NCLEX RN exam blood lab
A platelet transfusion is to be administered to a child with acute lymphocytic leukemia. Which step would the nurse do first? 1. Administer the platelets rapidly through the intravenous (IV) line. 2. Set the intravenous (IV) pump to run for 8 hours. 3. Flush the intravenous (IV) line with a dextrose solution. 4. Check the vital signs every 2 hours during the transfusion.
1. Administer the platelets rapidly through the intravenous (IV) line. Platelets are fragile and should be administered as quickly as possible, within 1 hour, or as fast as the child can tolerate the infusion. There are minimal numbers of red blood cells (RBCs) and white blood cells contained within the infusion, which reduces the risk of a severe reaction. Platelets must be infused within 1 hour. They may be infused as rapidly as the child's cardiovascular status will tolerate. A dextrose solution is not appropriate for flushing a blood derivative line because it may cause hemolysis of RBCs. Two hours is too long an interval between checks of the child's vital signs. Vital signs should be obtained before the infusion, 15 minutes after initiation of the infusion, and at the end of the infusion.
Which characteristic of O-negative blood explains why people with this blood type are classified as "universal donors"? 1. It does not have any of the antigens that can cause a reaction. 2. The donor can donate blood more frequently than other people. 3. More people have this blood type, so it is more universally available. 4. It is more frequently administered when compared with other blood types.
1. It does not have any of the antigens that can cause a reaction. Type O Rh-negative red blood cells will not cause an antigen-antibody reaction in people with O, A, B, AB, Rh-positive, or Rh-negative blood; therefore, this type of blood can be administered "universally" to others. However, an exact match of blood type is preferred because there may be other factors in the donor's blood that can cause a reaction. People, regardless of their blood types, can donate blood approximately every 2 months. The availability of blood type does not affect the compatibility of donated blood with a recipient's blood. Although it is a common blood type, this is not why people with this type are considered universal donors.
Which action would the nurse take first when a client who is receiving a blood transfusion develops fever, chills, and low back pain? 1. Stop the blood transfusion and infuse saline. 2Administer the prescribed antipyretic. 3Obtain a prescription for an antihistamine. 4Notify the blood bank about the symptoms
1. Stop the blood transfusion and infuse saline. Fever, chills, and low back pain indicate an acute hemolytic reaction, which is potentially life threatening; discontinuing the transfusion immediately and infusing saline limits kidney damage. Although the client has a fever, administering an antipyretic before stopping the transfusion would allow the transfusion reaction to continue. The client's safety must be addressed first. Obtaining a prescription for an antihistamine may be done after stopping the transfusion and infusing saline. Although the blood bank generally is notified if a reaction occurs, this would be done after stopping the transfusion.
Which combination of maternal and infant blood type would be an indication for administration of Rho (D) immune globulin (RhoGAM) to the postpartum client? 1. Mother A positive and infant O positive 2. Mother O negative and infant O positive 3. Mother AB negative and infant B negative 4. Mother B positive and infant B negative
2. Mother O negative and infant O positive All Rh-negative mothers with Rh-positive infants are candidates for Rho(D) immune globulin; postpartum RhoGAM is not indicated if the mother is Rh positive or if both the mother and the infant are Rh negative.
After receiving 75 mL of packed red blood cells (PRBCs), a client complains of chills and low back pain. Which action would the nurse take first? 1.Check the client's temperature. 2. Stop the client's infusion of PRBCs. 3. Cover the client with a warm blanket. 4.Take the client's blood pressure and pulse.
2. Stop the client's infusion of PRBCs. The client's symptoms suggest a transfusion reaction, and the nurse's initial action would be to stop infusing PRBCs and infuse normal saline. The nurse will send the blood bag to the laboratory for hemolysis testing. The other actions are also appropriate, once the transfusion has been stopped. Chills and fever may also occur with a transfusion reaction, and the temperature should be assessed and the client may be covered with a warmed blanket for comfort. Hypotension and tachycardia may occur with transfusion reaction and the nurse should check the blood pressure and pulse.
A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing? 1. Lactated Ringer solution 2. 5% dextrose and water 3. 0.9% normal saline 4. 0.45% normal saline
3. 0.9% normal saline Blood and blood products for transfusion should be infused/diluted only with 0.9% normal saline solution. Solutions other than normal saline are incompatible and may cause RBC destruction by hemolysis.
Which action would the nurse take when administering a transfusion of 2 units of packed red blood cells (PRBCs) to a client? 1. Infuse lactated Ringer's solution with the PRBCs. 2. Warm the blood to 98°F (36.7°C) to prevent chills. 3. Infuse the blood at a slow rate during the first 15 minutes. 4. Draw blood samples from the client after each unit is transfused
3. Infuse the blood at a slow rate during the first 15 minutes. A slow rate provides time to recognize a reaction that is developing before too much blood is administered. Normal saline may be infused with blood, but lactated Ringer's solution will cause red blood cell hemolysis. Blood is not warmed to 98°F (36.7°C) to prevent chills; this could cause clotting and hemolysis. Drawing blood samples from the client after each unit is transfused is not necessary.
When administering albumin intravenously, which fluid shift would the nurse anticipate? 1. Interstitial compartment to the intracellular compartment 2. Intravascular compartment to the interstitial compartment 3. Interstitial compartment to the intravascular compartment 4. Extracellular compartment to the intracellular compartment
3. Interstitial compartment to the intravascular compartment Intravenous albumin increases colloid osmotic pressure, resulting in a pull of fluid from the interstitial compartment to the intravascular compartment. Intravascular compartment to the interstitial compartment and extracellular compartment to the intracellular compartment are opposite to the actual shift of fluids when albumin is administered.
When a client who is receiving a transfusion of packed red blood cells (PRBCs) after cardiac surgery experiences chest discomfort, chills, and anxiety, which action by the nurse is a priority? 1. Administer nitroglycerin. 2. Monitor the client's vital signs. 3. Stop the transfusion and administer normal saline. 4. Ask the client to describe the pain using a 0 to 10 scale
3. Stop the transfusion and administer normal saline. The chest discomfort and anxiety may indicate an acute hemolytic reaction to the transfusion; the nurse's first action would be to stop the transfusion and administer normal saline to improve renal perfusion and prevent acute kidney injury secondary to hemolysis. Nitroglycerin may need to be administered if the client is experiencing angina, but the first action when a hemolytic reaction is suspected would be to stop the transfusion and infuse saline. Monitoring the vital signs is important, but it would be done after stopping the transfusion to prevent ongoing exposure to the PRBCs. Asking the client to further describe symptoms is needed but not until risk for hemolysis is decreased by stopping the transfusion.
When a client has type A negative blood, which blood types can potentially be used for transfusion? 1. Type O positive 2. Type AB positive 3. Type A or O negative 4. Type A or AB negative
3. Type A or O negative Both A and O negative blood are compatible with the client's blood. A negative is the same as the client's blood type and preferred; in an emergency, type O negative blood also may be given. Although type O blood may be used, it will have to be Rh negative; Rh positive blood is incompatible with the client's blood and will cause hemolysis. Type AB positive blood is incompatible with the client's blood and will cause hemolysis. Type A negative blood is compatible with the client's blood, but type AB negative is incompatible and will cause hemolysis.
For which condition is fresh frozen plasma (FFP) ordered ? 1.Thrombocytopenia 2.Oxygen deficiency 3.Clotting factor deficiency 4. Low hemoglobin
3.Clotting factor deficiency FFP is an unconcentrated form of blood plasma containing all of the clotting factors except platelets. It can be used to supplement red blood cells (RBCs) when other blood products are not available or to correct a bleeding problem of unknown cause. Thrombocytopenia is a condition of low platelet count and is not treated with FFP. An oxygen deficiency and low hemoglobin may be improved indirectly with FFP, but it is not a definitive treatment.
To be a universal recipient, a person must have which blood type? 1. A 2. B 3. O 4. AB
4. AB Type AB blood has both A and B antigens on its red blood cells (RBCs) and no antibodies against either antigen in their plasma. Clients with type AB blood can receive packed RBCs of any ABO blood type. Blood types A, B, and O are not universal recipients because each has antibodies against another blood type. People with type O blood are called "universal donors."Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle to end of the semester to try to cram information.
In which order would the nurse complete these steps when administering a blood transfusion? 1.Ascertain that intravenous catheter size is 18 or 20 gauge. 2.Check primary health care provider's prescription. 3.Change main line solution to normal saline. 4.Check client identification before hanging unit of blood. 5.Obtain vital signs and history of transfusions.
Check primary health care provider's prescription. Obtain vital signs and history of transfusions. Ascertain that intravenous catheter size is 18 or 20 gauge. Change main line solution to normal saline. Check client identification before hanging unit of blood
When a client who has just started a transfusion of packed red blood cells reports chest pain, flank pain, difficulty breathing, and chills, which complication would the nurse suspect? 1. Urticarial reaction 2. Hemolytic reaction 3. Circulatory overload 4. Anaphylactic reaction
Hemolytic reaction Chest and flank pain, nausea, difficulty breathing, and chills are early signs of hemolytic reaction, which occurs with incompatible blood. This type of reaction occurs within minutes of starting the infusion. Urticarial reactions are minor allergic reactions that cause hives. Circulatory overload typically would occur with rapid infusion of blood and would not occur within minutes of starting a transfusion. Anaphylaxis would be associated with difficulty breathing and chest discomfort, but flank pain and chills are not typical of anaphylaxis.
In which order will the nurse take these actions when caring for a client who is having a hemolytic reaction to a transfusion of packed red blood cells? 1.Change the intravenous (IV) administration set. 2.Stop the transfusion. 3.Notify the primary health care provider and blood bank. 4.Run 0.9% normal saline at a rapid rate
Stop the transfusion. Change the intravenous (IV) administration set. Run 0.9% normal saline at a rapid rate. Notify the primary health care provider and blood bank
