Nokea
A patient lives with a diagnosis of sickle cell anemia and receives frequent blood transfusions. The nurse should recognize the patients consequent risk of what complication of treatment?
- A. Hypovolemia
- B. Vitamin B12 deficiency
- C. Thrombocytopenia
- D. Iron overload
Correct Answer: D
Rationale: Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.
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A patients diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin (Coumadin), an anticoagulant. When assessing the therapeutic response to this medication, what is the nurses most appropriate action?
- A. Assess for signs of myelosuppression.
- B. Review the patients platelet level.
- C. Assess the patients capillary refill time.
- D. Review the patients international normalized ratio (INR).
Correct Answer: D
Rationale: The INR and aPTT serve as useful screening tools for evaluating a patients clotting ability and to monitor the therapeutic effectiveness of anticoagulant medications. The patients platelet level is not normally used as a short-term indicator of anticoagulation effectiveness. Assessing the patient for signs of myelosuppression and capillary refill time does not address the effectiveness of anticoagulants.
Two units of PRBCs have been ordered for a patient who has experienced a GI bleed. The patient is highly reluctant to receive a transfusion, stating, Im terrified of getting AIDS from a blood transfusion. How can the nurse best address the patients concerns?
- A. All the donated blood in the United States is treated with antiretroviral medications before it is used.
- B. That did happen in some high-profile cases in the twentieth century, but it is no longer a possibility.
- C. HIV was eradicated from the US blood supply in the early 2000s.
- D. The chances of contracting AIDS from a blood transfusion in the United States are exceedingly low.
Correct Answer: D
Rationale: The patient can be reassured about the very low possibility of contracting HIV from the transfusion. However, it is not an absolute impossibility. Antiretroviral medications are not introduced into donated blood. The blood supply is constantly dynamic, due to the brief life of donated blood.
A patient is receiving a blood transfusion and complains of a new onset of slight dyspnea. The nurses rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurses most appropriate action?
- A. Slow the infusion rate and monitor the patient closely.
- B. Discontinue the transfusion and begin resuscitation.
- C. Pause the transfusion and administer a 250 mL bolus of normal saline.
- D. Discontinue the transfusion and administer a beta-blocker, as ordered.
Correct Answer: A
Rationale: The patient is showing early signs of hypervolemia; the nurse should slow the infusion rate and assess the patient closely for any signs of exacerbation. At this stage, discontinuing the transfusion is not necessary. A bolus would worsen the patients fluid overload.
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 has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following?
- A. Plasma cells
- B. Neutrophils
- C. Red blood cells
- D. Platelets
Correct Answer: A
Rationale: A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.