PrepU Chapter 28: Assessment of Hematologic Function and Treatment Modalities - ML6

A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis?

Hemophilia Explanation: Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

Crackles auscultated bilaterally Explanation: Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?

"The condition is likely caused by a vitamin B12 deficiency." Explanation: Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12 -intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and the absorption of vitamin B12 may be diminished. Megaloblastic anemia may be caused by a folate deficiency; however, the client's history of gastrectomy indicates the likely cause is a vitamin B12 deficiency. Megaloblastic anemia causes large erythrocytes (RBCs), not small or rigid.

A client donated two units of blood to be used for transfusion during spinal fusion surgery. The client received one unit of autologous blood during the procedure but the second unit is not needed during the procedure. The nurse knows which action will come after the procedure is completed?

Discard the additional unit. Explanation: In autologous donation, the client's own blood is collected for a future transfusion, particularly for an elective surgery where the potential for transfusion is high, such as an orthopedic procedure. If the blood is not used, it is discarded. The blood is not used for its components. The client will not be given the unit of blood unless it is required. The additional unit will not be released to the general population for use.

A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply. Stop the transfusion Apply oxygen via a face mask Notify the primary health care provider Slow the rate of the transfusion Administer diphenhydramine as prescribed

Notify the primary health care provider Stop the transfusion Administer diphenhydramine as prescribed Explanation: Some clients develop urticaria (hives) or generalized itching during a transfusion; the cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. The nurse should stop the transfusion and notify the primary health care provider of the client's symptoms. If the symptoms subside, the transfusion can be resumed. The client does not need oxygen. Slowing the rate of the transfusion would not help reduce the symptoms.