NUR105 M4.4: ATI-Video Case Studies: Blood Administration
Question: A nurse is preparing to initiate the transfusion of a unit of packed RBCs to a client. After the unit of blood has arrived, which of the following procedures will help the nurse protect the client against the possibility of a blood-group incompatibility?NUR105 M4.4: ATI-Video Case Studies
Answer: Comparing the ID numbers on the blood unit with those on the order form and the client’s wristband
Explanation: The nurse should verify the ID numbers on the blood unit, the order form, and the client’s wristband to ensure that the blood is the correct type and has been properly matched, reducing the risk of blood-group incompatibility.
Question: A nurse is caring for a client who is receiving a blood transfusion and reports itching. The nurse observes areas of urticaria on the client’s skin. Which of the following actions should the nurse take?
Answer: Stop the blood transfusion.NUR105 M4.4: ATI-Video Case Studies
Explanation: Itching and urticaria can be signs of an allergic reaction to the transfusion. The nurse should stop the transfusion immediately to prevent further complications.
Question: A client who is anticipating total hip replacement is considering autologous transfusion. When teaching this client about autologous transfusion, it is important to emphasize that:
Answer: It reduces the risk of mismatched blood. NUR105 M4.4: ATI-Video Case Studies
Explanation: Autologous transfusion involves collecting and storing the patient’s own blood for later use. It reduces the risk of receiving mismatched blood and transfusion reactions.
Question: A nurse is caring for a client who is about to receive a unit of RBCs and states, “This is my third unit of blood today. I don’t want to get some disease from all this blood.” Which of the following responses should the nurse make?
Answer: “Donated blood is carefully screened for infectious diseases.”
Explanation: The nurse should reassure the client that donated blood undergoes rigorous screening for infectious diseases to ensure its safety for transfusion.
Question: A nurse started a transfusion of packed RBCs for a client 1 hr ago. The client has suddenly developed shaking chills, muscle stiffness, and a temperature of 38.6. The client appears flushed and reports a headache and “nervousness.” The nurse should identify that the client has most likely developed which of the following types of transfusion reaction?NUR105 M4.4: ATI-Video Case Studies
Answer: Febrile nonhemolytic
Explanation: The client’s symptoms, such as shaking chills, fever, and headache, are indicative of a febrile nonhemolytic transfusion reaction.
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