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A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels lightheaded and she appears visibly pale. What is the nurses most appropriate action?
- A. Help her into a sitting position with her head lowered below her knees.
- B. Administer supplementary oxygen by nasal prongs.
- C. Obtain a full set of vital signs.
- D. Inform a physician or other primary care provider.
Correct Answer: A
Rationale: A donor who appears pale or complains of faintness should immediately lie down or sit with the head lowered below the knees. He or she should be observed for another 30 minutes. There is no immediate need for a physicians care. Supplementary oxygen may be beneficial, but may take too much time to facilitate before a syncopal episode. Repositioning must precede assessment of vital signs.
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A patients wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?
- A. Plasminogen
- B. Thrombin
- C. Prothrombin
- D. Plasmin
Correct Answer: D
Rationale: The substance plasminogen is required to lyse (break down) the fibrin. Plasminogen, which is present in all body fluids, circulates with fibrinogen and is therefore incorporated into the fibrin clot as it forms. When the clot is no longer needed (e.g., after an injured blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn catalyzes the conversion of fibrinogen to fibrin so a clot can form.
An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place?
- A. Fibrin will be activated at the bleeding site.
- B. Platelets will aggregate at the injury site.
- C. Thromboplastin will form a clot.
- D. Prothrombin will be converted to thrombin.
Correct Answer: B
Rationale: Following vasoconstriction, circulating platelets aggregate at the site and adhere to the vessel and to one another, forming an unstable hemostatic plug. Events involved in the clotting cascade take place subsequent to this initial platelet action.
A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood?
- A. A man who is 81 years of age
- B. A woman whose blood pressure is 88/51 mm Hg
- C. A man who donated blood 4 months ago
- D. A woman who has type 1 diabetes
Correct Answer: B
Rationale: For potential blood donors, systolic arterial BP should be 90 to 180 mm Hg, and the diastolic pressure should be 50 to 100 mm Hg. There is no absolute upper age limit. Donation 4 months ago does not preclude safe repeat donation and diabetes is not a contraindication.
A patient undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions?
- A. Safe transfusion for patients with a history of transfusion reactions
- B. Prevention of viral infections from another persons blood
- C. Avoidance of complications in patients with alloantibodies
- D. Prevention of alloimmunization
Correct Answer: B
Rationale: The primary advantage of autologous transfusions is the prevention of viral infections from another persons blood. Other secondary advantages include safe transfusion for patients with a history of transfusion reactions, prevention of alloimmunization, and avoidance of complications in patients with alloantibodies.
A patient on the medical unit is receiving a unit of PRBCs. Difficult IV access has necessitated a slow infusion rate and the nurse notes that the infusion began 4 hours ago. What is the nurses most appropriate action?
- A. Apply an icepack to the blood that remains to be infused.
- B. Discontinue the remainder of the PRBC transfusion and inform the physician.
- C. Disconnect the bag of PRBCs, cool for 30 minutes and then administer.
- D. Administer the remaining PRBCs by the IV direct (IV push) route.
Correct Answer: B
Rationale: Because of the risk of infection, a PRBC transfusion should not exceed 4 hours. Remaining blood should not be transfused, even if it is cooled. Blood is not administered by the IV direct route.