Lewis Chapter 33 Elsevier Flashcards
The nurse is caring for a patient with metastatic cancer and notes a hemoglobin level of 87 mmol/L and hematocrit of 26%. The nurse should place highest priority on initiating interventions that will reduce which of the following symptoms?
A. Thirst
B. Fatigue
C. Headache
D. Abdominal pain
B. The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions.
The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells (PRBCs). After obtaining the first unit from the blood bank, the nurse should ask which of the following health team members to assist in checking the unit before administration?
A. Unit secretary
B. A phlebotomist
C. A physician’s assistant
D. Another registered nurse
D. Before hanging a transfusion, the registered nurse (RN) must check the unit with another RN or with a licensed practical nurse (i.e., another licensed individual), depending on employer policy.
Before starting a transfusion of packed red blood cells (PRBCs) for a patient with anemia, the nurse should arrange for a peer to monitor their other assigned patients for how many minutes once the nurse begins the transfusion?
A. 5
B. 15
C. 30
D. 60
B. As part of standard procedure, the nurse remains with the patient for the first 15 minutes (or 50 mL) after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing.
The nurse is preparing to administer an ordered blood transfusion to a patient. Which of the following intravenous solutions should the nurse use when priming the blood tubing?
A. Lactated Ringer’s
B. 5% dextrose in water
C. 0.9% sodium chloride
D. 0.45% sodium chloride
C. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives the blood that is left in the tubing when the bag is empty. Lactated Ringer’s and 5% dextrose in water should not be used as it will cause red blood cell (RBC) hemolysis
The nurse notes a health care provider’s order written at 1000 hours for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. The nurse obtains the transfusion at 1130 hours. Which of the following times is the latest time that the nurse should plan to begin the administration?
A. 1145 hours
B. 1200 hours
C. 1230 hours
D. 1530 hours
B. The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.
The nurse receives a health care provider’s order to transfuse fresh-frozen plasma to a patient suffering from an acute blood loss. Which of the following procedures is best for infusing this blood product?
A. Infuse the fresh-frozen plasma as rapidly as the patient will tolerate.
B. Hang the fresh-frozen plasma as a piggyback to the primary IV solution.
C. Infuse the fresh-frozen plasma as a piggyback to a primary solution of normal saline.
D. Hang the fresh-frozen plasma as a piggyback to a new bag of primary IV solution without KCl.
A. The fresh-frozen plasma should be administered as rapidly as possible and should be used within 2 hours of thawing. Fresh-frozen plasma and platelets may be infused over 15–30 minutes. Fresh-frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh-frozen plasma is infused, unless a second IV line has been started for the transfusion.
Before beginning a transfusion of red blood cells (RBCs), which of the following actions by the nurse should be of highest priority to avoid an error during this procedure?
A. Check the identifying information on the unit of blood against the patient’s ID bracelet.
B. Select new primary IV tubing primed with lactated Ringer’s solution to use for the transfusion.
C. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction.
D. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.
A. The patient’s identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient.
The blood bank notifies the nurse that the two units of blood ordered for a patient who is anemic are ready for pickup. The nurse should take which of the following actions to prevent an adverse effect during a blood transfusion?
A. Immediately pick up both units of blood from the blood bank.
B. Infuse the blood slowly for the first 15 minutes of the transfusion.
C. Regulate the flow rate so that each unit takes at least four hours to transfuse.
D. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.
B. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes (or 50 mL) after hanging a unit of blood. Blood needs to be used within 30 minutes of retrieving it from the blood bank, so picking up both units would not be allowed. Each unit of blood should take no more than 4 hours to transfuse, and administering blood with dextrose in water will cause red blood cell (RBC) hemolysis.
Which of the following patients is most likely to experience anemia with an etiology of increased destruction of red blood cells (RBCs)?
A. A 32-year-old patient who has a diagnosis of sickle cell disease
B. A 59-year-old patient whose alcoholism has precipitated folic acid deficiency
C. A 30-year-old woman with a history of “heavy periods” accompanied by anemia
D. A 3-year-old patient whose impaired growth and development is attributable to thalassemia
A. The etiology of sickle cell anemia involves increased hemolysis. Thalassemia and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia surrounding menstruation is a direct result of blood loss.
The nurse is caring for a patient with a diagnosis of polycythemia vera. Which of the following interventions should the nurse anticipate?
A. Encourage deep breathing exercises and coughing.
B. Assist with or perform phlebotomy at the bedside.
C. Teach the patient how to maintain a low-activity lifestyle.
D. Perform thorough and regularly scheduled neurological assessments.
B. Primary polycythemia may often require phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurological manifestations are not typical.
The nurse is caring for a patient who has immune thrombocytopenic purpura (ITP). Which of the following nursing interventions is priority?
A. Administration of packed red blood cells
B. Administration of clotting factors VIII and IX
C. Administration of oral or intravenous corticosteroids
D. Maintenance of reverse isolation and application of standard precautions
C. Common treatment modalities for immune thrombocytopenic purpura (ITP) include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP.
The nurse is caring for a patient with a diagnosis of hemophilia who fell down an escalator earlier in the day and is now experiencing bleeding in their left knee joint. Which of the following actions is priority?
A. Immediate transfusion of platelets
B. Resting the patient’s knee to prevent hemarthroses
C. Assistance with intracapsular injection of corticosteroids
D. Range-of-motion exercises to prevent thrombus formation
B. In patients with hemophilia, joint bleeding requires resting of the joint in order to prevent deformities from hemarthrosis. Clotting factors, not platelets or steroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.
