A nurse is caring for an infant who has coarctation of the aorta.
Which of the following should the nurse identify as an expected finding?

The correct answer is D. Use a solution of 0.9% sodium chloride to flush the transfusion tubing.

Choice A reason: Storing a unit of blood at room temperature for 1 hour prior to the infusion is not recommended. Blood products should be kept refrigerated until just before the transfusion to minimize the risk of bacterial contamination. The recommended storage temperature for packed RBCs is 1-6°C. If blood is left at room temperature, it should be infused within 30 minutes to ensure safety.

Choice B reason: Ensuring that the transfusion is completed within 6 hours is not correct. The standard practice is to complete a blood transfusion over 2 to 4 hours, depending on the volume and the patient’s condition. This is to reduce the risk of bacterial growth and transfusion reactions. Prolonging the transfusion time beyond 4 hours increases the risk of bacterial contamination and can compromise the efficacy of the transfused red blood cells.

Choice C reason: Obtaining venous access using a 22-gauge needle is not ideal for a transfusion of packed RBCs. A larger bore needle, typically an 18-gauge or 20-gauge, is preferred to ensure adequate flow of the viscous packed RBCs and to prevent hemolysis. The smaller the gauge number, the larger the needle diameter, so a 22-gauge needle might be too small and could damage the red blood cells during the transfusion.

Choice D reason: Using a solution of 0.9% sodium chloride to flush the transfusion tubing is the correct action. Normal saline is isotonic and is the only fluid compatible with packed RBCs. It is used to prime the transfusion set and to flush the line before and after the transfusion to prevent hemolysis and clotting within the tubing.

The correct answer is choice c. Swelling of the face.

Choice A rationale:

Urinary frequency is a common symptom during pregnancy, especially in the first and third trimesters, due to hormonal changes and the growing uterus pressing on the bladder. It is generally not a cause for concern unless accompanied by other symptoms like pain or burning during urination, which could indicate a urinary tract infection.

Choice B rationale:

Bleeding gums are also common during pregnancy due to hormonal changes that increase blood flow to the gums, making them more sensitive and prone to bleeding. This condition, known as pregnancy gingivitis, is usually not serious but should be managed with good oral hygiene.

Choice C rationale:

Swelling of the face can be a sign of preeclampsia, a serious condition characterized by high blood pressure and damage to other organs, often the kidneys. Preeclampsia typically occurs after 20 weeks of gestation but can develop earlier. It requires immediate medical attention to prevent complications for both the mother and the baby.

Choice D rationale:

Faintness upon rising, or orthostatic hypotension, is relatively common during pregnancy due to changes in blood circulation. It can usually be managed by rising slowly from a sitting or lying position. However, if fainting is frequent or severe, it should be discussed with a healthcare provider to rule out other underlying conditions.