A nurse is reviewing a client's blood compatibility results before a blood transfusion. The crossmatch shows agglutination and incompatibility between the donor's red blood cells and the client's plasma. What action should the nurse take?

Administer the blood transfusion slowly to observe for any reactions.

Discontinue the blood transfusion immediately and return the blood to the blood bank.

Increase the infusion rate to flush out the incompatibility.

Mix the incompatible blood with normal saline before transfusion.

Answer and Explanation

The Correct Answer is B

A) Incorrect: Administering the blood transfusion when agglutination and incompatibility are detected is unsafe and may lead to severe transfusion reactions. The nurse should not proceed with the transfusion.

B) Correct: In the presence of agglutination and incompatibility between the donor's red blood cells and the client's plasma, the nurse must discontinue the blood transfusion immediately and return the blood to the blood bank. This ensures the client's safety and prevents further adverse reactions.

C) Incorrect: Increasing the infusion rate will not resolve the incompatibility issue and may worsen the client's condition. The nurse should stop the transfusion promptly.

D) Incorrect: Mixing the incompatible blood with normal saline will not resolve the incompatibility issue and is not a safe practice. The nurse should not proceed with the transfusion and should return the blood to the blood bank.

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Correct Answer is A

Explanation

A: Notify the healthcare provider immediately to obtain a blood transfusion order – This is the priority action because the client’s hemoglobin level of 8 g/dL, along with symptoms of hypoxia, indicates a need for urgent medical intervention. Obtaining an order for a transfusion is crucial for addressing the underlying issue of low hemoglobin and associated hypoxia.
B: Administer supplemental oxygen to the client to improve oxygenation – While this action is important, it is not the first step. The low hemoglobin indicates a need for a transfusion, and notifying the provider can lead to quicker treatment.
C: Initiating IV access with a large-bore catheter is an important step in preparation for a possible blood transfusion, but it is not the first action. The client's current symptoms must be managed promptly.
D: Ambulation may be contraindicated post-major surgery, especially when the client is symptomatic. It could exacerbate the client's condition and is not the immediate priority in this scenario.

A. A-negative (A-), B-negative (B-), AB-negative (AB-), and O-positive (O+). B. A-positive (A+), O-negative (O-), AB-negative (AB-), and B-positive (B+). C. A-negative (A-), B-positive (B+), AB-negative (AB-), and O-positive (O+). D. All of the above E. None F. None

Correct Answer is D

Explanation

A. A-negative (A-), B-negative (B-), AB-negative (AB-), and O-positive (O+) are all compatible with AB-positive (AB+) since AB+ individuals can receive any blood type.
B. A-positive (A+), O-negative (O-), AB-negative (AB-), and B-positive (B+) are also compatible for the same reason.
C. A-negative (A-), B-positive (B+), AB-negative (AB-), and O-positive (O+) are all suitable donor types.
D. AB-positive (AB+) is the universal recipient and can receive blood from any blood type.

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A nurse is reviewing a client's blood compatibility results before a blood transfusion. The crossmatch shows agglutination and incompatibility between the donor's red blood cells and the client's plasma. What action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has undergone major surgery and has a hemoglobin level of 8 g/dL. The client is experiencing symptoms of hypoxia, including tachycardia and shortness of breath. The nurse suspects the need for a blood transfusion. What action should the nurse take first?

Correct Answer is A

Explanation

A client with blood type AB-positive (AB+) requires a blood transfusion. Which blood types can safely donate to this client?

Correct Answer is D

Explanation

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