172 Final Exam Hondros term 3
What gauge needle would we use for donating blood? - correct answer ✔16-
18 gauge needle
How long should you scrub the site? Hub? - correct answer ✔Site-30
seconds, Hub-15 seconds
What is our preferred method used to clean a site or hub? Why? - correct
answer ✔chlorhexidine (lasts 24 hours)
What should you pay attention to using any type of iodine on a patient? -
correct answer ✔allergies to shellfish
Complications - correct answer ✔Hematoma's (contributed to anticoag
therapy or poor technique)
Can we initiate blood? - correct answer ✔Not initiate, but we can verify
things and stop the blood if we suspect a reation to it.
What are the first signs of a reaction to blood product? - correct answer
✔Restlessness, sob, rash, vitals taking
The first action you do when you see a reaction to blood? - correct answer
✔STOP the transfusion, not REMOVE it.
Blood products - correct answer ✔Albumin is a blood expander and can
cause pulmonary edema, increase cardiac output (increase BP), you are at
,NO risk for transmitting hepatitis from albumin, acts as a transport for the
protein
Patient who needs to receive packed red blood cells - correct answer
✔admitted with bright red emesis, heart rate of 120, high pulse low bp, Hgb of
7.8 (usually an Hgb under 9 is a sign of patient being unstable)
Biggest risk of packed RBC's is fluid volume overload, which patient would be
at risk? - correct answer ✔68 year old with hx of CHF
Transfusion associated transgraft verst post disease- Who is at risk? - correct
answer ✔Someone who is immunocompromised- patient with AIDS
Patient who is exhibiting S&S of acute hemolytic transfusion reaction, LPN at
bedside would immediately do what action? - correct answer ✔Stop the
blood transfusion
Patient has 0+ blood and gets B+ blood, patient has reaction, what is the
reaction and expected treatment? - correct answer ✔Stop the transfusion
LPN in the room and has obtained vitals, notices that RN is priming with LR,
what action would LPN take? - correct answer ✔Tell the RN that you only
prime blood with NS solution.
Patient has IV with albumin, what will LPN care of this patient include? -
correct answer ✔Monitor for crackles and tachycardia
Observing new nurse providing phlebotomy, what would require intervention?
- correct answer ✔They take the blood back to nurse's station to label them
(should be done prior)
, During blood collection, nurse notices hematoma. What action would you
take? - correct answer ✔DC collection and apply pressure to site until
bleeding stops
What symptoms would you expect to observe in a patient that has a citric
toxicity (causes hypocalcemia) from a rapid blood transfusion? - correct
answer ✔Positive trousseau sign, Positive Chvostek's sign
TACO - correct answer ✔causes hypertension, severe headache, JVD,
Dyspnea, pink frothy sputum (sputum is on another question, not this one)
Patient getting packed RBC, what are signs that they are having an acute
reaction? - correct answer ✔Chest pain, tachycardia, hypotension (back pain
as well which is not on test)
When inserting IV on elderly adult with fragile veins, which interventions would
you like to implement? - correct answer ✔Placing tourniquet over the
patient's gown, using BP cuff as tourniquet, lowering the angle of approach
into the vein
When inserting IV, it would be important to maintain the patient's safety by? -
correct answer ✔wash hands prior to inserting IV, applying tape or
stabilization device to prevent from pistoning, release tourniquet BEFORE
flushing
Side note - correct answer ✔Nurse's responsibility for applying bio-patch to
CBC site per facility policy with dressing change, I will stop the infusion if
adverse effect occur.
What gauge needle would we use for donating blood? - correct answer ✔16-
18 gauge needle
How long should you scrub the site? Hub? - correct answer ✔Site-30
seconds, Hub-15 seconds
What is our preferred method used to clean a site or hub? Why? - correct
answer ✔chlorhexidine (lasts 24 hours)
What should you pay attention to using any type of iodine on a patient? -
correct answer ✔allergies to shellfish
Complications - correct answer ✔Hematoma's (contributed to anticoag
therapy or poor technique)
Can we initiate blood? - correct answer ✔Not initiate, but we can verify
things and stop the blood if we suspect a reation to it.
What are the first signs of a reaction to blood product? - correct answer
✔Restlessness, sob, rash, vitals taking
The first action you do when you see a reaction to blood? - correct answer
✔STOP the transfusion, not REMOVE it.
Blood products - correct answer ✔Albumin is a blood expander and can
cause pulmonary edema, increase cardiac output (increase BP), you are at
,NO risk for transmitting hepatitis from albumin, acts as a transport for the
protein
Patient who needs to receive packed red blood cells - correct answer
✔admitted with bright red emesis, heart rate of 120, high pulse low bp, Hgb of
7.8 (usually an Hgb under 9 is a sign of patient being unstable)
Biggest risk of packed RBC's is fluid volume overload, which patient would be
at risk? - correct answer ✔68 year old with hx of CHF
Transfusion associated transgraft verst post disease- Who is at risk? - correct
answer ✔Someone who is immunocompromised- patient with AIDS
Patient who is exhibiting S&S of acute hemolytic transfusion reaction, LPN at
bedside would immediately do what action? - correct answer ✔Stop the
blood transfusion
Patient has 0+ blood and gets B+ blood, patient has reaction, what is the
reaction and expected treatment? - correct answer ✔Stop the transfusion
LPN in the room and has obtained vitals, notices that RN is priming with LR,
what action would LPN take? - correct answer ✔Tell the RN that you only
prime blood with NS solution.
Patient has IV with albumin, what will LPN care of this patient include? -
correct answer ✔Monitor for crackles and tachycardia
Observing new nurse providing phlebotomy, what would require intervention?
- correct answer ✔They take the blood back to nurse's station to label them
(should be done prior)
, During blood collection, nurse notices hematoma. What action would you
take? - correct answer ✔DC collection and apply pressure to site until
bleeding stops
What symptoms would you expect to observe in a patient that has a citric
toxicity (causes hypocalcemia) from a rapid blood transfusion? - correct
answer ✔Positive trousseau sign, Positive Chvostek's sign
TACO - correct answer ✔causes hypertension, severe headache, JVD,
Dyspnea, pink frothy sputum (sputum is on another question, not this one)
Patient getting packed RBC, what are signs that they are having an acute
reaction? - correct answer ✔Chest pain, tachycardia, hypotension (back pain
as well which is not on test)
When inserting IV on elderly adult with fragile veins, which interventions would
you like to implement? - correct answer ✔Placing tourniquet over the
patient's gown, using BP cuff as tourniquet, lowering the angle of approach
into the vein
When inserting IV, it would be important to maintain the patient's safety by? -
correct answer ✔wash hands prior to inserting IV, applying tape or
stabilization device to prevent from pistoning, release tourniquet BEFORE
flushing
Side note - correct answer ✔Nurse's responsibility for applying bio-patch to
CBC site per facility policy with dressing change, I will stop the infusion if
adverse effect occur.
