Questions and Answers
What is the normal range of hemoglobin (Hgb) for females in grams per deciliter?
Which of the following is NOT a potential sign or symptom of a transfusion reaction?
What is the main cause of febrile non-hemolytic transfusion reactions?
Which of the following must occur to avoid transfusion reactions due to wrong blood type?
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What can lead to an acute hemolytic reaction during a blood transfusion?
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Which of the following describes transfusion-associated circulatory overload (TACO)?
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Which nursing action is essential before initiating a blood transfusion?
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What is the typical reaction time for febrile non-hemolytic transfusion reactions to manifest?
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How can the risk of allergic transfusion reactions be minimized?
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Which blood component is most likely to contain antigens that may react during a transfusion?
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What is the primary reason for using packed red blood cells (PRBCs) instead of whole blood during transfusions?
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Which symptom is NOT typically associated with Transfusion-Associated Circulatory Overload (TACO)?
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What is the appropriate initial action upon recognizing signs of a transfusion reaction?
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Which group can safely donate blood to a patient with A- blood type?
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What is a common cause of Transfusion-Related Acute Lung Injury (TRALI)?
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Which of the following is a significant risk factor for developing TACO during a blood transfusion?
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What condition is characterized by an excess destruction of red blood cells?
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What is a classic sign of bacterial contamination during a blood transfusion?
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In the context of blood types, which of the following combinations is true?
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For patients with Rh-negative blood type, what is the essential guideline regarding blood transfusions?
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Which of the following is a common nursing intervention after a patient experiences a suspected transfusion reaction?
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What is the primary mechanism causing Transfusion-Related Acute Lung Injury (TRALI)?
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What should be the infusion rate of packed RBCs to ensure completion within 3-4 hours?
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What condition involves a defect in the production of red blood cells?
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What is the nursing priority after confirming a transfusion reaction in a patient?
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What causes the formation of megaloblasts in Megaloblastic anemia?
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Which condition is associated with autoimmune attack and may lead to B12 deficiency?
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In patients with sickle cell disease, what primarily causes the pain experienced during a sickle cell crisis?
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Which anemia is characterized by decreased production of red blood cells due to damage to marrow stem cells?
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What is a likely consequence of untreated vitamin B12 deficiency?
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What assessment would best help detect a sickle cell crisis?
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What dietary consideration is crucial for individuals diagnosed with thalassemia?
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Which symptom is NOT typically associated with anemia?
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What is the primary treatment goal for anemia management?
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What condition is commonly associated with increased risk of infections, particularly pneumonia and meningitis, in sickle cell disease patients?
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During assessment, which finding would suggest iron deficiency anemia?
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What is a common characteristic of hereditary hemochromatosis?
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Which psychosocial impact is commonly associated with chronic anemia in older adults?
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What type of anemia might a patient experience if they have chronic kidney disease?
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What laboratory test is crucial for diagnosing sickle cell disease?
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What is the primary purpose of a Type and Screen test before a blood transfusion?
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Febrile non-hemolytic reactions are the most dangerous type of transfusion reaction.
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List one symptom indicative of an allergic reaction during a blood transfusion.
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Blood must be infused within ___ hours to avoid infection.
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Match the following transfusion reactions with their characteristics:
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Which of the following components may cause a severe allergic reaction during transfusion?
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The infusion rate for packed RBCs should not exceed 5mL/min during the first 15 minutes.
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What are two common symptoms of an acute hemolytic reaction?
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A nurse must witness the ___ signature before a blood transfusion.
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What is one common sign of a transfusion reaction?
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Which type of anemia is characterized by unusually large, abnormal, immature red blood cells?
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Iron deficiency anemia can result from blood loss, dietary deficiency, or malabsorption.
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What is the primary treatment goal for managing anemia?
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In sickle cell disease, the hemoglobin molecule is defective leading to __________ shape of red blood cells.
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Match the type of anemia to its cause:
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Which symptom is commonly associated with vitamin B12 deficiency?
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Hydration is not important in the management of sickle cell disease.
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What type of anemia is characterized by inherited RBC disorders causing abnormal hemoglobin production?
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Patients with megaloblastic anemia may experience __________ due to nerve damage.
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What is a common complication of untreated anemia?
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Blood transfusions are an effective treatment for all types of anemia.
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What is the term for the increased risk of infections, including pneumonia, in patients with sickle cell disease?
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Patients experiencing __________ in sickle cell crisis typically report excruciating pain.
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Which of the following is a feature of aplastic anemia?
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Fatigue and pallor are symptoms that can indicate the presence of anemia.
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Which of the following symptoms is commonly associated with Transfusion-Associated Circulatory Overload (TACO)?
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Transfusion-Related Acute Lung Injury (TRALI) can occur anytime after a transfusion especially within 6 hours.
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What should be done immediately if a transfusion reaction is suspected?
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A patient with type O blood has ______ antibodies present in their plasma.
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Match the following blood types with their corresponding characteristics:
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What is a common cause of bacterial contamination of blood during transfusion?
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Rh-positive individuals can receive blood from both Rh-positive and Rh-negative donors.
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List one nursing assessment finding to monitor in a patient experiencing a transfusion reaction.
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Transfusion-Associated Circulatory Overload (TACO) can cause _______ at the base of the lungs.
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Match the various transfusion reactions with their symptoms.
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What is the primary treatment for suspected bacterial contamination during a transfusion?
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Packed Red Blood Cells (PRBCs) are considered safer than whole blood for transfusions.
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Name a patient population at increased risk for Transfusion-Associated Circulatory Overload (TACO).
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To prevent transfusion-associated complications, it is crucial to transfuse blood products within ______ hours.
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What should be avoided to minimize the risk of complications associated with hemophilia during nursing management?
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In cases of active bleeding for patients with hemophilia, what is the most appropriate intervention?
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Which of the following is an essential education point for patients with hemophilia regarding procedures?
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What coping strategy is recommended for patients experiencing pain from hematomas and joint bleeds in hemophilia?
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The mechanism causing bleeding in Disseminated Intravascular Coagulation (DIC) primarily involves what process?
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Which of the following best describes the early stage of DIC?
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What is a common complication associated with late-stage DIC?
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Which condition is NOT typically a trigger for DIC?
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Which medication is specifically used to prevent clotting in DIC treatment?
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In DIC assessment, which finding is typically observed?
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Which of the following treatments is NOT appropriate for managing DIC?
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Which symptom is most directly related to tissue ischemia in the context of DIC?
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What is the significance of elevated D-dimer levels in DIC patients?
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Which of the following statements about DIC is false?
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Which of the following is an indication of a life-threatening severity level in DIC?
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Study Notes
Composition of Blood
- Ratio of Red Blood Cells (RBCs) to plasma:
- Males: 40-54%
- Females: 37-47%
- Hemoglobin (Hgb) indicates O2-carrying capacity:
- Male Hgb: 13-18 g/dL
- Female Hgb: 12-15 g/dL
- RBC count in 100 mL blood:
- Male RBCs: 4.6-6.2 million/mm³
- Female RBCs: 4.2-5.4 million/mm³
Blood Transfusion Process
- Transfusions are performed for RBCs, platelets, and plasma.
- Verification steps include:
- Order, Type and Screen, Consent, Education, Assessment (vital signs, lung health)
- Type and Screen: ensures blood type compatibility to prevent reactions.
- Nurse must witness consent; educate patient on symptoms signaling reactions (e.g., back pain, trouble breathing).
- Blood must be infused within 4 hours; infusion rate must not exceed 5 mL/min for the first 15 minutes.
Types of Transfusion Reactions
- Febrile non-hemolytic reactions: most common, caused by antibodies to donor leukocytes.
- Signs: chills, fever (≥1°C elevation within 2 hours).
- Acute hemolytic reactions: life-threatening, from incompatible donor blood.
- Signs: fever, chills, low back pain, dyspnea, anxiety, hematuria.
- Allergic reactions: sensitivity to plasma proteins.
- Signs: hives, itching, flushing; severe cases may require epinephrine.
- Transfusion-associated circulatory overload (TACO): hypervolemia from rapid transfusion.
- Signs: dyspnea, orthopnea, tachycardia, jugular vein distention.
- Transfusion-related acute lung injury (TRALI): fatal pulmonary edema unrelated to circulatory overload.
- Signs: acute shortness of breath, hypoxia, fever.
- Bacterial contamination: rare but serious; contamination during donation or processing.
- Signs: fever, chills, hypotension.
Nursing Management for Transfusion Reactions
- Immediately stop transfusion, maintain an IV line with normal saline.
- Monitor vital signs, respiratory and cardiovascular status, and assess for symptoms like anxiety or chills.
- Notify the healthcare provider and the blood bank; send blood container and tubing for testing.
Blood Types and Compatibility
- Blood types are determined by the presence of antigens:
- Type A: antigen A; Type B: antigen B; Type AB: both; Type O: neither.
- Antibodies develop against absent antigens:
- Type A develops anti-B antibodies; Type B develops anti-A; Type AB has no antibodies; Type O has both anti-A and anti-B.
- Rh factor: Positive (+) has Rh protein; Negative (-) lacks it; Rh- can only receive from Rh- donors.
Anemias Overview
- Most common blood disorder, classified as hypoproliferative (defective RBC production) or hemolytic (excess RBC destruction).
- Hypoproliferative examples:
- Iron deficiency anemia, renal disease anemia, aplastic anemia.
- Hemolytic examples:
- Sickle cell disease, thalassemia, immune hemolytic anemia.
Anemia Assessment and Management
- Conduct health history, physical exam, and laboratory tests (H&H, iron studies, vitamin levels).
- Management involves dietary therapy, medication supplementation (iron, B12, folate), and potential transfusions.
- Monitor for complications such as heart failure, confusion, and injuries from falls.
Sickle Cell Disease
- Genetic disorder causing severe hemolytic anemia due to defective hemoglobin (HbS).
- Sickle-shaped RBCs obstruct blood flow, leading to pain and reduced oxygen capacity.
- Key treatment: hydration, oxygen, pain management. Bone marrow transplants are reserved for severe cases.
Neutropenia
- Characterized by decreased neutrophils due to production issues or increased destruction. Requires careful monitoring and management strategies to prevent complications from infections.
Heme and Care of the Hematologic Patient
Composition of Blood
- Blood consists of plasma and cellular components, with a ratio of RBCs to plasma varying by gender.
- For males, the RBC to plasma ratio is 40-54%; for females, it's 37-47%.
- Hemoglobin (Hgb) is crucial for oxygen transport:
- Males: 13-18 g/dL
- Females: 12-15 g/dL.
- RBC count in 100mL of blood:
- Males: 4.6-6.2 million/mm3
- Females: 4.2-5.4 million/mm3.
Blood Transfusion
- Transfusions are commonly performed for RBCs, platelets, or plasma.
- Verification process includes order compliance, consent, education, and assessment of vital signs and lung function.
- Type and screen ensures blood type compatibility to prevent adverse reactions.
- Transfusion must occur within 4 hours to prevent infections, with a recommended initial rate of no more than 5 mL/min for the first 15 minutes.
Transfusion Reactions
- Types of reactions include:
- Febrile non-hemolytic reactions: most common, preventable with leukocyte filters, causing chills and fever.
- Acute hemolytic reactions: life-threatening; occurs with incompatible blood, symptoms include fever, low back pain, hypotension.
- Allergic reactions: sensitivity to plasma proteins, ranging from mild (hives) to severe (shock).
- Transfusion-associated circulatory overload (TACO): due to rapid volume overload, symptoms involve dyspnea and high blood pressure.
- Transfusion-related acute lung injury (TRALI): potentially fatal pulmonary edema occurring post-transfusion.
- Bacterial contamination: rare but serious; may cause hypotension and fever if contaminated blood is transfused.
Signs and Symptoms of Transfusion Reaction
- Common signs include shortness of breath, back pain, dark urine, fever/chills, and dizziness.
Anemias and Hematologic Disorders
Types and Causes of Anemia
- Anemia manifests as lower hemoglobin levels and lower RBC counts, indicating underlying disorders.
- Anemias can be categorized into hypoproliferative (production issues) and hemolytic (destruction issues).
- Common causes include deficiencies in iron, vitamin B12, and folate, or diseases like cancer.
Hypoproliferative vs. Hemolytic Anemias
- Hypoproliferative examples:
- Iron deficiency anemia, anemia due to renal disease, megaloblastic anemia from vitamin deficiencies.
- Hemolytic examples:
- Sickle cell disease, thalassemia, and autoimmune conditions.
Assessment and Management of Anemia
- Conduct thorough health history including dietary habits and medication usage.
- Laboratory evaluations include hemoglobin, hematocrit, iron studies, and vitamin levels.
- Management strategies involve correcting the underlying cause, dietary therapy, or transfusions.
- Monitor vital signs, manage fatigue, educate patients on medication adherence, and assess potential complications such as heart failure or confusion.
Sickle Cell Disease
- An inherited disorder where defective hemoglobin leads to sickle-shaped RBCs, compromising blood flow and causing pain.
- The only cure is a bone marrow or stem cell transplant, typically reserved for severe cases.
- Management focuses on hydration, oxygenation, pain relief, and infection prevention due to spleen damage.
Neutropenia
- Defined as decreased neutrophil production or increased destruction, increasing infection risk.
- Assessment and monitoring are critical to managing complications effectively.
General Considerations
- Recognize the unique risks and complications each hematologic condition poses, especially in elderly patients.
- Ensure patient education on disease processes and signs of potential complications to empower self-management.
Hemophilia Nursing Management
- Monitor patients during hemorrhage episodes; poor clot formation leads to delayed wound healing.
- Administer Fresh Frozen Plasma (FFP) to replenish coagulation factors during active bleeding episodes.
- Educate patients to avoid substances that interfere with platelet aggregation, including aspirin, NSAIDs, certain herbal supplements (chamomile, nettle, alfalfa), and alcohol to reduce fall risks.
- Encourage avoidance of injections and invasive procedures due to increased bleeding risks.
- Advise wearing a medical identification bracelet for emergencies.
- Provide support for coping with the psychological impacts of hemophilia.
- Manage pain related to hematomas and joint hemorrhage.
Disseminated Intravascular Coagulation (DIC)
- DIC results from an altered hemostasis mechanism, causing massive microcirculation clotting, leading to bleeding as clotting factors get consumed.
- Symptoms stem from tissue ischemia and bleeding; DIC is a manifestation of an underlying disorder, not a standalone disease.
- Excess clotting provokes fibrinolysis, yielding fibrin degradation products that serve as anticoagulants, heightening the risk of bleeding.
- Characteristic bleeding symptoms include low platelet and fibrinogen levels, and prolonged coagulation times (elevated PTT, thrombin time, PT; high fibrin and D-dimer).
- DIC has two stages:
- Early stage: Overactive clotting produces blood clots that obstruct blood flow and damage organs.
- Late stage: Clotting factors and platelets are depleted, leading to bleeding beneath the skin, from the nose or mouth, and deep within tissues.
- Severity varies, with potential for life-threatening complications.
DIC Triggers
- Common triggers include sepsis, trauma, shock, cancer, abruptio placentae, toxic reactions, and allergies; infections and cancers are the primary causes.
- Other triggers involve inflammation from tissue damage (burns or trauma) and clotting factor depletion due to pregnancy complications (placental abruption, amniotic fluid embolism).
DIC Treatment
- Address the underlying issue, correct any ischemia, replenish fluids and electrolytes, and maintain blood pressure.
- Administer coagulation factor replacements and anticoagulants like heparin or low-molecular-weight heparin to prevent bleeding.
- Blood products such as pack cells or FFP may be transfused as necessary.
DIC Assessment and Complications
- Assess for low platelet counts and increased bleeding time.
- Monitor fibrinogen levels, which are typically decreased during DIC.
- Complications can include kidney injury from ischemia, gangrene from lack of perfusion, pulmonary embolism, ARDS, and stroke.
DIC Medications
- Treatment aims to prevent further clotting; options include:
- Unfractionated heparin
- Low-molecular-weight heparin (e.g., Lovenox, Fragmin)
- Warfarin (Coumadin)
- Direct oral anticoagulants (Dabigatran, Rivaroxaban, Apixaban, Edoxaban)
- Aspirin for anti-platelet effect.
Medication Calculation Practice
- Calculate dosages based on available concentrations:
- For Valium 1 mg with availability of 3 mg/mL, the needed volume is 0.3 mL/dose.
- For Colace 50 mg with availability of 100 mg/15 mL, the needed volume is 7.5 mL/dose.
Blood Transfusion Guidelines
- AB- blood can be safely transfused to:
- AB- patients
- A- patients can receive AB- blood.
- Individuals with O- or B- blood cannot receive AB- blood safely.
- Rh compatibility: Rh positive patients can accept both Rh positive and negative blood, while Rh negative patients require Rh negative blood only.
Blood Transfusion Protocols
- When a patient is scheduled for IV antibiotics during a blood transfusion, best practice is to administer antibiotics as scheduled via a second IV access site.
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Description
This quiz covers the key elements of blood composition, including the ratios of red blood cells to plasma and hemoglobin levels. It also addresses the steps involved in the blood transfusion process and types of transfusion reactions. Test your knowledge on these vital aspects of hematology and patient care.
