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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.
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An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate?
- A. Stool for occult blood
- B. Bone marrow biopsy
- C. Lumbar puncture
- D. Urinalysis
Correct Answer: A
Rationale: Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.
A patients wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?
- A. Plasminogen
- B. Thrombin
- C. Prothrombin
- D. Plasmin
Correct Answer: D
Rationale: The substance plasminogen is required to lyse (break down) the fibrin. Plasminogen, which is present in all body fluids, circulates with fibrinogen and is therefore incorporated into the fibrin clot as it forms. When the clot is no longer needed (e.g., after an injured blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn catalyzes the conversion of fibrinogen to fibrin so a clot can form.
Fresh-frozen plasma (FFP) has been ordered for a hospital patient. Prior to administration of this blood product, the nurse should prioritize what patient education?
- A. Infection risks associated with FFP administration
- B. Physiologic functions of plasma
- C. Signs and symptoms of a transfusion reaction
- D. Strategies for managing transfusion-associated anxiety
Correct Answer: C
Rationale: Patients should be educated about signs and symptoms of transfusion reactions prior to administration of any blood product. In most cases, this is priority over education relating to infection. Anxiety may be an issue for some patients, but transfusion reactions are a possibility for all patients. Teaching about the functions of plasma is not likely a high priority.
An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place?
- A. Fibrin will be activated at the bleeding site.
- B. Platelets will aggregate at the injury site.
- C. Thromboplastin will form a clot.
- D. Prothrombin will be converted to thrombin.
Correct Answer: B
Rationale: Following vasoconstriction, circulating platelets aggregate at the site and adhere to the vessel and to one another, forming an unstable hemostatic plug. Events involved in the clotting cascade take place subsequent to this initial platelet action.
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.