Blood Transfusion

Preprocedure PRBC Transfusion

1.Confirm Rx 2.Check that pt blood is typed & matched 3.Verify written consent 4.Explain procedure 5.Educate on signs of reaction 6.Take baseline vitals 7.Assess for signs of hypervolemia 8.Apply gloves 9.Confirm proper equipment use & start IV

required hemoglobin level for blood donation

12.5 g/dL

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4:00 pm

a process in which platelets and leukocytes are removed from the blood.

Apheresis

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure?

Apply pressure over the site for 5-7 minutes

Vitamin ________and _______ deficiencies are characterized by the production of abnormally large erythrocytes.

B12 & folate

Platelet Transfusion Preprocedure

Confirm Rx Verify written consent Explain procedure Teach signs of reaction Obtain baseline vitals Assess for hypovolemia Use gloves Use 22+g needle

used to treat aplastic anemia and thrombocytopenia.

Eltrombopag

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Hair color Herbal supplements Ethnicity Dietary intake Medication use

Herbal supplements Ethnicity Dietary intake Medication use

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

_____________ anemia is characterized by small RBCs due to insufficient hemoglobin.

Microcytic

Platelet Transfusion Procedure

Obtain platelets Double check labels & ID w/ another nurse Check for unusual color or clumping Use immediately Infuse over 30-60min Observe throughout procedure for signs of reaction Take vitals Flush line with saline

a condition in which the blood contains a large amount of red blood cells, increasing the viscosity of the blood

Polycythemia vera

helps decreased sensitization.

Red blood cell phenotyping

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take?

Refuses to administer the blood

A client with ascites is scheduled to receive albumin. To have the greatest therapeutic effect, the nurse expects what infusion rate and what oral fluid intake? Slow intravenous (IV) rate and liberal fluid intake Slow IV rate and restricted fluid intake Rapid IV rate and withheld fluid intake Rapid IV rate and moderate fluid intake

Slow IV rate & restricted fluid intake

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?

T lymphocytes

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes

Which is the major function of neutrophils? a. Phagocytosis b. Rejection of foreign tissue c. Destruction of tumor cells d. Production of immunoglobulins

a. Phagocytosis

Which is a symptom of severe thrombocytopenia? a. Dyspnea b. Petechiae c. Inflammation of the mouth d. Inflammation of the tongue

b. Petechiae

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? a. Basophils b. Monocytes c. Neutrophils d. Eosinophils

c. Neutrophils

low platelet count

thrombocytopenia

Which client is not a candidate for blood donation according to the American Heart Association? a. 26 year old female with hemoglobin 11.0 g/dL b. 18 year old male weighing 52 kg. c. 50 year old female with pulse 95 beats/minute d. 86 year old male with blood pressure 110/70 mmHg

a. 26 year old female with hemoglobin 11.0 g/dL

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? a. B lymphocyte b. Neutrophil c. Basophils d. Plasma cell

c. Basophils

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? a. White sclera b. Jugular venous distention c. Absence of tenting skin turgor d. Strong pedal pulses

b. Jugular venous distention

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption? a. Thrombocytopenia b. Neutropenia c. Myelodysplastic syndrome d. Anemia

d. Anemia

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. Lymphoid stem cell b. Monocyte c. Myeloid stem cell d. Neutrophil

c. Myeloid stem cell

Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in _______ dose.

epoetin alfa

A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client? a. Administer eltrombopag b. Administer epoetin alfa c. Place the client in a private room d. Enforce strict contact isolation

a. Administer eltrombopag

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a. Production of antibodies called immunoglobulin (Ig) b. Rejection of foreign tissue c. Phagocytosis d. Destruction of tumor cells

c. Phagocytosis

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a. Critically low arterial oxygen saturation b. Elevated erythrocyte concentration c. Elevated creatinine d. Decreased hematocrit

d. Decreased hematocrit

The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion? a. Family history of transfusion reactions b. Number of pregnancies c. Diagnosis d. Age

b. Number of pregnancies

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? a. Blood transfusion reaction b. Splintering of bone fragments c. Shock d. Hemorrhage

d. Hemorrhage

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? a. Basophils b. T lymphocytes c. Plasma cells d. Monocytes

b. T lymphocytes

High _____________ levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when EPO is administered to a target hemoglobin of >12 g/dL.

hemoglobin

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? a. Oxygen therapy b. Iron chelation therapy c. Therapeutic phlebotomy d. Anticoagulation therapy

b. Iron chelation therapy

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What condition do these signs suggest?

Circulatory Overload

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? a. Fresh frozen plasma b. Vitamin B12 c. Folate d. Iron

d. Iron

stored iron

ferritin

A nurse is caring for a client who is receiving a unit of packed red blood cells. Which findings lead the nurse to suspect a transfusion reaction caused by incompatible blood? Select all that apply. Cyanosis Backache Shivering Bradycardia Hypertension

Backache Shivering

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?

Epoetin alfa

effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin.

Epoetin alfa

stimulate granulocytosis( increasing WBC count)

Filgratism ( Neupogen) and Sagramostim

After receiving 75 mL of packed red blood cells, the client complains of chills and low back pain. The nurse suspects a hemolytic transfusion reaction and stops the infusion. The blood bag and a urine specimen are sent to the laboratory. What will the urine specimen be tested for? Specific gravity Free hemoglobin Carboxyhemoglobin Disseminated intravascular coagulation (DIC

Free Hemoglobin

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) Intubation and mechanical ventilation Oxygen Serial chest x-rays Intra-aortic balloon pump Fluid support

Intubation and mechanical ventilation Oxygen Fluid support

With ___________ deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin.

Iron

The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. Lean meats Leafy green vegetables Organic foods Animal fats Nuts and seeds

Lean meats Leafy green vegetables Nuts and seeds

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?

Monitor for edema at least once per shift

Procedure PRBC Tranfusion

Obtain PRBC's Double check label w/ another nurse Check blood for bubbles, discoloration, clumping Begin transfusion w/n 30m Run slowly (5ml/min) for first 15m Monitor for first 15-30min Ensure time does not run over 4h Change tubing after every 2 units

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?

Phlebotomy

______________ levels correlate to iron deficiency and decrease as an initial response to anemia before hemoglobin and serum iron levels drop.

Serum ferritin

A client with biliary cirrhosis receives serum albumin therapy. What is the most effective method for the nurse to evaluate the client's response to therapy? Weight daily Vital signs frequently Urine output every half hour Urine albumin level every shift

Weight daily

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? a. Administer acetaminophen 500 mg po, as ordered b. Notify the physician c. Administer aspirin (ASA) 325 mg po, as ordered d. Reposition the client to a high Fowler position and continue to monitor the pain

a. Administer acetaminophen 500 mg po, as ordered

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? a. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. b. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. c. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. d. This type of exercise increases arterial circulation as it returns to the heart.

a. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? a. Ensure there is an oxygen delivery device at the bedside. b. Place the client in a recumbent position with legs elevated. c. Remove the intravenous line. d. Administer prescribed PRN anti-anxiety agent.

a. Ensure there is an oxygen delivery device at the bedside.

Which term refers to the percentage of blood volume that consists of erythrocytes? a. Hematocrit b. Erythrocyte sedimentation rate (ESR) c. Hemoglobin d. Differentiation

a. Hematocrit

Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client? a. Hypovolemia b. Hypertension c. Hyperthermia d. Infection

a. Hypovolemia

A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions? a. Iron b. Potassium c. Hemoglobin d. Calcium

a. Iron

Which blood cell type is matched correctly with its function? a. Leukocyte: Fights infection b. Plasma cell: Cell-mediated immunity c. T lymphocyte: Humoral immunity d. B lymphocyte: Secretes immunoglobulin

a. Leukocyte: Fights infection

A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency? a. Serum ferritin: 15 ng/mL b. Hemoglobin: 16 g/dL c. Serum iron: 100 g/dL d. Total iron-binding capacity: 300 g/dL

a. Serum ferritin: 15 ng/mL

Which type of lymphocyte is responsible for cellular immunity? a. T lymphocyte b. B lymphocyte c. Plasma cell d. Basophil

a. T lymphocyte

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? a. The client is having a febrile nonhemolytic reaction. b. The client is experiencing vascular collapse. c. The client is having an allergic reaction to the blood. d. The client is having decrease in tissue perfusion from a shock state.

a. The client is having a febrile nonhemolytic reaction.

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? a. Vitamin B12 deficiency b. Vitamin A deficiency c. Folic acid deficiency d. Vitamin C deficiency

a. Vitamin B12 deficiency

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client a. may be developing an infection. b. has leukopenia. c. has thrombocytopenia. d. may be developing anemia

a. may be developing an infection.

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? a. Questions the administration of both medications b. Assesses the hemoglobin level c. Holds the epoetin alfa if the BUN is elevated d. Ensures the client has completed dialysis treatment

b. Assesses the hemoglobin level

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? a. Sickle cell anemia b. Essential thrombocythemia c. Extreme leukocytosis d. Renal transplantation

b. Essential thrombocythemia

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? a. Lithotomy position b. Lateral position with one leg flexed c. Supine with head of the bed elevated 30 degrees d. Jackknife position

b. Lateral position with one leg flexed

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? a. The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply. b. The liver and spleen can resume production of blood cells through extramedullary haematopoiesis. c. Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. d. The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem ce

b. The liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? a. "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." b. "You will have to decide if refusing the blood transfusion is worth the risk to your health." c. "I understand your concern. The blood is carefully screened but is not completely risk free." d. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."

c. "I understand your concern. The blood is carefully screened but is not completely risk free."

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: a. Fibrinogen. b. Prothrombin. c. Albumin. d. Globulin

c. Albumin.

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? a. Increased mean corpuscular volume b. Increased reticulocyte count c. Decreased level of erythropoietin d. Decreased total iron-binding capacity

c. Decreased level of erythropoietin

A client is prescribed an intravenous dose of iron dextran. What is the nurse's best action? a. Informs the client that one dose will reverse iron-deficiency anemia b. Checks the client's hemoglobin level the following day c. Ensures that epinephrine is available d. Realizes that use of this medication will produce a false-positive when checking stool for blood

c. Ensures that epinephrine is available

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client? a. Elevate the client's head of the bed. b. Apply supplemental oxygen to maintain the client's oxygenation. c. Use an electric razor when assisting client with shaving. d. Where a mask when entering the client's room.

c. Use an electric razor when assisting client with shaving.

A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client? a. "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." b. "I will eat more dairy products such as milk, yogurt, and ice cream every day." c. "I will eat a spinach salad with lunch and dinner." d. "I will eat a meat source such as chicken or pork with each meal."

d. "I will eat a meat source such as chicken or pork with each meal."

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? a. Decreased total iron-binding capacity b. Increased mean corpuscular volume c. Increased reticulocyte count d. Decreased level of erythropoietin

d. Decreased level of erythropoietin

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? a. Documenting the reaction in the client's medical record. b. Notifying the blood bank of the reaction. c. Informing the client to leave a urine sample after the client's next void. d. Disposing of the blood container and tubing in biohazard waste.

d. Disposing of the blood container and tubing in biohazard waste.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? a. Rubs the site vigorously b. Uses a 23-gauge needle c. Injects into the deltoid muscle d. Employs the Z-track technique

d. Employs the Z-track technique

After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action? a. Apply a tourniquet above the antecubital fossa. b. Assist the client into an erect position. c. Lower the arm below the level of the heart. d. Hold firm pressure on the venipuncture site.

d. Hold firm pressure on the venipuncture site.

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? a. Levels of plasma proteins b. Thrombocyte count c. WBC count d. RBC count

d. RBC count

One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem? a. Exacerbation of congestive heart failure b. Delayed hemolytic reaction c. Bacterial contamination of blood d. Transfusion-related acute lung injury

d. Transfusion-related acute lung injury

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? Improved clotting of blood 2 Formation of red blood cells 3 Activation of white blood cells (WBCs) Correct4 Effective cardiac output

effective cardiac output

myeloproliferative disorder characterized by increase in abnormal platelets

essential thrombocythemia

Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise ______________ levels in the client with end-stage renal disease.

hematocrit

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

megaloblasts

Fresh frozen plasma are infused due to a low ____________ level, not light-colored hemoglobin.

platelet

removal of platelets from blood

platelet pheresis