Hinkle Ch. 29: Nonmalignant Hematologic Disorders
A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? A high number of pregnancies can increase the risk of reaction. If the patient has never been pregnant, it increases the risk of reaction. Obtaining information about gravidity and parity is routine information for all female patients. If the patient has been pregnant, she may have developed allergies.
A high number of pregnancies can increase the risk of reaction. The patient history is an important component of the pretransfusion assessment to determine the history of previous transfusions as well as previous reactions to transfusion. The history should include the type of reaction, its manifestations, the interventions required, and whether any preventive interventions were used in subsequent transfusions. The nurse assesses the number of pregnancies a woman has had, because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation.
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: A-positive blood to an A-negative client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. B-positive blood to an AB-positive client.
A-positive blood to an A-negative client. An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.
A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client? Vaso-occlusive crisis Pneumocystis pneumonia Acute chest syndrome Acute muscular strain
Acute chest syndrome One of the unique manifestations of sickle cell disease is "acute chest syndrome," a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client's symptoms do not correlate with a diagnosis of acute muscular strain.
A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? Adequate nutrition Avoidance of NSAIDs Constant access to clotting factor concentrates Meticulous hygiene
Adequate nutrition Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency.
The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents? Administer factor VIII intravenously at the first sign of bleeding Encourage the toddler to participate in playground activities with other toddlers Administer over-the-counter preparations for a cold Use nasal packing for any nose bleeds
Administer factor VIII intravenously at the first sign of bleeding Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, however, playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided because they will interfere with platelet aggregation. Nasal packing is avoided because when the nasal packing is removed, bleeding may occur.
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Administer the prescribed enoxaparin (Lovenox). Encourage a diet high in vitamin K. Have the client limit physical activity. Monitor partial thromboplastin (PTT) time.
Administer the prescribed enoxaparin (Lovenox). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.
A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? Limiting the client's intake of oral and IV fluids Administering and evaluating the effectiveness of opioid analgesics Encouraging the client to ambulate immediately Limit foods that contain folic acid
Administering and evaluating the effectiveness of opioid analgesics The priority nursing intervention is to manage the acute pain. Client-controlled analgesia is frequently used in the acute care setting. A patient with sickle cell crisis experiences severe extreme pain, the use of IV fluids and oral intake is need to hydrate the patient, the patient is initially placed on bed rest during the crisis due to extreme fatigue. The patient must continue to ingest folic acid and are placed on a daily folic acid supplement .
A client comes to the walk-in clinic reporting weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? Aplastic anemia Pernicious anemia Iron deficiency anemia Agranulocytosis
Aplastic anemia Clients with aplastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron deficiency anemia, or agranulocytosis.
A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Ask if taking a blood pressure has ever produced pain in the upper arm. Ask if taking a blood pressure has ever caused bruising in the hand and wrist. Ask if taking a blood pressure has ever produced the need for medication.
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints.
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? Assesses the hemoglobin level Questions the administration of both medications Ensures the client has completed dialysis treatment Holds the epoetin alfa if the BUN is elevated
Assesses the hemoglobin level Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse: Assigns the client to a private room Allows unlicensed assistive personnel who reports having a sore throat to provide care Places the client in isolation and allows no visitors Changes the water in the humidifier for oxygen therapy every 48 hours
Assigns the client to a private room The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions need to be followed, such as allowing no visitors with infection. Water in oxygen humidifiers should be changed every 24 hours.
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? B12 C A Folate
B12 The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? Beans, dried fruits, and leafy, green vegetables Fruits high in vitamin C, such as oranges and grapefruits Berries and orange vegetables Dairy products
Beans, dried fruits, and leafy, green vegetables Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Bleeding gums Epistaxis Hematemesis Bradypnea Hypertension
Bleeding gums Epistaxis Hematemesis Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells
Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.
Which is a symptom of Cooley anemia? Bronzing of the skin Inflammation of the mouth Inflammation of the tongue Dyspnea
Bronzing of the skin Clients with Cooley anemia exhibit symptoms of severe anemia and a bronzing of the skin, which is caused by hemolysis of erythrocytes. Dyspnea, stomatitis (inflammation of the mouth), and glossitis (inflammation of the tongue) are symptoms of pernicious anemia.
Which is a symptom of hemochromatosis? Bronzing of the skin Inflammation of the mouth Inflammation of the tongue Weight gain
Bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.
The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? C A D E
C Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? CBC antibiotic chest radiograph ECG
CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse: Checks the client's BUN and creatinine Instructs the client not to lift more than 20 pounds Teaches the client to bend at the back when lifting objects Questions the physician about the use of both medications
Checks the client's BUN and creatinine Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.
A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? Assess for edema. Assess skin integrity frequently. Assess the client's level of consciousness frequently. Closely monitor intake and output.
Closely monitor intake and output. The client with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the client's intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.
A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings (lower RBC's, WBC's, Hemoglobin, Hematocrit, Platelets). What is the most important action for the nurse to take? Continue with the present infusion rate of heparin. Consult with the physician about discontinuing heparin. Begin treatment with the prescribed warfarin (Coumadin). Increase the heparin infusion by 100 units per hour.
Consult with the physician about discontinuing heparin. Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? Potassium level of 5.2 mEq/L Magnesium level of 2.5 mg/dL Calcium level of 9.4 mg/dL Creatinine level of 6 mg/100 mL
Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? Decreased level of erythropoietin Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count
Decreased level of erythropoietin As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? Do not take medication with orange juice because it will delay absorption of the iron. Iron may cause indigestion and should be taken with an antacid such as Mylanta. Dilute the liquid preparation with another liquid such as juice and drink with a straw. Discontinue the use of iron if your stool turns black.
Dilute the liquid preparation with another liquid such as juice and drink with a straw. Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.
You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? Avoid any sports that tire you out. Drink at least 8 glasses of water every day. Avoid any activity that makes you short of breath. Stay on oxygen therapy 24/7.
Drink at least 8 glasses of water every day. During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? Eating calf's liver with a glass of orange juice Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms
Eating calf's liver with a glass of orange juice Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Employs the Z-track technique Uses a 23-gauge needle Injects into the deltoid muscle Rubs the site vigorously
Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle.
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? Erythrocytes that are microcytic and hypochromic Erythrocytes that are macrocytic and hyperchromic Clustering of platelets with sickled red blood cells An increased number of erythrocytes
Erythrocytes that are microcytic and hypochromic A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
A teenaged client with hemophilia sustains a leg laceration after falling off a skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be prescribed for administration to control bleeding? Fresh frozen plasma A colloid solution such as hetastarch (Hespan) A crystalloid solution such as lactated Ringer's Albumin
Fresh frozen plasma Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hetastarch, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
When assessing a client with anemia, which assessment is essential? Health history, including menstrual history in women Family history Age and gender Lifestyle assessments, such as exercise routines
Health history, including menstrual history in women When assessing a client with anemia, it is essential to assess the client's health history. Women should be questioned about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy.
A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? Hematocrit of 60% Erythrocyte count of 6.5 m/?L Leukocyte count of 11,500/mm3 Platelet value of 350,000/mm3
Hematocrit of 60% Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis.
A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? Potassium level Creatinine level Hemoglobin level Folate levels
Hemoglobin level When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.
A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Risk for falls related to complaints of dizziness Fatigue related to decreased hemoglobin and hematocrit
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Activity intolerance Impaired tissue integrity Impaired oral mucous membranes Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.
The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? Iron deficiency anemia Megaloblastic anemia Sickle cell anemia Aplastic anemiaIron deficiency anemia
Iron deficiency anemia People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.
While assessing a client, the nurse discovers the client has a history of restless leg syndrome. Which hematological condition does the nurse associate with this condition? Thalassemia Folate deficiency anemia Sickle cell disease Iron deficiency anemia
Iron deficiency anemia Restless leg syndrome is common in as many as 24% of those with iron deficiency anemia.
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? It is part of the required assessment information. It is important for the nurse to determine what type of foods the patient will eat. It may indicate deficiencies in essential nutrients. It will determine what type of anemia the patient has.
It may indicate deficiencies in essential nutrients. A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.
A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? It will remove the major site of red blood cell (RBC) destruction. It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will increase red blood cell (RBC) production to compensate for blood loss.
It will remove the major site of red blood cell (RBC) destruction. For clients with autoimmune hemolytic anemia, if corticosteroids do not produce remission, a splenectomy (i.e., removal of the spleen) may be performed because it removes the major site of RBC destruction.
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count
Low ferritin level concentration The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's breathing and reviewing the client's arterial blood gases Monitoring the client's heart rate and reviewing the client's hemoglobin Monitoring the client's blood pressure and reviewing the client's hematocrit
Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.
A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? Loss of vibratory and position senses Neurologic involvement Severity of the disease Insufficient intake of dietary nutrients
Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.
A nurse cares for a client with aplastic anemia. Which laboratory results will the nurse expect to find with this client? Select all that apply. Neutrophil count 1200/microliter Hemoglobin 7 g/dL Platelets 35,000 microliters White blood cell count 10,000/microliter Neutrophil count 17,000/microliter
Neutrophil count 1200/microliter Hemoglobin 7 g/dL Platelets 35,000 microliters Aplastic anemia causes pancytopenia, or overall decrease to all myeloid stem cell-derived cells. Pancytopenia manifests as neutrophil count less than 1500/microliter, hemoglobin less than 10 g/dL, and platelets less than 50,000/microliter.
The nurse prepares a teaching plan for a client who is hospitalized with sickle cell disease. Which intervention(s) should the nurse include in the teaching plan? Select all that apply. Never exceed the recommended dosages of analgesics. Dress warmly in cold temperatures. Wear constrictive clothing to support circulation during exercise. Restrict fluid intake during crisis. Avoid travel to high altitude areas.
Never exceed the recommended dosages of analgesics. Dress warmly in cold temperatures. Avoid travel to high altitude areas. A client who is diagnosed with sickle cell disease requires specific education to prevention a sickle cell crisis. Interventions in the client's plan of care include avoiding travel to high altitude, because this may require a need for increased oxygen to prevent sickling; dressing warmly in cold temperatures or when inside an air-conditioned room, because temperature extremes is a risk factor for crisis; and avoiding exceeding recommended dosages of analgesics to decrease the risk for complications. Dehydration is a risk factor for sickle cell crisis; therefore, the client is encouraged to drink water throughout the day, increasing the amount when exercising or spending time in a hot, dry climate. It is important to avoid vigorous physical exercise and leg positions or clothing that cause vasoconstriction.
The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about? Nitrous oxide Nitric oxide Betamethasone Terbutaline
Nitric oxide Inhaled nitric oxide—not nitrous oxide (laughing gas), a vasodilating agent—is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.
The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? Stop the nosebleed Put in an IV line Ask someone to clean the bedpan Notify the physician
Notify the physician Thrombocytopenia is evidenced by purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucous membrane, and the gastrointestinal tract, also occurs. Internal hemorrhage, which can be severe and even fatal, is possible. This nurse should notify the physician of the suspected disorder.
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. Inform the client that she will feel better after receiving a bath and clean sheets. Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.
Obtain the pain medication and delay the bath and position change until the medication reaches its peak. When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.
A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? Milk Orange juice Leafy green vegetables Kidney beans
Orange juice Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron.
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Hypertension Osteoporosis Muscle wasting Truncal obesity
Osteoporosis Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.
While assessing a client, the nurse will recognize what as the most obvious sign of anemia? Pallor Tachycardia Flow murmurs Jaundice
Pallor On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Pallor, tachycardia, and a sore tongue Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia
Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia
Pancytopenia Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. The condition may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? Aplastic anemia Iron deficiency anemia Sickle cell anemia Pernicious anemia
Pernicious anemia A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? Platelet count, prothrombin time, and partial thromboplastin time Platelet count, blood glucose levels, and white blood cell (WBC) count Thrombin time, calcium levels, and potassium levels Fibrinogen level, WBC, and platelet count
Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.
A nurse should expect to administer which vaccine to the client after a splenectomy? Recombivax HB Attenuvax Pneumovax 23 Tetanus toxoid
Pneumovax 23 Pneumovax 23, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy. Recombivax HB is a vaccine for hepatitis B. Attenuvax is a live, attenuated virus vaccine for immunization against measles (rubeola). Tetanus toxoid is administered to prevent tetanus resulting from impaired skin integrity caused by traumatic injury.
Which of the following is considered an antidote to heparin? Protamine sulfate Vitamin K Narcan Ipecac
Protamine sulfate Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.
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? Administer the unit of blood Check with the blood bank first and then administer the blood with their permission Refuse to administer the blood Ask the client if he was ever known as Donald A. Smith
Refuse to administer the blood To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the blood bank about the discrepancy. The blood bank should then take the necessary steps to correct the name on the label on the unit of blood.
A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? Vitamin E Meat, egg yolks, oysters, and shellfish Rich sources of vitamin C Sources of vitamin B12
Rich sources of vitamin C Sources of vitamin C such as citrus fruits and juices, strawberries, green peppers, and tomatoes enhance the absorption of nonheme iron. To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal. Meat, egg yolks, oysters, and shellfish are the sources of heme iron whose absorption is influenced by body need. Vitamin E and sources of vitamin B12 do not promote the absorption of iron.
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? Bone marrow aspiration Schilling test Bone marrow biopsy Magnetic resonance imaging (MRI) study
Schilling test The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Take 1 hour before breakfast Take with dairy products Decrease intake of fruits and juices Decrease intake of dietary fiber
Take 1 hour before breakfast Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.
A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? Takes over-the-counter iron supplements Eliminates use of alcohol Takes 60 grams of protein each day Takes a daily multiple vitamin pill
Takes over-the-counter iron supplements When a client receives multiple transfusions and takes iron supplements, there may be a problem with iron overload. It is recommended that clients who are experiencing anemia either avoid or limit alcohol due to interference of alcohol with utilization of essential nutrients. The typical U.S. diet includes 60 grams of protein daily. Clients may be prescribed multivitamins.
A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? The client's PT is within reference ranges. Arterial blood sampling tests positive for the presence of factor XIII. The client's platelet level is below 100,000/mm3. The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels.
A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? The onset of a bacterial infection Bleeding Abdominal pain Diarrhea
The onset of a bacterial infection Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).
A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? To closely monitor the rate of administration To administer vitamin B12 injections To instruct the client to rest immediately if chest pain develops To assess for enlargement and tenderness over the liver and spleen
To closely monitor the rate of administration In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? Vitamin A Vitamin D Vitamin E Vitamin K
Vitamin K Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.
Which medication is the antidote to warfarin? Vitamin K Protamine sulfate Aspirin Clopidogrel
Vitamin K The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.
A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? Take ibuprofen for joint pain. Take warm baths to lessen pain. Wear a medical identification bracelet. Undergo genetic testing and counseling if the client is male.
Wear a medical identification bracelet. Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? Women lose iron through menstrual cycles Women rarely manifest the gene expression Women have lower hemoglobin levels Women require grater folic acid supplementation
Women lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.
The nurse is planning care for a client diagnosed with immune thrombocytopenia. Which nursing intervention should be included in the plan of care? teaching coughing and deep-breathing techniques to help prevent infection administering platelets, as ordered, to maintain an adequate platelet count giving aspirin, as ordered, to control body temperature administering stool softeners, as ordered, to prevent straining during defecation
administering stool softeners, as ordered, to prevent straining during defecation The nurse should take measures to prevent bleeding because the client with immune thrombocytopenia is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding. Therefore, the nurse should give stool softeners to prevent straining, which may result from constipation. Teaching coughing techniques would be inappropriate because coughing raises ICP. Platelets rarely are transfused prophylactically in clients with immune thrombocytopenia because the cells are destroyed, providing little therapeutic benefit. Aspirin interferes with platelet function and is contraindicated in clients with immune thrombocytopenia.
Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease? amount and quality of factor VIII amount and quality of factor IX quality of factor XI quality of factor VIII
amount and quality of factor VIII In a less serious form of hemophilia A, von Willebrand's disease, the amount and quality of factor VIII is diminished.
An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? intrinsic factor vitamin B extrinsic factor hemoglobin
intrinsic factor Pernicious anemia develops when a client lacks intrinsic factor, which normally is present in stomach secretions. Intrinsic factor is necessary for absorption of vitamin B12. Vitamin B12, the extrinsic factor in blood, is required for the maturation of erythrocytes.
A client with sickle cell anemia has a low hematocrit. high hematocrit. normal hematocrit. normal blood smear.
low hematocrit. A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to the bathroom. to the bedside commode. onto the bedpan. to a standing position so he can urinate.
onto the bedpan. A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." "DIC occurs when the immune system attacks platelets and causes massive bleeding." "DIC is a complication of an autoimmune disease that attacks the body's own cells." "DIC is caused when hemolytic processes destroy erythrocytes."
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).
A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? "Eat small amounts of bland, soft foods frequently." "Eat larger amounts of bland, soft foods less frequently." "Eat cold, bland foods with a large amount of water." "Eat low-fiber blended foods only."
"Eat small amounts of bland, soft foods frequently." Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition.
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? "I feel hot all of the time." "I have a difficult time falling asleep at night." "I have an increase in my appetite." "I have difficulty breathing when walking 30 feet."
"I have difficulty breathing when walking 30 feet." Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigued and able to sleep often with a decrease in appetite, not an increase.
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? "I will occasionally take a stool softener if I feel constipated." "I will call the doctor if my stools turn black." "I will increase my fluid and fiber intake while I am taking the iron tablets." "I will take the iron with orange juice about an hour before eating."
"I will call the doctor if my stools turn black." Iron replacement therapy may change the color of stool, usually to dark green or black. Iron is best absorbed on an empty stomach, so the client is instructed to take the supplement an hour before meals. Many clients have difficulty tolerating iron supplements because of gastrointestinal (GI) side effects (primarily constipation). Limit GI side effects by adding a stool softener or increasing dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will stop taking it if my stool turns black." "I will take it in the morning with orange juice." "I will be sure to take this medication with food." "I will limit my intake of raw fruit and vegetables."
"I will take it in the morning with orange juice." The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.
A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? "I'll watch my gums for bleeding when I brush my teeth." "I'll use an electric razor to shave." "I'll eat four servings of fresh, dark green vegetables every day." "I'll report unexplained or severe bruising to my doctor right away."
"I'll eat four servings of fresh, dark green vegetables every day." The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? "Most likely, the father is the carrier of the gene." "The trait is passed down through the mother." "The child must inherit two defective genes, one from each parent." "It is an acquired, not a hereditary disorder."
"The child must inherit two defective genes, one from each parent." Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, the person carries the sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.
Place the pathophysiological processes in order for how sickle cell disease leads to fatigue. Decreased hemoglobin in RBC Increased inflammatory cytokines Inflamed vascular endothelium Decreased muscle strength
1. Decreased hemoglobin in RBC 2. Inflamed vascular endothelium 3. Increased inflammatory cytokines 4. Decreased muscle strength Fatigue is common and multifactorial in sickle cell disease. Decreased hemoglobin in the sickled red blood cell leads to inflammation of the vascular endothelium and increased inflammatory cytokines. These factors lead to decreased muscle strength--exacerbating fatigue.
A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur? 1 to 2 months 3 to 5 months 6 to 12 months Longer than 12 months
6 to 12 months Ferrous sulfate can increase hemoglobin levels in a few weeks, and anemia may be corrected in a few months. However, it takes 6 to 12 months for stored iron replenishment to occur.
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? A hemolytic reaction to mismatched blood A hemolytic reaction to Rh-incompatible blood A hemolytic allergic reaction caused by an antigen reaction A hemolytic reaction caused by bacterial contamination of donor blood
A hemolytic allergic reaction caused by an antigen reaction Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.
