A 40-year-old patient with polycystic kidney disease is scheduled to receive a kidney transplant.
When the nurse begins to administer 2 units of leukocyte-poor packed red blood cells to treat a low hemoglobin level, the patient asks why this has been prescribed.
What is the appropriate response from the nurse?
“It will reduce the risk of receiving white blood cells from the donor that could impair the function of your transplanted kidney.”
“All pre-transplant patients receive leukocyte-poor blood because it is better absorbed by the body.”
“It causes fewer blood reactions in pre-transplant patients.”
“It is less likely to cause hemolysis, or destruction of the blood cells, after transfusion.”
The Correct Answer is A
Choice A rationale:
Leukocyte-poor packed red blood cells (LP-PRBCs) have a significantly reduced number of white blood cells (WBCs), also known as leukocytes. This is crucial for pre-transplant patients like the one in the question for several reasons:
Prevention of Alloimmunization: WBCs in blood transfusions carry human leukocyte antigens (HLAs), which are proteins on the surface of cells that play a role in the immune system. Exposure to foreign HLAs can cause the recipient's immune system to develop antibodies against them, a process called alloimmunization. These antibodies can then attack and damage the transplanted kidney, leading to rejection. By reducing the number of WBCs in the transfusion, LP-PRBCs significantly lower the risk of alloimmunization.
Reduced Incidence of Febrile Non-Hemolytic Transfusion Reactions (FNHTRs): FNHTRs are the most common type of transfusion reaction, characterized by fever, chills, and occasionally other symptoms like nausea and vomiting. They are thought to be caused by cytokines released from WBCs in the transfused blood. LP-PRBCs, with their reduced WBC content, have been shown to lower the incidence of FNHTRs.
Potential Benefits for Graft Survival: Some studies have suggested that the use of LP-PRBCs for transfusions may improve long-term graft survival rates in kidney transplant patients, although more research is needed to confirm these findings.
Choice B rationale:
This statement is incorrect. While LP-PRBCs may have some advantages in terms of absorption or utilization, this is not the primary reason for their use in pre-transplant patients. The main goal is to reduce the risk of alloimmunization and other transfusion-related complications.
Choice C rationale:
This statement is partially correct. LP-PRBCs do tend to cause fewer blood reactions, particularly FNHTRs, as explained in the rationale for Choice A. However, this is not the most comprehensive or accurate explanation for their use in pre-transplant patients.
Choice D rationale:
This statement is not directly relevant to the use of LP-PRBCs in pre-transplant patients. While LP-PRBCs may have a lower risk of hemolysis, this is not the primary reason for their use in this specific context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Affiliation with a medical or nursing school can offer some benefits, but it's not the most crucial factor to consider when seeking a new job.
Nurses in these facilities may have opportunities for professional development and involvement in research, but these benefits might not be available to all nurses.
The quality of the work environment, staffing levels, and support for nurses can vary significantly in facilities affiliated with schools.
Prioritizing Magnet status ensures a focus on nursing excellence and a commitment to providing a supportive work environment.
Choice B rationale:
Having the latest technology can be appealing, but it doesn't guarantee a positive work experience for nurses.
The most important factors for job satisfaction and quality patient care are often related to the work environment, staffing levels, and leadership support.
Magnet hospitals prioritize these factors, leading to better outcomes for both nurses and patients.
Choice C rationale:
Inquiring about nurse-patient ratios is essential, but it's not the only indicator of a positive work environment.
Magnet hospitals typically have favorable nurse-patient ratios, but they also excel in other areas that contribute to job satisfaction and quality care.
These areas include: shared governance, leadership support, professional development opportunities, and a focus on evidence-based practice.
Choice D rationale:
Magnet status is the highest recognition a hospital can achieve for nursing excellence.
It signifies a commitment to: quality patient care, positive work environments for nurses, professional development, and shared governance.
Research consistently demonstrates that Magnet hospitals have: lower nurse turnover rates, higher patient satisfaction scores, and better patient outcomes.
Seeking employment in a Magnet hospital is the most beneficial advice for a nurse looking for a job that prioritizes nursing excellence, job satisfaction, and quality patient care.
Correct Answer is D
Explanation
Choice A rationale:
Incorrect. Deep-breathing exercises could potentially worsen stridor. Stridor is a high-pitched, wheezing sound caused by a partial obstruction of the upper airway. Deep breathing can increase airflow through the narrowed airway, making the stridor more pronounced and potentially worsening the obstruction. In severe cases, it could lead to complete airway obstruction and respiratory distress.
Risk of aggravation: Deep-breathing exercises could aggravate the underlying cause of stridor, such as laryngeal edema or vocal cord dysfunction, by increasing inflammation or muscle tension in the airway.
Delay in definitive treatment: Focusing on deep-breathing exercises might delay more definitive interventions, such as intubation, which might be necessary to secure the airway and prevent respiratory failure.
Choice B rationale:
Incorrect. While albuterol nebulizer therapy can be helpful for bronchospasm, it is not the first-line treatment for stridor. Stridor is typically caused by an upper airway obstruction, and albuterol primarily targets the lower airways (bronchioles).
Limited effectiveness: Albuterol might not be effective in reducing stridor caused by upper airway obstruction, as it does not directly address the narrowing of the airway.
Potential for adverse effects: Albuterol can cause tachycardia, tremors, and anxiety, which could further complicate the patient's condition.
Choice C rationale:
Not the most immediate action. While calling a Rapid Response might be necessary if the patient's condition deteriorates, the first priority is to secure the airway and ensure adequate ventilation.
Time-consuming: Activating a Rapid Response team can take several minutes, and the patient's condition might not allow for that delay.
Choice D rationale:
Prioritizes airway management: Intubation is the most effective way to secure the airway and ensure adequate ventilation in a patient with stridor. It bypasses the obstruction and allows for controlled delivery of oxygen and ventilation.
Addresses potential for deterioration: Stridor can rapidly progress to complete airway obstruction, so prompt preparation for intubation is crucial to prevent respiratory failure.
Involves the primary healthcare provider: Consulting the primary health care provider ensures timely decision-making, appropriate medication administration (such as sedatives or paralytics for intubation), and coordination of care.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
