia, hemophilia, and leukocytopenia are not diagnosed based on platelet counts of less than 150,000.

Which intervention may increase the risk of fluid overload during transfusion therapy in older adults? Administering normal saline concurrently in a second intravenous site Administering blood slowly at an infusion rate of 2 to 4 hours per unit Maintaining a gap of 2 full hours after administration of 1 unit before the next unit Monitoring the patient's kidney function and fluid status before initiating the therapy

Administering normal saline concurrently in a second intravenous site Older patients undergoing transfusion therapy are at a high risk of fluid overload; concurrent administration of normal saline into the other intravenous site should be avoided. The infusion rate in older patients should be one unit per 2 to 4 hours to avoid the risk of fluid overload. Maintaining a specific interval of time between consecutive transfusions is necessary to prevent fluid overload. Assessing the kidney function and fluid status of the patient before initiating the therapy is very important. This helps to determine the volume and infusion rate to reduce the risk of fluid overload.

Which condition is contraindicated for acute normovolemic hemodilution autologous blood transfusion therapy? Anemia Obesity Liver failure Cardiac failure

Anemia. Acute normovolemic hemodilution is a type of autologous blood transfusion therapy. This therapy involves the withdrawal of a patient's red blood cells and volume replacement just before a surgical procedure. This type of autologous transfusion is not used with anemia. Obese and cardiac failure patients can receive this therapy to avoid the risk for transfusion reactions. This therapy is not contraindicated for patients with liver failure.

The registered nurse teaches a student nurse about nursing interventions to be taken before starting transfusion therapy. Which intervention made by the student nurse shows ineffective understanding? Verifying the medical prescription Assessing laboratory values of the patient Diluting the blood products with normal saline Obtaining venous access using a central catheter

Diluting the blood products with normal saline Blood products are diluted with normal saline during the transfusion therapy, not before starting it. The nurse verifies the medical prescription for the type of product, dose, and transfusion time mentioned in the prescription before starting the therapy. The patient's laboratory values should meet the guidelines for blood product transfusion; this action should occur before starting the therapy. Obtaining venous access should be initiated before starting the blood transfusion.

Which intervention most effectively protects a patient with polycythemia vera? Taking rectal temperatures Avoiding the use of dentures Using warm compresses on trauma sites Encouraging the use of an electric shaver

Encouraging the use of an electric shaver. The patient with polycythemia vera should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time. Dentures may be used by patients with thrombocytopenia as long as they fit properly and do not rub. To prevent rectal trauma, rectal thermometers should not be used. Oral or tympanic temperatures should be taken. Ice (not heat) should be applied to areas of trauma.

Which sign is a neurologic manifestation of acute leukemia? Select all that apply. Fever Fatigue Headache Hematuria Ecchymoses

Fever, Fatigue, Headache. Fever, fatigue, and headache are neurologic manifestations of acute leukemia. Hematuria is a renal manifestation of acute leukemia. Ecchymoses is an integumentary manifestation of acute leukemia.

A patient diagnosed with thrombocytopenia is advised transfusion therapy with platelets from a single donor. Which nursing intervention helps in improving the effectiveness of the therapy? Ensuring the ABO compatibility Using a straight filtered tubing Assessing febrile reactions during infusion therapy Initiating the therapy immediately after receiving the product

Initiating the therapy immediately after receiving the product A patient with thrombocytopenia should undergo platelet transfusion therapy. Platelets are fragile and must be infused immediately after being brought to the patient's room. Platelet transfusion therapy does not require ABO compatibility. Using straight filtered tubing causes occlusion of the lumen of the tube due to adhesion of platelets. A single donor is advised for this patient to reduce the chances of febrile transfusion reactions.

The nurse knows that a patient with a B-negative blood type can receive which blood product? O-negative A-negative AB-positive B-positive

O-negative A patient with B-negative blood can receive either type B-negative or type O-negative blood. A patient with a negative Rh factor must also receive blood with a negative Rh factor due to the potential for an infusion reaction to the Rh antigen. Receiving either A-negative or AB-positive puts the patient at risk for a reaction because the patient has antibodies against the A antigen. Receiving B-positive blood puts the patient at risk for an infusion reaction to the Rh factor.

Which type of transfusion therapy may be safe even if the ABO factors are incompatible? Packed red blood cells Washed red blood cells Pooled platelets Fresh frozen plasma

Pooled platelets ABO compatibility is not necessary during platelet transfusions because platelets do not contain antigens that can evoke an antigen-antibody reaction. Transfusions of packed red blood cells (RBCs) and washed RBCs require ABO compatibility determination. Fresh frozen plasma contains the donor's ABO antibodies, which could react with the recipient's RBC antigens.

The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority? Provide pain medications as needed. Apply cool compresses to the patient's forehead. Increase food sources of iron in the patient's diet. Encourage the patient's use of two methods of birth control.

Provide pain medications as needed. Analgesics are needed to treat sickle cell pain. The nurse would provide pain medications as needed. Cool compresses do not help the patient in sickle cell crisis. Warm soaks or compresses can help reduce pain perception. Increasing iron in the diet and discussing birth control are not priorities for the patient in sickle cell crisis.

Which nursing intervention would be the priority when caring for a patient with a platelet count of 10,000/mm3? Transfusing platelets Providing low dosage of chemotherapy Providing intravascular immunoglobulin and intravascular anti-Rho Providing corticosteroid therapy for inhibiting antiplatelet antibodies

Transfusing platelets. Severe bruises on the skin indicate internal bleeding. Nosebleeds, gum bleeding, and heavy menstrual bleeding are indicators of external bleeding. When the platelet count is less than 10,000/mm3, immediate treatment should involve platelet transfusion to avoid further serious complications. A low dosage of chemotherapy is a part of aggressive therapy. Intravascular immunoglobulin and intravascular anti-Rho are given to prevent further destruction of antibody-coated platelets. Corticosteroids are used to suppress the immune system.

A patient develops fever, chills, and shock rapidly after initiation of infusion therapy. The primary health care provider diagnoses the condition as a bacterial infection and advises termination of the therapy. Which assessment finding supports the diagnosis? Urticaria Bounding pulse Redness of the head and neck Cloudiness of the product in the blood bag

Cloudiness of the product in the blood bag A bacterial contamination of the blood products leads to a rapid development of fever, chills, and shock. Any presence of discoloration, gas bubbles, or cloudiness in the blood bag is an indication of a bacterial infection. Urticaria is observed in patients with allergic transfusion reactions. A bounding pulse is a manifestation of circulating overload. Redness of the head and neck is a manifestation of acute pain transfusion reactions.

A patient is prescribed a 200 mL infusion of packed red blood cells to be administered over 2 hours. What would be the consequence if the blood product is diluted with normal saline and infused at a rate of 3 mL/min? Allergy Clotting Hemolysis Fluid overload

Fluid overload The infusion rate prescribed by the healthcare provider is 1.6 mL/min (200 mL in 2 hours). Infusion of the blood product at a rate of 3 mL/min may cause rapid infusion leading to fluid overload. Allergies may occur in patients with a medical history of allergic transfusion reactions. Clotting occurs when blood products are diluted with any intravenous solution other than normal saline. Hemolysis is caused by a blood type or Rh incompatibility.

Which type of transfusion requires more stringent monitoring every 15 minutes throughout the transfusion? Plasma transfusions Platelet transfusions Red blood cell transfusions White blood cell transfusions

White blood cell transfusions Strict monitoring is required for every 15 minutes for up to 60 minutes throughout a white blood cell transfusion because white blood cells contain many antigens that may react with the recipient immune system. During plasma transfusions, the first 15 minutes are crucial. A platelet transfusion is done when the platelet count is below 10,000 mm 3. The vital signs should be monitored during the first 15 minutes and again after the transfusion. During red blood cell transfusion, the patient should be monitored for hemolytic reactions for the first 15 to 30 minutes.

The nurse is providing teaching to a patient who follows a lacto-ovo vegetarian diet. Which statement by the nurse is most appropriate regarding a sufficient intake of vitamin B12? "Egg yolks contain a high amount of vitamin B12." "You should seriously consider eating meat again." "Avoid dairy products as they inhibit the absorption of vitamin B12." "Try to eat fish, especially salmon, twice weekly, because it is high in vitamin B12."

"Egg yolks contain a high amount of vitamin B12." Vitamin B12 is found in animal protein, eggs, and dairy products. Telling the patient to change his or her beliefs about consuming meat is dictatorial and not supportive. Dairy products contain vitamin B12; therefore absorption is not inhibited. Salmon contains omega-3 fatty acids, which may prevent heart disease, but not vitamin B12 deficiency.

Which patient is at increased risk for development of hemophilia? 1The son of the woman who is a carrier 2The son of the father who has hemophilia 3The daughter of a woman who is a carrier 4The daughter of a father who has hemophilia

1The son of the woman who is a carrier. Hemophilia is an X-linked recessive trait; therefore the son of a mother who is a carrier is more likely to develop hemophilia. The son of a father with hemophilia will not develop hemophilia. The daughter of a mother who is a carrier may also be a carrier. The daughter of the father with hemophilia will be a carrier.

A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused? 100 - 150 mL 200 - 250 mL 300 - 350 mL 400 - 450 mL

200 - 250 mL Anemia is usually treated by administering 200 mL (200 ─ 250 mL) of packed red blood cells over 4 hours. A volume of 100 ─ 150 mL is below the range of the required volume of 200 ─ 250 mL and may not be sufficient for the patient to recover. A volume of 300 mL or higher is above the required range.

What laboratory reports should be used to assess a patient diagnosed with idiopathic thrombocytopenic purpura who is symptomatic? SATA. 1Potassium 2Hematocrit 3Hemoglobin 4Magnesium 5White blood cell count

2Hematocrit 3Hemoglobin Hemoglobin and hematocrit may be low in a patient with symptomatic idiopathic thrombocytopenic purpura. Potassium and magnesium are not related to the diagnosis of ITP. White blood cell count is not indicated.

A patient diagnosed with thrombotic thrombocytopenic purpura should be assessed for which complications? SATA. 1Septicemia 2Renal failure 3Myocardial infarction 4Right-sided heart failure 5Cerebrovascular accident

2Renal failure 3Myocardial infarction 5Cerebrovascular accident Renal failure, myocardial infarction, and cerebrovascular accidents occur from tissue ischemia resulting from platelet aggregation and clotting. Septicemia and right-sided heart failure are not complications of thrombotic thrombocytopenic purpura.

A patient recently diagnosed with polycythemia vera (PV) has a serum hemoglobin of 20 g/dL, elevated leukocytes and platelets, a purplish flushed appearance, and reports intense itching. A family member asks the nurse if the patient will get better. How does the nurse respond? 1"This is a temporary and easily treatable condition." 2"Most people with this disease will die within 2 years." 3"With aggressive management, people can live for over 10 years." 4"Because these symptoms are severe, this episode will probably be fatal."

3"With aggressive management, people can live for over 10 years." PV is a type of cancer of the red blood cells. With aggressive treatment, patients can live for 10 to 15 years. Without treatment, most patients die within 2 years. PV is not a temporary condition and requires aggressive treatment. Because these symptoms are severe, this episode will probably be fatal is not a true statement.

Which laboratory value indicates hemophilia? 1Increased platelet count 2Decreased platelet count 3Increased partial thromboplastin time 4Increased time for platelet plug formation

3Increased partial thromboplastin time Abnormal partial thromboplastin time (aPTT) indicates the time needed for clotting. Thus an increased partial thromboplastin time is an indicator hemophilia. Increased platelet count indicates thrombocytosis. A decreased platelet count indicates thrombocytopenia. Increased time taken for platelet plug formation indicates a platelet disorder.

What patient is at a lower risk for febrile transfusion reactions? A patient receiving a platelet transfusion A patient who has received multiple blood transfusions A patient receiving a white blood cell (WBC) transfusion A patient receiving leukocyte-reduced red blood cell transfusion

A patient receiving leukocyte-reduced red blood cell transfusion. Febrile transfusion reactions occur most often in patients with anti-WBC antibodies. Leukocyte-reduced red blood cells are least antigenic and do not cause febrile transfusion reactions. Febrile transfusion reactions occur most often in the patient with anti-WBC antibodies, which can develop after multiple transfusions, WBC transfusions, and platelet transfusions. The patient develops chills, tachycardia, fever, hypotension, and tachypnea. Giving leukocyte-reduced blood or single-donor HLA-matched platelets reduces the risk for this type of reaction. WBC filters may be used to trap WBCs and prevent their infusion into the patient.

Which type of leukemia most commonly has its onset during adulthood? Acute lymphocytic leukemia (ALL) Acute myelogenous leukemia (AML) Chronic lymphocytic leukemia (CLL) Chronic myelogenous leukemia (CML)

Acute myelogenous leukemia (AML) AML is the most common form of adult-onset leukemia. ALL is the most common in children. CLL is the most common chronic form of adult leukemia. CML is a rarer form of adult leukemia.

A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient? Giving iron supplements Providing analgesic medication Encouraging strenuous exercise Administering intravenous (IV) fluids

Administering intravenous (IV) fluids Dehydration can cause increased sickling of HbS cells and can also make occlusion worse, causing more tissue ischemia. Patients should be taught to consume 3 to 4 L of fluid daily as a maintenance measure, and hospitalized patients should be given IV fluids. Patients should engage in mild, low-impact exercise. Iron supplements will not improve hypoxia since iron deficiency is not the underlying problem. Analgesics are given for pain, but do not directly affect oxygenation.

A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood? Antiplatelet antibodies Elevated platelet counts Elevated red blood cells Low hemoglobin & hematocrit

Antiplatelet antibodies Antiplatelet antibodies are consistent with the autoimmune form of thrombocytopenic purpura. Platelet counts would not be elevated. Red blood cell counts would not be diagnostic for thrombocytopenic purpura. Low hemoglobin & hematocrit may occur, but they are not diagnostic for thrombocytopenic purpura.

A patient with leukemia is undergoing hematopoietic stem cell transplantation using stem cells harvested from the patient before high-dose chemotherapy. Which type of transplantation procedure is being used for this patient? Allogeneic Syngeneic Autologous Engraftment

Autologous Patients who receive their own stem cells harvested before high-dose therapy are receiving autologous transplants. Allogeneic transplants are stem cells harvested from the patient's sibling or a matched unrelated donor. Engraftment refers to successful "taking" of the donor cells into the recipient. Syngeneic transplants occur when cells are harvested from an identical sibling.

Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease? Platelet count Prothrombin time Coagulation factor Partial prothromboplastin time

Coagulation factor Lack of factor VII causes hemophilia A and lack of factor XI causes hemophilia B; thus the coagulation factor can be used to differentiate between classic hemophilia and Christmas disease. The difference in the platelet count indicates thrombocytopenia. Platelet count would not be beneficial in the differentiation of hemophilia and Christmas disease. Prothrombin time is tested in a patient who has symptoms of bleeding disorders. Partial prothromboplastin time indicates a deficiency of one or more of the coagulation factors in the patient's plasma but would not differentiate between hemophilia and Christmas disease.

What intervention performed during a transfusion reaction may further complicate the condition? Stopping the transfusion and removing the blood tubing Providing the access for infusions and flushing with normal saline Returning the component bag, labels, and all tubing to the laboratory Flushing the intravenous contents of the tubing with normal saline before removing

Flushing the intravenous contents of the tubing with normal saline before removing Flushing the contents of the blood transfusion tubing will allow more blood to enter the patient and aggravate transfusion reactions. The transfusion should be stopped immediately and the blood tubing should be removed to prevent more blood from entering the patient's circulation. If the patient does not have any other intravenous access, the access site should be flushed with normal saline. The component bag, labels, and all tubing should be returned to the laboratory or blood bank for further investigation if hemolytic reaction or bacterial reaction is suspected.

While performing an admission assessment on a 55-year-old woman, the nurse notes a serum hemoglobin level that indicates anemia. Which question does the nurse ask the patient first? Does she consume red meat regularly? Does she still have menstrual periods? Does she take a vitamin supplement? Has she has noticed blood in her stools?

Has she has noticed blood in her stools? Any adult with iron deficiency should be evaluated for abnormal bleeding, especially from the GI tract; therefore the nurse should ask about blood in her stools. Dietary intake of iron should be assessed, but this is a less common cause of iron deficiency anemia. Blood loss from periods is not as likely in an older woman. A vitamin B12 deficiency results in pernicious anemia; therefore asking whether she takes a vitamin supplement is important, but still does not address how she got anemia.

Which changes should be monitored during the first 15 to 30 minutes in a patient who is undergoing blood transfusion? Hyperkalemia Fluid overload Febrile reaction Hemolytic reaction

Hemolytic reaction Hemolytic reaction may occur during the infusion of the first 50 mL of the blood. Therefore the nurse should remain with the patient for the first 15 to 30 minutes in order to monitor for hemolytic reaction. The use of frozen samples or samples that are more than a week old may lead to hyperkalemia. The nurse monitors an older patient's vital signs every 15 minutes throughout the transfusion to check for signs of fluid overload. Fluid overload may also occur as a result of rapid transfusion. Febrile reaction is observed after multiple transfusions, or during white blood cell and platelet transfusions.

What type of transfusion reaction is characterized by disseminating intravascular coagulation? Febrile transfusion reactions Bacterial transfusion reactions Hemolytic transfusion reactions Acute pain transfusion reactions

Hemolytic transfusion reactions Hemolytic transfusion reactions occur as a result of antigen antibody complexes formed due to incompatibility between the donor and recipient's blood. These complexes destroy the blood vessel walls and organs. This reaction is characterized by disseminating intravascular coagulation and circulatory collapse. Febrile transfusion reactions are characterized by the development of anti-white blood cell antibodies. Bacterial transfusion reactions are caused by the contamination of blood products. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pa

A patient with a large, painless lymph node has a biopsy that reveals Reed-Sternberg cells. Which form of cancer does this finding indicate? Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma Acute myelogenous leukemia

Hodgkin lymphoma Reed-Sternberg cells are indicative of Hodgkin lymphoma. Acute myelogenous leukemia is characterized by atypical blood cells. A diagnosis of multiple myeloma begins with a positive finding of a serum monoclonal protein in the blood. Non-Hodgkin lymphoma includes all lymphoid cancers that do not have the Reed-Sternberg cell.

Which statements are true regarding blood group compatibility? Select all that apply. Individuals with a positive Rh factor have the Rh antigen. Individuals with blood type A have A antigens and anti-B antibodies. Individuals with blood type B have B antigens and anti-A antibodies. Individuals with blood type AB have A and B antigens and anti-A and B antibodies. Individuals with blood type O have A and B antigens and no antibodies.

Individuals with a positive Rh factor have the Rh antigen. Individuals with blood type A have A antigens and anti-B antibodies. Individuals with blood type B have B antigens and anti-A antibodies. Patients with positive Rh factor have Rh antigen. They can receive blood from patients with or without Rh antigen. Patients with blood type A have A antigens and anti-B antibodies. They can receive blood only from same blood type and O blood type. Patients with blood type B have B antigens and anti-A antibodies. They can receive blood only from the same blood type and the O blood type. The patient with blood type AB have A and B antigens and no circulating antibodies. Therefore, this blood type is known as a universal acceptor. Patients with blood type O have no antigens.

Which intravenous solution is compatible for administration with blood products? Normal saline Ringer's lactate Dextrose in water Dextrose solution

Normal saline Normal saline solution is compatible and can be used as a solution for administration with blood products. Solutions such as Ringer's lactate, dextrose in water, and dextrose solution are not compatible with blood products because they may cause clotting or hemolysis of blood cells.

Which intravenous solution is compatible for administration with blood products? Normal saline Lactated Ringer's Dextrose in water Dextrose solution

Normal saline Normal saline solution is compatible and can be used as a solution for administration with blood products. Solutions such as lactated Ringer's, dextrose in water, and dextrose solution are not compatible with blood products because they may cause clotting or hemolysis of blood cells.

The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention? Nosebleed Reports of pain Increased temperature Decreased urine output

Nosebleed. The patient with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately. The patient's report of pain, decreased urine output, and increased temperature are not the highest priority.

What is a possible complication if a filtered, straight, long tubing with a 19-gauge needle is used to transfuse pooled platelets? Hemolysis Fluid overload Occlusion of the lumen of tubing Occlusion of the lumen of catheter

Occlusion of the lumen of tubing Platelet infusions should not be administered with the standard blood administration set because the filter traps the platelets. In addition, the longer tubing increases the blockage of the lumen of the tubing due to adherence of the platelets to the lumen. Hemolysis does not occur due to the administration set. An increase in the infusion rate can cause fluid overload in the patient. Occlusion of the lumen of catheter occurs due to decrease in the size of the needle.

Which data is least required when initiating a transfusion process? Patient's band name Patient's band number Patient's room number Patient's date of birth

Patient's room number According to The Joint Commission's National Patient safety goals, the patient's room number is not an acceptable form of identification. As per the safety goals, the patient's identification is based on the patient's band name, band number, and identification of the blood component. The date of birth is part of the standard identification process.

A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? Cefaclor Gentamicin Penicillin V Vancomycin

Penicillin VProphylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in patients with sickle cell disease (SCD). Cefaclor and vancomycin are antibiotics more specific for short-term use and would be inappropriate for this patient. Gentamicin is a drug that can cause liver and kidney damage with long-term use.

A nurse is caring for a patient with a gastrointestinal (GI) bleed and a history of thrombocytopenia. The physician orders a transfusion. The nurse prepares for which type of transfusion? Plasma Platelets White blood cells (WBCs) Packed red blood cells (PRBCs)

Platelets Platelet transfusions are indicated for patients with thrombocytopenia who are actively bleeding. A WBC transfusion is rarely used but is indicated for neutropenic patients with active infections. PRBC is transfused when a patient is actively bleeding. However, this patient also has a deficiency of platelets due to the history of thrombocytopenia, which would require replacement of platelets. Plasma transfusions are usually administered to replace blood volume and clotting factors.

A patient has been diagnosed with immunohemolytic anemia. Which treatment does the nurse anticipate administering for this disorder? Steroids Immunoglobulin G Analgesic medications Packed red blood cells (RBCs)

Steroids Steroids are given for immunohemolytic anemia to suppress the immune response that is breaking down RBCs. Analgesics are an important part of treatment for sickle cell crisis. Immunoglobulin G is one of the mediators of immunohemolytic anemia. Packed RBCs are given when anemia is severe to replace blood loss.

What treatment does the nurse expect a patient diagnosed with hemophilia to receive? Rituximab Corticosteroids Synthetic factor VIII Packed red blood cells

Synthetic factor VIII Synthetic factor VIII is administered to replace the clotting factor missing in the patient with hemophilia. Rituximab and corticosteroids are indicated for patients with idiopathic thrombocytopenic purpura. Administration of red blood cells is not indicated.

Why is filtered tubing used during infusion of blood products? To reduce hemolysis To remove aggregates To prevent fluid overload To avoid blood borne pathogens

To remove aggregates Filtered tubing is used during the administration of blood product to remove aggregates and possible contaminants during the infusion. Hemolysis is prevented by diluting the blood products with normal saline only. Fluid overload is prevented by maintaining an adequate infusion rate if signs of fluid volume overload are present. Blood borne pathogens are prevented by proper handling of the equipment.

What type of transfusion reaction can be prevented by using irradiated blood products? Febrile transfusion reactions Bacterial transfusion reactions Hemolytic transfusion reactions Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-associated graft-versus-host disease (TA-GVHD) Transfusion-associated graft-versus-host disease (TA-GVHD) occurs when the donor's T-cell lymphocytes attack host tissue. Irradiated blood products can be used to prevent TA-GVHD because irradiation destroys T-cells and their cytokine products. Febrile transfusion reactions are prevented by using white blood cell poor blood products. Bacterial transfusion reactions are prevented by using contamination-free blood products and equipment. Hemolytic transfusion reactions are prevented by determining the ABO compatibility before transfusion.

The nurse is caring for a female patient who has been receiving prophylactic heparin following surgery 10 days ago. The patient has swelling and tenderness in the right leg, and laboratory results show low platelets. What drugs are most likely to be prescribed for this patient? SATA. 1Argatroban (Acova) 2Rituximab (Rituxan) 3Lepirudin (Refludan) 4Carfilzomib (Kyprolis) 5Azathioprine (Imuran) 6Bortezomib (Velcade)

1Argatroban (Acova) 3Lepirudin (Refludan) Swelling and tenderness in the legs, along with low platelets, are signs of deep vein thrombosis (DVT). For the postsurgical female patient who received heparin for more than one week and presents with DVT, heparin-induced thrombocytopenia is the likely diagnosis. Drug management for HIT is with a direct thrombin inhibitor such as argatroban (Acova) and lepirudin (Refludan). Azathioprine (Imuran) and rituximab (Rituxan) are corticosteroids used to inhibit production of antiplatelet autoantibodies in idiopathic thrombocytopenic purpura (ITP). Carfilzomib (Kyprolis) and bortezomib (Velcade) are protease inhibitors used to treat multiple myeloma.

A patient presents to the emergency department with a new onset of bruising and a petechial rash around the upper chest and arms. The patient's lab demonstrates a platelet count of 51,000 platelets per milliliter. What action by the nurse is most appropriate? 1Administer corticosteroids 2Plan for bone marrow aspiration 3Implement bleeding precautions 4Examine the patient's history for recent virus

3Implement bleeding precautions Implementing bleeding precautions is priority for a patient with new bruising, petechial rash, and a platelet count of 51,000 per mL. Administering corticosteroids is not indicated because the platelet count is above 50,000. Bone marrow aspiration may be done, but it is not a priority. It is important to examine the patient's history for recent virus; however, implementing bleeding precautions is the priority.

In caring for a patient with sickle cell disease, what does the nurse suggest can help with preventing future sickle cell crises? 1Pap smear 2Colonoscopy 3Influenza vaccine 4Testicular examination

3Influenza vaccine Influenza and pneumococcal vaccines will prevent infections, which often precipitate sickle cell crisis. Cancer screenings such as Pap smear, colonoscopy, and testicular exam are important in all individuals; however, influenza and pneumonia are common and easily preventable.

What symptom is priority for the nurse to assess for in a patient diagnosed with hemophilia A? 1Confusion 2Chest pain 3Joint swelling 4Renal function tests

3Joint swelling Joint swelling in a patient with hemophilia A is an indication of bleeding in the joints, which should be addressed immediately. Confusion is not as important as assessing for joint swelling. Chest pain is not a common finding with hemophilia. Renal function tests are not indicated.

Which platelet disorder involves the failure of blood to clot after a trauma, in spite of having the ability to form blood clots? 1Hemophilia 2Heparin-induced thrombocytopenia 3Thrombotic thrombocytopenic purpura 4Autoimmune thrombocytopenic purpur

3Thrombotic thrombocytopenic purpura In patients with thrombotic thrombocytopenic purpura, platelets clump together abnormally in the capillaries while few remain in circulation. Because few platelets are in circulation, the blood may not be able to form clots after trauma. Hemophilia is a genetic disorder caused by clotting factor deficiencies. Heparin-induced thrombocytopenia is an immunity-mediated clotting disorder that causes an unexplained drop in the platelet count. Autoimmune thrombocytopenic purpura causes the production of antibodies against one's own platelets.

The nurse is teaching a patient who has just been diagnosed with polycythemia vera (PV) about long-term management of this disease. Which statement by the patient indicates a need for further teaching? 1"I should drink at least 3 liters of fluid each day." 2"I will exercise slowly only if my provider approves." 3"I may need to have treatments 5 times each week." 4"I should floss my teeth to promote good dental health."

4"I should floss my teeth to promote good dental health." Patients with PV should avoid flossing to prevent oral bleeding. Patients may need pheresis 2 to 5 times weekly to decrease the numbers of red blood cells and decrease blood viscosity. Patients should remain hydrated and should be taught to consume at least 3 liters of fluid daily. Patients should only exercise on their provider's advice and should do so slowly.

Which patient is least likely to require red blood cell transfusion therapy? A patient who sustained trauma. A patient with impaired red blood cell maturation. A patient with problems that destroy RBCs. A patient with a hemoglobin level of 8 g/dL.

A patient with a hemoglobin level of 8 g/dL. Blood transfusion therapy is initiated in a patient with anemia if the hemoglobin level is less than 6 g/dL. Thus a patient with a hemoglobin level of 8 g/dL would not receive a blood transfusion unless he or she is symptomatic. Red blood cell transfusion therapy is preferred in patients who sustained trauma and had blood loss. Patients with impaired red blood cell (RBC) maturation may need infusion therapy for maintaining perfusion. Patients with problems that destroy RBCs may require a transfusion to maintain vital functions.

The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient? Frequent and thorough handwashing Administering prophylactic drug therapy Taking vital signs every 4 hours, day and night Monitoring laboratory values to look for abnormalities

Frequent and thorough handwashing Prevention and early detection strategies are used to protect the patient in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Drug therapy is a major defense against infections that develop in the patient with sickle cell disease, but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the patient for infection and monitoring the daily complete blood count (CBC) with differential white blood cell (WBC) count is early detection, not prevention. Taking vital signs every 4 hours will help with early detection of infection, but is not prevention.

The nurse is infusing platelets to a patient who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow? Administer intravenous (IV) corticosteroids before starting the transfusion. Allow the platelets to stabilize at the patient's bedside for 30 minutes. Infuse the transfusion over a 15- to 30-minute period. Set up the infusion with the standard transfusion "Y" tubing.

Infuse the transfusion over a 15- to 30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received; they are considered to be quite fragile. A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the patient quickly and efficiently.

The nurse is preparing to administer a bone marrow transplant using peripheral blood stem cells (PBSCs) to a patient with leukemia. Which action is necessary for safe administration of this product? Stopping the infusion if the patient develops red urine Infusing the bone marrow through a peripheral catheter Thawing the peripheral blood stem cells prior to infusion Using blood administration tubing to infuse the stem cells

Thawing the peripheral blood stem cells prior to infusion PBSCs are frozen and must be thawed prior to administration. PBSCs should be infused through the patient's central catheter. Red urine will occur secondary to the breakage of red blood cells in the infused stem cells and is not an indication for stopping the infusion. Blood administration tubing should not be used because stem cells can catch in the filter, resulting in fewer stem cells reaching the patient.

What type of transfusion reaction is characterized by rapid onset of dyspnea and hypoxia within 6 hours of transfusion? Hemolytic transfusion reactions Acute pain transfusion reaction (APTR) Transfusion-related acute lung injury (TRALI) Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-related acute lung injury (TRALI) Transfusion-related acute lung injuries (TRALI) are characterized by a rapid onset of dyspnea and hypoxia within 6 hours of the transfusion. This transfusion reaction occurs when donor blood contains antibodies against the recipient's neutrophil antigens, human leukocyte antigen, or both. Hemolytic transfusion reactions occur because of an ABO incompatibility. Apprehension, headache, chest pain, low back pain, tachycardia, and tachypnea are clinical manifestations of hemolytic transfusion reactions. Acute pain transfusion reactions (APTR) are manifested as severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck. Transfusion-associated graft-versus-host disease (TA-GVHD) occurs when the donors T-cell lymphocytes attack host tissue. Thrombocytopenia, anorexia, nausea, vomiting, chronic hepatitis, weight loss, and recurrent infection are symptoms of transfusion-related acute lung injury.

What intervention during the transfusion therapy of fresh frozen plasma may cause complications? Determining ABO compatibility Using small filters with shorter tubing Infusing fresh frozen plasma immediately after thawing Infusing the products as rapidly as tolerated by the patient

Using small filters with shorter tubing Fresh frozen plasma should be administered through a Y-set or straight filtered tubing to avoid complications. ABO compatibility determination is required for the transfusion of plasma products because the plasma contains the donor's ABO antibodies, which could react with the patient's RBC antigens. A delay in the infusion of plasma products after thawing makes the clotting factors inactive. Thus, fresh frozen plasma should be infused immediately and rapidly after thawing.

Which blood component is responsible for providing immunity? 1Red blood cells 2Platelets 3White blood cells 4Albumin

3White blood cells White blood cells (WBCs) are responsible for providing immunity and starting the inflammatory response. Red blood cells (RBCs) carry oxygen and carbon dioxide and are responsible for gas exchange in the capillaries. Platelets are important for blood clotting. Albumin is a plasma protein and helps maintain oncotic pressure in the vascular compartment.

The registered nurse teaches a student nurse about the actions to be followed after an infusion of blood products. Which statement made by the student nurse shows ineffective understanding? "I will dispose of the bag safely after infusion." "I will dispose of the tubing safely after infusion." "I will document every detail of the transfusion." "I will monitor the vital signs of the patient after the transfusion."

"I will monitor the vital signs of the patient after the transfusion." The vital signs of the patient should be assessed before, during, and after the infusion therapy. Accurate vital signs help to determine any changes caused by transfusion reactions. Disposal of the bag and tubing safely after transfusion helps prevent the spread of blood borne pathogens. The transfusion details (such as the type of product infused, product number, volume infused, time of infusion, and any adverse reactions) should be documented in the patient record.

The nurse is teaching a patient with newly diagnosed anemia about conserving energy. What should the nurse tell the patient? Select all that apply. 1"Provide yourself with four to six small, easy-to-eat meals daily." 2"Perform your care activities in groups to conserve your energy." 3"Stop activity when shortness of breath or palpitations are present." 4"Allow others to perform your care during periods of extreme fatigue." 5"Drink small quantities of protein shakes and nutritional supplements daily." 6"Perform a complete bath daily to reduce your chance of getting an infection."

1"Provide yourself with four to six small, easy-to-eat meals daily." 3"Stop activity when shortness of breath or palpitations are present." 4"Allow others to perform your care during periods of extreme fatigue." 5"Drink small quantities of protein shakes and nutritional supplements daily." It is critical to have others help the anemic patient who extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the patient. Drinking small protein or nutritional supplements will help rebuild the patient's nutritional status. Having four to six small meals daily is preferred over three large meals; this practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. A complete bath should be performed only every other day; on days in between, the patient can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities should be spaced every hour or so rather than in groups to conserve energy; the time just before and after meals should be avoided.

The nurse assesses the patient with which hematologic problem first? 1 32-year-old with pernicious anemia who needs a vitamin B 12 injection 2 81-year-old with thrombocytopenia and an increase in abdominal girth 3 67-year-old with acute myelocytic leukemia with petechiae on both legs 4 40-year-old with iron deficiency anemia who needs a Z-track iron injection

2 81-year-old with thrombocytopenia and an increase in abdominal girth An increase in abdominal girth in a patient with thrombocytopenia indicates possible hemorrhage; this warrants further assessment immediately. The 32-year-old with pernicious anemia, the 40-year-old with iron deficiency anemia, and the 67-year-old with acute myelocytic leukemia do not indicate any acute complications, so the nurse can assess them after assessing the patient with thrombocytopenia.

A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused? 100 to 150 mL 200 to 250 mL 300 to 350 mL 400 to 450 mL

200 to 250 mL Anemia is usually treated by administering 200 mL (200 - 250 mL) of packed red blood cells over 4 hours. A volume of 100 to 150 mL is below the range of the required volume of 200 to 250 mL and may not be sufficient for the patient to recover. A volume of 300 mL or higher is above the required range.

The nurse is caring for a patient with multiple sclerosis who presents with a petechial rash on the upper chest and neck. Laboratory results show low platelets, hemoglobin, and hematocrit, as well as high megakaryocytes in the bone marrow. What drugs are most likely to be prescribed for this patient? Select all that apply. 1Argatroban (Acova) 2Rituximab (Rituxan) 3Lepirudin (Refludan) 4Azathioprine (Imuran) 5Carfilzomib (Kyprolis) 6Bortezomib (Velcade

2Rituximab (Rituxan) 4Azathioprine (Imuran) A petechial rash with low platelets, hemoglobin, and hematocrit and high megakaryocytes in bone marrow, along with the presence of another autoimmune disease like multiple sclerosis, indicate idiopathic thrombocytopenic purpura (ITP). Azathioprine (Imuran) and rituximab (Rituxan) are corticosteroids used to inhibit production of antiplatelet autoantibodies in ITP. Drug management for heparin-induced thrombocytopenia is with a direct thrombin inhibitor such as argatroban (Acova) and lepirudin (Refludan). Carfilzomib (Kyprolis) and bortezomib (Velcade) are protease inhibitors used to treat multiple myeloma.

A registered nurse (RN) from pediatrics has "floated" to the medical-surgical unit. Which patient should be assigned to the float nurse? 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

42-year-old with sickle cell disease receiving a transfusion of packed red blood cells. Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion; therefore he or she should be assigned to the patient with sickle cell disease. Aplastic anemia, folic acid deficiency, and polycythemia vera are problems more commonly seen in adult patients who should be cared for by nurses who are more experienced in caring for adults.

A patient develops urticaria, itching, bronchospasm, and anaphylaxis 24 hours after a blood transfusion therapy. What could be the possible reason behind this? Febrile transfusion reactions Allergic transfusion reactions Hemolytic transfusion reactions Acute pain transfusion reactions

Allergic transfusion reactions Allergic reactions usually occur during or up to 24 hours after a transfusion. The common manifestations include utricaria, itching, bronchospasm, or anaphylaxis. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies. Hemolytic transfusion reactions are characterized by dissemination intravascular coagulation and circulatory collapse. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pain, hypertension, and redness.

The nurse is assessing a patient who will be undergoing a hematopoietic stem cell transplantation. The medical history of the patient shows past allergic reactions to this type of transfusion therapy. What would be the correct line of treatment? Infusion of pooled platelets Infusion of packed red blood cells Infusion of leukocyte-reduced red blood cells Infusion of white blood cells

Infusion of leukocyte-reduced red blood cells Patients with a history of allergic reactions to transfusion therapy who have undergone hematopoietic stem cell transplantation are at greater risk. An infusion of leukocyte-reduced red blood cells is preferred because this procedure is least likely to cause a transfusion reaction. An infusion of pooled platelets is preferred for patients with thrombocytopenia without a history of transfusion reactions. An infusion of packed red blood cells helps treat patients with a hemoglobin level less than 6 g/dL without a history of transfusion reactions. Infusion of white blood cells is usually done to treat patients with sepsis or a neutropenic infection.

A patient reports anorexia, nausea, and vomiting. The laboratory findings of the patient show decreased levels of platelets and chronic hepatitis. The patient had received transfusion therapy 2 weeks before the manifestations appeared. What could be the possible reason behind the patient's condition? Hemolytic transfusion reactions Acute pain transfusion reaction (APTR) Transfusion-related acute lung injury (TRALI) Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-associated graft-versus-host disease (TA-GVHD) Signs of transfusion-associated graft-versus-host disease (TA-GVHD) include anorexia, nausea, vomiting, thrombocytopenia, and chronic hepatitis; these symptoms occur 1 or 2 weeks after receiving a transfusion. Apprehension, headache, chest pain, low back pain, tachycardia and tachypnea are clinical manifestations of hemolytic transfusion reactions. Acute pain transfusion reactions (APTR) are manifested as severe chest pain, back pain, joint pain, hypertension, and redness. A transfusion-related acute lung injury (TRALI) occurs when donor blood contains antibodies against the recipient's neutrophil antigens, HLA, or both. Thrombocytopenia, anorexia, nausea, vomiting, chronic hepatitis, weight loss, and recurrent infection are clinical manifestations of transfusion-related acute lung injury.

What is the priority action performed by the nurse to avoid blood transfusion complications? Use Ringer's lactate and dextrose in water for infusion. Administer normal saline solution with the blood products. Use of appropriate filters to remove the sediment formed in the stored blood. Verify the patient's name and number, check blood compatibility, and note the expiration date.

Verify the patient's name and number, check blood compatibility, and note the expiration date. The first precautionary action that should be performed to avoid blood transfusion complications is to verify the patient's name and check whether the hospital identification band name and number are identical to those on the blood component tag. This action ensures that the correct blood component is administered to the patient. The expiration date is checked at the same time to avoid use of a contaminated sample. Ringer's lactate and dextrose in water is not infused with blood products as it may cause hemolysis of the blood cells. Instead, a normal saline solution is administered with blood products; however, this is done only after the patient's name, number, blood compatibility, and blood product expiration date are verified. Using appropriate filters is necessary to remove sediment from the stored blood; however, this is not done before the patient's name, number, blood compatibility, and blood product expiration date are verified.