A nurse is assessing a patient who received a blood transfusion 2 hours ago.
The nurse notes that the patient has developed dyspnea, orthopnea, tachypnea, and crackles on lung auscultation.
Which type of transfusion reaction should the nurse suspect?
Transfusion-related acute lung injury (TRALI)
Transfusion-associated circulatory overload (TACO)
Allergic reaction.
Febrile nonhemolytic reaction.
The Correct Answer is B
Choice A rationale:
Transfusion-related acute lung injury (TRALI) is characterized by acute respiratory distress and is usually not associated with abdominal symptoms.
TRALI is more common in patients receiving plasma-containing blood products.
Choice B rationale:
Transfusion-associated circulatory overload (TACO) occurs when a patient receives a volume of blood or blood products that exceeds their circulatory system's capacity.
Symptoms include dyspnea, orthopnea, tachypnea, and crackles on lung auscultation, which match the symptoms described in the question.
This condition is more likely when blood products are transfused too rapidly or in excessive volume.
Choice C rationale:
Allergic reactions to blood transfusions typically present with symptoms like itching, hives, and flushing, rather than the respiratory symptoms and crackles on lung auscultation described in the question.
Choice D rationale:
Febrile nonhemolytic reactions are characterized by fever and chills and do not typically manifest as dyspnea, orthopnea, tachypnea, or crackles on lung auscultation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Transfusion-related acute lung injury (TRALI) is characterized by acute respiratory distress and is usually not associated with abdominal symptoms.
TRALI is more common in patients receiving plasma-containing blood products.
Choice B rationale:
Transfusion-associated circulatory overload (TACO) occurs when a patient receives a volume of blood or blood products that exceeds their circulatory system's capacity.
Symptoms include dyspnea, orthopnea, tachypnea, and crackles on lung auscultation, which match the symptoms described in the question.
This condition is more likely when blood products are transfused too rapidly or in excessive volume.
Choice C rationale:
Allergic reactions to blood transfusions typically present with symptoms like itching, hives, and flushing, rather than the respiratory symptoms and crackles on lung auscultation described in the question.
Choice D rationale:
Febrile nonhemolytic reactions are characterized by fever and chills and do not typically manifest as dyspnea, orthopnea, tachypnea, or crackles on lung auscultation.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale:
A+ blood can be safely transfused to a client with blood type O-.
The rationale is that the recipient, in this case, does not have antibodies against the A antigen, which is present on A+ blood.
Therefore, there is no antigen-antibody reaction.
Choice B rationale:
B- blood can be safely transfused to a client with blood type O-.
The rationale is similar to choice A, as the recipient does not have antibodies against the B antigen, which is present on B- blood.
Choice C rationale:
AB+ blood contains both A and B antigens and RhD antigen, which can potentially react with antibodies present in a client with blood type O-.
Therefore, it is not safe to transfuse AB+ blood to a client with blood type O-.
Choice D rationale:
O+ blood can be safely transfused to a client with blood type O-.
The rationale is that O+ blood does not have A or B antigens, which could react with antibodies present in the recipient.
Choice E rationale:
O- blood is compatible with blood type O- because it does not contain A, B, or RhD antigens, which could be targeted by antibodies in the recipient.
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