Nokea
The nurses brief review of a patients electronic health record indicates that the patient regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible?
- A. The patient may chronically produce excess red blood cells.
- B. The patient may frequently experience a low relative plasma volume.
- C. The patient may have impaired stem cell function.
- D. The patient may previously have undergone bone marrow biopsy.
Correct Answer: A
Rationale: Persistently elevated hematocrit is an indication for therapeutic phlebotomy. It is not used to address excess or deficient plasma volume and is not related to stem cell function. Bone marrow biopsy is not an indication for therapeutic phlebotomy.
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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.
A patient is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize?
- A. The importance of adhering to prescribed immunosuppressant therapy
- B. The need to report any signs or symptoms of infection promptly
- C. The need to ensure adequate folic acid, iron, and vitamin B12 intake
- D. The importance of limiting activity postoperatively to prevent hemorrhage
Correct Answer: B
Rationale: After splenectomy, the patient is instructed to seek prompt medical attention if even relatively minor symptoms of infection occur. Often, patients with high platelet counts have even higher counts after splenectomy, which can predispose them to serious thrombotic or hemorrhagic problems. However, this increase is usually transient and therefore often does not warrant additional treatment. Dietary modifications are not normally necessary and immunosuppressants would be strongly contraindicated.
An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction?
- A. Ensure that blood components are never infused at a rate greater than 125 mL/hr.
- B. Administer prophylactic antihistamines prior to all blood transfusions.
- C. Establish baseline vital signs for all patients receiving transfusions.
- D. Be vigilant in identifying the patient and the blood component.
Correct Answer: D
Rationale: The most common causes of acute hemolytic reaction are errors in blood component labeling and patient identification that result in the administration of an ABO-incompatible transfusion. Actions to address these causes are necessary in all health care settings. Prophylactic antihistamines are not normally administered, and would not prevent acute hemolytic reactions. Similarly, baseline vital signs and slow administration will not prevent this reaction.
The nurse is preparing to administer a unit of platelets to an adult patient. When administering this blood product, which of the following actions should the nurse perform?
- A. Administer the platelets as rapidly as the patient can tolerate.
- B. Establish IV access as soon as the platelets arrive from the blood bank.
- C. Ensure that the patient has a patent central venous catheter.
- D. Aspirate 10 to 15 mL of blood from the patients IV immediately following the transfusion.
Correct Answer: A
Rationale: The nurse should infuse each unit of platelets as fast as patient can tolerate to diminish platelet clumping during administration. IV access should be established prior to obtaining the platelets from the blood bank. A central line is appropriate for administration, but peripheral IV access (22-gauge or larger) is sufficient. There is no need to aspirate after the transfusion.
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.