CCRN -- Immune/Hematology Questions and Answers Graded A+

CCRN -- Immune/Hematology Questions and Answers Graded A+ A 52-year-old man returns to the hospital 2 weeks after being discharged from an admission for upper gastrointestinal bleed. He has been vomiting bright red blood for the past 24 hours. Laboratory parameters reveal a hemoglobin of 6 g/dL and a hematocrit of 20%. Vital signs are blood pressure 90/60 mm Hg; heart rate 120 beats/min and regular; and respiratory rate 22 breaths/min and shallow. He has received two units of red blood cells (RBCs) in the emergency department. The physician has ordered four more units of RBCs. Which two lab values must be carefully monitored in this patient? a. Calcium and potassium b. BUN and Cr c. Bilirubin and amylase d. sodium and magnesium a. Calcium and potassium RATIONALE: Patients receiving multiple transfusions must be monitored closely for hyperkalemia because stored blood has a high potassium content resulting from aging and hemolysis of RBCs. Hypocalcemia is a potential problem because citrate used as an anticoagulant in banked blood binds with calcium. This prevents clot formation and reduces the calcium level in the banked blood. TEST-TAKING STRATEGY: Because the question relates to a patient receiving multiple units of banked blood, consider which problems are related to this situation. The kidney can be affected by hemoglobinemia in transfusion reactions, but symptoms of a transfusion reaction are not in this case study, so eliminate option b. Option c might be considered later because hepatitis C (non-A/non-B) can occur with multiple transfusions and would elevate bilirubin, but this would not be evident acutely, so eliminate option c. Of the electrolytes listed in options a and d, the ones that you should associate most with potential complications of blood transfusion are calcium and potassium. Choose option a. A 52-year-old patient with a history of alcoholism is admitted with massive esophageal bleeding. After infusion of several liters of normal saline, the crossmatched blood is now available. A nursing action that can prevent a transfusion reaction is to: a. obtain a detailed transfusion history b. monitor vs q15min after starting the transfusion c. administer histamines before initiating the blood transfusion d. check the patient's identification and blood type w/the blood identification and type carefully d. check the patient's identification and blood type w/the blood identification and type carefully RATIONALE: To prevent a transfusion reaction, the nurse must ensure