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A patient is prescribed a transfusion of washed packed red blood cells. What should the nurse realize as being the rationale for the using this type of blood?
- A. Reduces the risk of hypothermia
- B. Cleans the blood cells of impurities
- C. Reduces the risk of a febrile reaction
- D. Removes potential harmful particles from the blood
Correct Answer: C
Rationale: The correct answer is C because washing packed red blood cells reduces the risk of a febrile reaction by removing white blood cells, plasma proteins, and other substances that could lead to an immune response. Choice A is incorrect as hypothermia is not a primary concern with washed packed red blood cells. Choice B is incorrect as the process does not cleanse blood cells of impurities. Choice D is incorrect as the main purpose of washing blood cells is to reduce the risk of adverse reactions, not to remove harmful particles.
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Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?
- A. There will be initial vasodilation
- B. Clotting factors play no role in its formation
- C. Platelets change their shape during the process
- D. Serotonin stimulates platelet aggregation
Correct Answer: C
Rationale: The correct answer is C: Platelets change their shape during the process of platelet aggregation in vascular injury. Platelets undergo shape change from a discoid to a spiky form, leading to the exposure of their glycoprotein receptors, which then bind to fibrinogen and other platelets to form a platelet plug. This process is crucial for hemostasis and preventing excessive bleeding.
Explanation for why other choices are incorrect:
A: There will be initial vasodilation - Vasodilation is not a direct result of platelet aggregation but rather an initial response to vascular injury to increase blood flow to the area.
B: Clotting factors play no role in its formation - Clotting factors are essential for the later stages of hemostasis, but platelet aggregation is primarily driven by platelet activation and shape change.
D: Serotonin stimulates platelet aggregation - While serotonin is released from platelets upon activation, it does not directly stimulate platelet aggregation.
Which of the following is not the criteria in the international prognostic index for non Hodgkin's lymphoma?
- A. Number of extranodal sites
- B. LDH level
- C. Lymphocyte count
- D. Performance status
Correct Answer: C
Rationale: The correct answer is C: Lymphocyte count. The International Prognostic Index (IPI) for non-Hodgkin's lymphoma includes factors such as age, number of extranodal sites, LDH level, performance status, and stage. Lymphocyte count is not a specific criteria in the IPI. This index is used to predict the outcome of patients with aggressive lymphomas. A higher score indicates a worse prognosis. A low lymphocyte count is not a consistent prognostic factor for non-Hodgkin's lymphoma, unlike the other factors listed. Therefore, choice C is not a criteria in the IPI, making it the correct answer.
A patient who is infected with hookworms produces signs and symptoms of anemia. Which of the following can be seen in the peripheral blood smear of the patient?
- A. Howell-Jolly bodies
- B. Basophilic stippling
- C. Target cells
- D. Spherocytes
Correct Answer: B
Rationale: The correct answer is B: Basophilic stippling. Hookworm infection can lead to anemia due to chronic blood loss. Basophilic stippling is a characteristic finding in the peripheral blood smear of patients with iron deficiency anemia, which can result from hookworm infection. Basophilic stippling represents the aggregation of ribosomes and is seen in erythrocytes that contain denatured ribosomal RNA. Howell-Jolly bodies are remnants of nuclear material and are typically seen in patients with functional asplenia. Target cells are seen in conditions like liver disease or hemoglobinopathies. Spherocytes are seen in immune hemolytic anemias.
A 2-month-old girl is found to have a small, hard mass on her scalp. The mass increases in size over the next 4 weeks. A biopsy is performed that confirms a diagnosis of embryonal rhabdomyosarcoma. You initiate chemotherapy with vincristine, dactinomycin, and cyclophosphamide. The child presents to clinic for day 1 of cycle 3 of chemotherapy, and the mass on her scalp is smaller. She is afebrile, absolute neutrophil count is 1,405 cells/mcL, platelet count is 154,000/mcL, and total bilirubin is 0.8 mg/dL. Her mother reports she looks very tired because her eyelids have been 'very droopy,' and she thinks she has a sore throat because her cry is hoarse. Her last bowel movement was 2 days ago. What is the most appropriate chemotherapy plan?
- A. Continue vincristine, dactinomycin, and cyclophosphamide at full dosage.
- B. Do not administer any chemotherapy; rhabdomyosarcoma is progressing and she needs different therapy.
- C. Administer dactinomycin and cyclophosphamide but hold the vincristine and reevaluate weekly. If the ptosis and hoarse cry resolve, vincristine can be resumed with a dose reduction and, if tolerated, re-escalated to the full dose in the future.
- D. Administer dactinomycin and cyclophosphamide but discontinue vincristine permanently.
Correct Answer: C
Rationale: The correct answer is C because the child is showing signs of vincristine-induced neurotoxicity, which can manifest as droopy eyelids (ptosis) and hoarse cry. Holding vincristine and reevaluating weekly allows for monitoring of symptoms. If resolved, vincristine can be resumed with a dose reduction to prevent further neurotoxicity. Dactinomycin and cyclophosphamide are continued to maintain treatment efficacy. Continuing full-dose vincristine (choice A) can worsen neurotoxicity. With rhabdomyosarcoma responding to the current regimen, stopping all chemotherapy (choice B) is not appropriate. Discontinuing vincristine permanently (choice D) may compromise the treatment plan.
A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: The correct answer is D: Assist the registered nurse (RN) to identify correctly the patient and the blood product. This is crucial to prevent transfusion reactions as it ensures the right blood is given to the right patient. Misidentification can lead to severe complications. Monitoring vital signs (A) is important but doesn't directly prevent transfusion reactions. Warming blood (B) may improve patient comfort but doesn't prevent reactions. Administering diphenhydramine (C) is not a standard pre-transfusion medication and should not be given without specific orders. Identifying the patient and blood product correctly is the best way to prevent transfusion reactions.