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Manual of IV Therapeutics 6th Edition Gorski Phillips Case Study Answer Key

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Manual of IV Therapeutics 6th Edition Gorski Phillips Case Study Answer Key

ISBN-13: 978-0803638464

ISBN-10: 0803638469

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Manual of IV Therapeutics 6th Edition Gorski Phillips Case Study Answer Key

ISBN-13: 978-0803638464

ISBN-10: 0803638469

 

 

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Free Nursing Test Questions:

 

Chapter 11: Transfusion Therapy

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   A nurse has transfused a unit of packed RBCs, which has a 250-mL bag of 0.9% sodium chloride attached. The follow-up I.V. order is to hang a 1000-mL bag of 5% dextrose in water. Which steps should be taken by the nurse after completing the transfusion and initiating the next I.V. order?

a. Aspirate the I.V. line before connecting the I.V. solution tubing.
b. Infuse the remaining sodium chloride before attaching the new primary I.V. administration set.
c. Flush the blood tubing with sodium chloride before changing to the primary I.V. administration set.
d. Disconnect the tubing while there is blood in the line and attach the primary I.V. administration set.

 

 

____     2.   A nurse obtains a blood specimen for type and cross match for a client suspected of having type A-positive blood. The nurse understands that A-positive blood contains which antibody in the plasma?

a. Anti-A
b. Anti-O
c. Anti-B
d. Anti-A and anti-B

 

 

____     3.   A maternal-child nurse is caring for a client who has type A-negative blood, received no prenatal care, and delivered a type A-positive fetus. The nurse is concerned for the client because previous exposure to an antigen through pregnancy or transfusion may cause the client to develop:

a. more antigens.
b. an antibody to an antigen.
c. tolerance to a transfusion.
d. alloimmunization to the antibody.

 

 

____     4.   A nurse is caring for a client diagnosed with thrombocytopenia. Thrombocytopenia is an abnormally low number of:

a. platelets in the blood.
b. antibodies in the blood.
c. RBCs in the blood.
d. white blood cells in the blood.

 

 

____     5.   A client presents to a hospital laboratory wishing to make an autologous donation. An autologous donation is defined as the donation of:

a. bone marrow to be used for transplant.
b. blood by a donor to be used only by the donor.
c. blood directly from one donor to a specified recipient.
d. blood in a similar structure from a volunteer donor to a compatible recipient.

 

 

____     6.   A unit of packed red blood cells (PRBCs) is ordered for a client with anemia. The physician does not specify a rate for the infusion, according to standards of practice. Thus, the nurse should set the transfusion drip rate so that the PRBCs will be infused within:

a. 1/2 hour.
b. 1 hour.
c. 2 hours.
d. 4 hours.

 

 

____     7.   A 25-year-old client who is a Jehovah’s Witness was recently diagnosed with multiple myeloma. The client presents with a hemoglobin (Hgb) level of 6 g/dL. The client’s physician orders a transfusion of 4 units of red blood cells, but the client refuses. Which is the most appropriate action by a nurse?

a. Do nothing.
b. Administer the transfusion as ordered.
c. Notify the physician of the client’s refusal.
d. Convince the client to accept the transfusion.

 

 

____     8.   A 90-year-old client is receiving 2 units of packed red blood cells. Furosemide (Lasix) 80 mg I.V. pyelography has been ordered after the first unit of blood has infused. The client asks a nurse why she is getting Lasix. The nurse’s response should be based on the understanding that furosemide:

a. prevents pulmonary emboli.
b. prevents circulatory overload.
c. lowers the blood pressure.
d. counteracts the transfusion-induced hypercalcemia.

 

 

____     9.   A nurse is caring for a client diagnosed with post-transfusion hepatitis after a blood transfusion. Which virus is the primary cause of post-transfusion hepatitis?

a. Hepatitis A virus
b. Hepatitis B virus
c. Cytomegalovirus
d. HIV

 

 

____   10.   A physician orders 1 unit of packed red blood cells for a client diagnosed with anemia. A nurse correctly infuses the blood cells over a period of:

a. 1 hour.
b. 2 hours.
c. 4 hours.
d. 6 hours.

 

 

____   11.   A nurse is preparing to administer a unit of packed red blood cells to a client. Which type of I.V. fluid should be used to facilitate the infusion of blood for this client?

a. Lactated Ringer’s
b. Normal saline
c. 5% dextrose in water
d. 5% dextrose and normal saline

 

 

____   12.   A nurse is caring for a client who is experiencing thrombocytopenia secondary to chemotherapy. Which laboratory test result would be consistent with thrombocytopenia from chemotherapy?

a. Low white blood cell count
b. Low platelet count
c. Low red blood cell count
d. High platelet count

 

 

____   13.   A physician instructs a nurse to obtain a fluid warmer before implementing written orders for a client. The nurse obtains the fluid warmer knowing that it is used primarily for the administration of:

a. parenteral nutrition (PN).
b. solutions for the pediatric client.
c. blood.
d. solutions for the geriatric client.

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____     1.   A client is concerned about receiving donated blood for fear of contracting AIDS. A nurse reassures the client knowing that all transfusions are screened for which antibodies? SELECT ALL THAT APPLY.

a. Syphilis
b. HIV
c. Surface hepatitis B
d. Mononucleosis
e. T-lymphotrophic virus

 

 

____     2.   A nurse sends a client’s blood specimen to the laboratory for a type and crossmatch. For which antigens in the blood system should the laboratory check? SELECT ALL THAT APPLY.

a. ABO blood groups
b. Rh factor
c. Immunoglobulin M (IgM)
d. Human leukocyte antigen (HLA)

 

 

____     3.   A nurse is ordered to perform a type and cross match on a client scheduled for surgery. During the “type and cross,” the laboratory technician tests the client’s blood for the presence of which antigens? SELECT ALL THAT APPLY.

a. ABO
b. HLA
c. Rh
d. IgM

 

 

____     4.   A nurse is preparing to administer blood to a client. Before hanging a unit of blood, which information is a nurse responsible for verifying with another nurse? SELECT ALL THAT APPLY.

a. ABO and Rh
b. Client identification with two independent identifiers
c. Donor unit number
d. Expiration date
e. Client room number

 

 

____     5.   A physician orders an infusion of fresh frozen plasma (FFP) for a client. A nurse administers the infusion knowing that FFP is used for which purposes? SELECT ALL THAT APPLY.

a. Platelet deficiencies
b. Demonstrated factor deficiencies
c. Warfarin sodium (Coumadin) drug reversal
d. Antithrombin III deficiency

 

 

Completion

Complete each statement.

 

  1. A client who is to receive 4 units of whole blood has a hemoglobin (Hgb) level of 5 g/dL. A nurse should anticipate that the complete blood count after transfusion will reflect an Hgb of ____ g/dL. Fill in the blank.

 

 

Chapter 11: Transfusion Therapy

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  C

When a unit of blood has finished infusion, the line should be flushed with approximately 20 to 30 mL sodium chloride before the blood administration set is taken down and the new primary administration set is connected.

Reference: Sink, B. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banking.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  C

An antigen is a substance capable of stimulating the production of an antibody and then reacting with that antibody in a specific way. The substances that can elicit an immunological response in the blood are the A and B antigens. Antibodies are found in the plasma or serum. Anti-B is the antibody in the plasma of a group A antigen.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B

An antigen is a substance capable of stimulating the production of an antibody and then reacting with that antibody in a specific way. If an Rh-negative mother is exposed to an Rh-positive fetus, the mother will build up antibodies in response to the D antigen exposure. After A and B, the most important RBC antigen is the D antigen.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  A

Platelets are administered to control or prevent bleeding from platelet deficiencies that result in either thrombocytopenia or the presence of functionally abnormal platelets.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B

Autologous transfusion refers to the collection, storage, and delivery of a client’s own blood. The five types of autologous donation are as follows: (1) predeposit, (2) post-traumatic salvage, (3) perioperative salvage or intraoperative deposit, (4) intraoperative salvage, and (5) postoperative salvage.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  D

Standards of practice dictate that if a physician has not ordered the rate, the transfusion must be completed within 4 hours. When a longer transfusion time is clinically indicated, the unit may be divided by the blood bank, and the portion that is not being transfused can be properly refrigerated.

Reference: Sink, B. L. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  C

The physician should be notified that the client has refused the treatment. Treatment without the client’s consent is the most frequently alleged act of battery involving nurses. Doing nothing would constitute negligence.

 

PTS:   1                    KEY:  Cognitive Level: Analysis

 

  1. ANS:  B

Diuretics, such as furosemide, may be administered to prevent or correct circulatory overload. Furosemide may lower blood pressure, but this is not why it is administered to this client. It is not given to counteract hypercalcemia and does not prevent pulmonary emboli.

Reference: Sink, B. L. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B

Viral hepatitis is still a serious risk in transfusion. With the current screening procedures, a recipient’s chance is 1 in 200,000 that a pint of blood may result in a non-A or non-B viral hepatitis. Currently, the risk of a transfusion-associated HIV infection is remote—no greater than 1 in 825,000.

Reference: Eberhard, W., Fiebig, M. D., & Busch, M. P. (2008). Infectious disease screening. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  C

American Association of Blood Banks (AABB) standards require that blood be infused within 4 hours because of warming of the blood at room temperature and increasing debris in the blood filter.

Reference: Sink, B. L. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B

0.9% sodium chloride (normal saline) is the only solution that is compatible with transfusion of blood according to AABB.

Reference: Sink, B. L. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B

Thrombocytopenia is a deficiency in platelet or functionally abnormal platelets.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  C

Specific equipment, called fluid or blood warmers, is available to warm blood, if needed. Only temperature devices specifically designed to warm blood should be used for blood component therapy. PN, pediatric, and geriatric infusions are not routinely warmed.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

MULTIPLE RESPONSE

 

  1. ANS:  A, B, C, E

Transfusions are screened for bloodborne pathogens; mononucleosis is not a bloodborne pathogen.

Reference: Eberhard, W., Fiebig, M. D., & Busch, M. P. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  A, B

The laboratory should test the client’s blood for ABO blood group and Rh factor. The HLA system, located on leukocytes, platelets, and most tissue cells, is screened before transplants or multiple transfusions. The IgM is one of the five different types of immunoglobulins in the blood.

Reference: Gebel, H. M., Pollack, M. S., & Bray, R. A. (2008). The HLA system. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  A, B, C

ABO, HLA, and Rh are all antigens present in human blood. IgM is an immunoglobulin, or immune antibody.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  A, B, C, D

The nurse’s responsibilities include blood product inspection; verification of client identification, product inspection, and expiration date; confirmation of compatibility between recipient and donor, and informed client consent; client education; and monitoring the client during and after administration. A client’s room number should never be used to verify the identification of a client.

Reference: Sink, B. (2008). Administration of blood components. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banking.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

  1. ANS:  B, C, D

FFP is prepared from whole blood by separating and freezing the plasma within 6 hours of collection. FFP does not provide platelets and is primarily used to provide replacement coagulation factors. It is indicated for clients with multiple coagulation factor deficiencies.

Reference: Phillips, L. D., & Gorski, L. (2014). Transfusion therapy. Manual of I.V. therapeutics: Evidence-based infusion therapy (6th ed.). Philadelphia, PA: F.A. Davis.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

COMPLETION

 

  1. ANS:

9

One unit of whole blood will raise an adult’s Hgb level by 1 g/dL and the hematocrit by about 3% to 4%. In a client with an Hgb level of 5 g/dL who is receiving 4 units of whole blood, the nurse should expect an Hgb level of 9 g/dL within 24 hours after the infusion.

Reference: AuBuchon, J. P. (2008). Hemotherapy decisions and their outcomes. In J. D. Roback, M. R. Combs, B. J. Grossman, & C. D. Hillyer (Eds.), Technical manual (16th ed.). Bethesda, MD: American Association of Blood Banks.

 

PTS:   1                    KEY:  Cognitive Level: Analysis

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