A client who received a blood transfusion develops symptoms such as epistaxis, hematuria, and menorrhagia 7 days after the transfusion.
What complication could be responsible for these symptoms?
Transfusion-associated graft-versus-host disease (TA-GVHD)
Transfusion-related immunomodulation (TRIM)
Post-transfusion purpura.
Viral infections.
The Correct Answer is C
Choice A rationale:
Transfusion-associated graft-versus-host disease (TA-GVHD) typically presents with symptoms of fever, rash, diarrhea, and pancytopenia 1 to 6 weeks after transfusion.
It is a delayed reaction, but it does not cause epistaxis, hematuria, and menorrhagia, which are bleeding symptoms.
Therefore, it is an unlikely choice for this scenario.
Choice B rationale:
Transfusion-related immunomodulation (TRIM) is a theory that blood transfusions may affect the immune system, but it does not typically present with the specific bleeding symptoms described in the scenario.
TRIM is more concerned with the immunosuppressive effects of transfusions.
Choice C rationale:
Post-transfusion purpura is a rare condition that occurs 5 to 12 days after a transfusion.
It is characterized by sudden severe thrombocytopenia (low platelet count) and bleeding symptoms, which can include epistaxis (nosebleeds), hematuria (blood in the urine), and menorrhagia (excessive menstrual bleeding)
This aligns with the symptoms described in the scenario, making it the most likely cause.
Choice D rationale:
Viral infections can be a complication of blood transfusions, but they do not typically present with these specific bleeding symptoms within 7 days after the transfusion.
Viral infections may cause a broader range of symptoms and have a longer incubation period.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
"I'll verify the physician's order for the specific blood product."
Choice A rationale:
Selecting any available intravenous site for the transfusion without verifying the physician's order is unsafe and can lead to administering the wrong blood product or causing an adverse reaction in the patient.
Verifying the order is a critical step in ensuring patient safety during a blood transfusion.
Choice B rationale:
Using a blood administration set with additives may be necessary in some cases, but it is not the primary action the nurse should take before starting the transfusion.
Verifying the physician's order is the first and most crucial step.
Choice C rationale:
Verifying the physician's order for the specific blood product is essential to confirm that the correct blood type and unit are being administered to the patient.
This step ensures ABO and Rh compatibility and minimizes the risk of transfusion reactions.
Choice D rationale:
Administering the transfusion as quickly as possible is not appropriate and can be dangerous.
Transfusions should be administered at a controlled and appropriate rate to monitor for any adverse reactions.
Rushing the transfusion can increase the risk of complications.
Correct Answer is B
Explanation
Choice A rationale:
Verifying the patient's identification is an essential step in patient safety, but it alone does not ensure transfusion safety.
Transfusion safety involves multiple steps beyond identification.
Choice B rationale:
Maintaining aseptic technique and infection control practices is crucial during a blood transfusion.
This includes using sterile equipment, wearing gloves, and following proper hand hygiene.
Infection can be a severe complication of transfusion if proper precautions are not taken.
Choice C rationale:
Administering blood products using old and sterile equipment is not a safe practice.
Blood transfusions require the use of fresh, sterile equipment to prevent contamination and ensure patient safety.
Choice D rationale:
Monitoring the patient's condition only after the transfusion is not sufficient to ensure safety.
Continuous monitoring during the transfusion is necessary to detect and respond to any adverse reactions promptly.
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