1. The nurse has hung one unit of packed red blood cells after performing all the necessary safety checks. The nurse is assessing for signs/symptoms of an acute transfusion reaction which include:
1. Hypothermia
2. Epistaxis
3. Nausea
4. Pruritus
Remember that when writing a multiple choice exam it is important to read the stem of the question twice and all your options twice. Let's breakdown the question by looking at the different options.
1. Hypothermia: this answer is incorrect because in an acute transfusion reaction one of the most common reactions is high fever (hyperthermia)
2. Epistaxis: a nose bleed does not occur
3. Nausea: this is not a sign/symptom of an acute reaction
4. Pruritus: itchiness is a common reaction in an acute reaction.
Other common reactions include fever, chills, or urticaria. Other signs occurring in a blood transfusion include severe shortness of breath, red urine and loss of consciousness may be the first indication of a more severe potentially fatal reaction.
Now, what would be the nurses course of action in the above situation? Write down the nursing interventions for this scenario and prioritize them. Later in the week we will examine these nursing actions.
In the meantime if any of you would like to try more CRNE style questions please visit our website at www.primededucation.ca and on the home page click on the CRNE style testing centre. For $55 dollars you will receive two attempts at 200 questions.
Good luck!
In the meantime if any of you would like to try more CRNE style questions please visit our website at www.primededucation.ca and on the home page click on the CRNE style testing centre. For $55 dollars you will receive two attempts at 200 questions.
Good luck!
