A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction?
The blood was infused too quickly and overwhelmed the client's circulatory system.
The donor blood was incompatible with that of the client.
The client had a sensitivity reaction to a plasma protein in the blood.
Antibodies to donor leukocytes remained in the blood.
The Correct Answer is B
A. The blood was infused too quickly and overwhelmed the client's circulatory system:
While infusing blood too quickly can lead to circulatory overload and related complications like heart failure or pulmonary edema, it is not the cause of an acute hemolytic transfusion reaction. Acute hemolytic reactions occur due to immune responses against incompatible donor blood.
B. The donor blood was incompatible with that of the client:
This is the correct answer. An acute hemolytic transfusion reaction happens when there is an incompatibility between the donor's blood and the recipient's blood. This can occur due to mismatched ABO blood types or Rh factor, leading to the recipient's immune system attacking and destroying the transfused red blood cells.
C. The client had a sensitivity reaction to a plasma protein in the blood:
Sensitivity reactions to plasma proteins can occur, but they typically result in different types of transfusion reactions, such as allergic reactions or febrile non-hemolytic reactions. These reactions are caused by antibodies to specific plasma proteins and are not the cause of acute hemolytic transfusion reactions.
D. Antibodies to donor leukocytes remained in the blood:
This option refers to febrile non-hemolytic transfusion reactions, which occur due to antibodies against donor leukocytes. However, this type of reaction is distinct from acute hemolytic reactions, which are primarily caused by ABO or Rh incompatibility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
A. Take the medication with milk to increase absorption:
This statement is incorrect. Taking ferrous sulfate with milk or dairy products is not recommended as they can decrease iron absorption. It's advisable to take iron supplements with water or juice, preferably on an empty stomach or with a small amount of food.
B. Take the medication on an empty stomach:
This statement is partially correct. While taking ferrous sulfate on an empty stomach can enhance absorption, some individuals may experience gastrointestinal discomfort or irritation. Therefore, it's often recommended to take iron supplements with a small amount of food to minimize potential side effects.
C. Eat foods high in fiber while on this medication:
This statement is generally correct. Consuming foods high in fiber can help prevent constipation, which is a common side effect of iron supplements. Including fiber-rich foods in the diet, such as fruits, vegetables, whole grains, and legumes, can promote regular bowel movements.
D. Report stools that are dark in color immediately:
This statement is correct. Dark or black stools can indicate the presence of digested blood, which may occur due to iron supplementation. It's important to report such changes to the healthcare provider promptly for further evaluation.
E. Eating citrus fruit and juices are recommended with meals:
This statement is correct. Citrus fruits and juices, such as oranges, grapefruits, and lemon juice, contain vitamin C, which can enhance iron absorption. Consuming vitamin C-rich foods or drinks along with iron supplements can help improve iron uptake by the body.
Correct Answer is A
Explanation
A. Work together to see how they can incorporate healthier choices into the foods enjoyed:
This approach emphasizes collaboration between the nurse and the client, focusing on finding ways to incorporate healthier food choices into the client's diet while considering their food preferences and cultural background. By working together, the nurse can help the client identify suitable substitutions, portion control strategies, and meal planning techniques that align with the dietary recommendations for coronary heart disease. This approach promotes active participation, empowers the client to make informed decisions, and increases the likelihood of long-term adherence to the dietary plan.
B. Tell the client if they do not change their diet, they are going to have a myocardial infarction:
This approach uses fear tactics or negative consequences to motivate behavior change, which is generally not recommended in healthcare settings. Fear-based strategies may lead to increased anxiety, stress, or resistance in the client, ultimately hindering motivation and adherence to the dietary plan. Positive reinforcement, education, and collaborative goal-setting are more effective in promoting behavior change and improving adherence to lifestyle modifications.
C. Give the client a list of foods to choose from:
Providing a list of foods can be a helpful tool in guiding food choices and promoting a balanced diet. However, this approach may not address the client's individual preferences, cultural considerations, or practical challenges in implementing dietary changes. Without personalized guidance and support, the client may struggle to navigate food options effectively and may experience difficulties in adhering to the dietary recommendations.
D. It is okay to cheat because of the medications:
Encouraging cheating or deviating from the dietary plan due to medications undermines the importance of dietary modifications in managing coronary heart disease. It is essential to emphasize the significance of following a heart-healthy diet and lifestyle, as medications alone may not be sufficient to manage the condition effectively. Providing education on medication adherence and dietary guidelines, along with ongoing support, helps reinforce the importance of consistent dietary habits in promoting cardiovascular health.
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