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A patient is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this patients adverse reaction?
- A. Antibodies to donor leukocytes remained in the blood.
- B. The donor blood was incompatible with that of the patient.
- C. The patient had a sensitivity reaction to a plasma protein in the blood.
- D. The blood was infused too quickly and overwhelmed the patients circulatory system.
Correct Answer: B
Rationale: An acute hemolytic reaction occurs when the donor blood is incompatible with that of the recipient. In the case of a febrile nonhemolytic reaction, antibodies to donor leukocytes remain in the unit of blood or blood component. An allergic reaction is a sensitivity reaction to a plasma protein within the blood component. Hypervolemia does not cause an acute hemolytic reaction.
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The nurse is describing normal RBC physiology to a patient who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following?
- A. Plasminogen
- B. Hemoglobin
- C. Hematocrit
- D. Fibrin
Correct Answer: B
Rationale: Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass. RBCs are not made of fibrin or plasminogen. Hematocrit is a measure of RBC volume in whole blood.
The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this patients health problem is due to what?
- A. Production of inadequate quantities of RBCs
- B. Premature release of immature RBCs
- C. Injury to the RBCs in circulation
- D. Abnormalities in the structure and function RBCs
Correct Answer: D
Rationale: Vitamin B12 and folic acid deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia. This pathologic process does not involve inadequate production, premature release, or injury to existing RBCs.
A clients health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions in light of the patients increased risk for what hematologic disorder?
- A. Leukemia
- B. Anemia
- C. Thrombocytopenia
- D. Lymphoma
Correct Answer: B
Rationale: Heavy alcohol use is associated with numerous health problems, including anemia. Leukemia and lymphoma are not associated with alcohol use; RBC levels are typically affected more than platelet levels.
The nurse is describing the role of plasminogen in the clotting cascade. Where in the body is plasminogen present?
- A. Myocardial muscle tissue
- B. All body fluids
- C. Cerebral tissue
- D. Venous and arterial vessel walls
Correct Answer: B
Rationale: Plasminogen, which is present in all body fluids, circulates with fibrinogen. Plasminogen is found in body fluids, not tissue.
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.