A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropeniC. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds:
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Solution
“Granulocyte transfusions replenish the low white blood cells until the body can produce its own.”
Granulocyte (neutrophil) replacement therapy is given until the patient’s blood values are normal and he is able to fight the infection himself. Options 1 and 3 are not therapeutic responses. The treatment in option 2 takes days and is not always able to prevent morbidity and mortality.
Nurse Bryan knows that the age group that uses the most units of blood and blood products is:
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Solution
The elderly above age 65 years.
People older than 65 years use 43 percent of donated blood. This number is expected to increase as the population ages.
Jonas comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called:
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Solution
Apheresis
The process of apheresis involves removal of whole blood from a donor. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn, and the remaining components are retransfused into the donor. Directed donation is collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Autologous donation is the collection and reinfusion of the patient’s own blood. Allogeneic donation is collected from a blood donor other than the recipient.
A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:
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Solution
Graft-versus-host disease (GVHD)
GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD.
Chris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching?
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Solution
packed red blood cells
Red blood cells contain antigens and antibodies that must be matched between donor and recipient. The blood products in options 2-4 do not contain red cells. Thus, they require no cross-match.
The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is:
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Solution
0.9 percent sodium chloride
0.9 percent sodium chloride is normal saline. This solution has the same osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are hypotonic solutions and can cause red cell lysis. The solution in option 4 may anticoagulate the patient and result in bleeding.
The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:
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Solution
Cardiac arrhythmias
Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can induce seizures, but they are typically not life-threatening. TCAs do not cause an elevation in body temperature. TCAs do not cause metabolic acidosis.
Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy?
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Solution
Lactic acidosis
Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness.
Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy?
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Solution
Tachycardia
Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease.
Mandy, a patient calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to:
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Solution
Stop taking the drug and come to the clinic to be seen today.
Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.