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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: Reduces the risk of a febrile reaction. Washed packed red blood cells are used to remove plasma proteins, white blood cells, and platelets, reducing the risk of febrile reactions caused by leukocytes and cytokines. Choice A is incorrect because washing red blood cells does not impact the risk of hypothermia. Choice B is incorrect as washing does not clean the cells of impurities. Choice D is incorrect as the washing process does not remove harmful particles from the blood.
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An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?
- A. Hodgkin disease
- B. Non-Hodgkin Lymphoma
- C. Multiple Myeloma
- D. Acute Thrombocytopenia
Correct Answer: C
Rationale: The correct answer is C: Multiple Myeloma. In this case, the patient's age, symptoms of fatigue, back, and rib pain without recent injuries are indicative of multiple myeloma. This condition is a type of cancer that affects plasma cells in the bone marrow, leading to bone pain and fatigue. Hodgkin disease and Non-Hodgkin Lymphoma typically present with lymph node enlargement rather than back and rib pain. Acute Thrombocytopenia would present with symptoms related to low platelet levels such as bleeding tendencies, not back and rib pain.
Plat. Transfusion is not indicated in:
- A. aplastic an.
- B. uraemia with bleeding
- C. DIC
- D. immunogenic thrombocytopenia
Correct Answer: D
Rationale: The correct answer is D: immunogenic thrombocytopenia. Platelet transfusion is not indicated in immunogenic thrombocytopenia because it involves antibodies attacking platelets, which would render transfused platelets ineffective. Platelet transfusion is indicated in aplastic anemia (A) to increase platelet count, in uremia with bleeding (B) to replace dysfunctional platelets, and in DIC (C) to help manage severe bleeding. In summary, platelet transfusion is contraindicated in immunogenic thrombocytopenia due to ineffective platelet response.
You have been asked to see a 15-year-old girl who is being referred for evaluation of an ovarian mass. Her history is also significant for secondary amenorrhea, and physical examination shows signs of virilization. As you review her family history, what syndrome will you consider?
- A. Li-Fraumeni syndrome
- B. DICER-1 syndrome
- C. Turner syndrome
- D. Beckwith-Wiedemann syndrome
Correct Answer: B
Rationale: The correct answer is B: DICER-1 syndrome. This syndrome is associated with ovarian tumors, secondary amenorrhea, and signs of virilization. DICER-1 gene mutations can lead to the development of Sertoli-Leydig cell tumors, which can present with these symptoms in adolescent girls. Li-Fraumeni syndrome (A) is characterized by a predisposition to various cancers but not specifically ovarian tumors. Turner syndrome (C) is associated with ovarian dysgenesis leading to primary amenorrhea, not secondary amenorrhea and virilization. Beckwith-Wiedemann syndrome (D) is a genetic overgrowth syndrome with a risk of embryonal tumors but not typically ovarian masses with virilization.
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: Correct Answer: D
Rationale:
1. Identifying the patient and blood product is crucial to prevent transfusion reactions.
2. Matching the patient's identity with the blood product minimizes risk of incompatibility.
3. This step ensures the right blood type and product are administered, preventing serious reactions.
4. LPNs play a key role in assisting the RN in verifying and confirming patient and blood product identity.
Summary:
A: Monitoring vital signs is important but doesn't directly prevent transfusion reactions.
B: Warming blood can improve patient comfort but does not prevent reactions.
C: Administering Benadryl addresses possible allergic reactions but doesn't prevent incompatibility issues.
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: 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.
Rationale:
1. Ptosis and hoarse cry are symptoms of vincristine-induced neurotoxicity.
2. Holding vincristine allows for resolution of these side effects.
3. Reevaluating weekly ensures close monitoring of symptoms.
4. If symptoms resolve, vincristine can be cautiously reintroduced with a dose reduction to prevent further neurotoxicity.
Summary:
A: Continuing all chemotherapy may worsen neurotoxicity.
B: Withholding all chemotherapy is not appropriate if two agents are effective.
D: Discontinuing vincristine permanently may limit treatment options.