11.  The doctor orders an Aprostadil (PGE) 0.1 mcg/kg/min IV infusion for an infant. The infusion is supplied in a 500 mcg/100 mL bag. The infant is 3.5 kg. What rate should the pump be programed to infuse in mL/hr? (enter numerics only, mL/hr is assumed in your answer)

9. Situation: An infant is born with complications and the nurse notices the infant has bounding upper extremity pulses, cold feet, and severely diminished femoral pulses.  Vitals: Blood pressure 64/42 mmHg on right arm and 52/40 mmHg on the right leg, heart rate 158 bpm, temperature 98.6F, respirations 52 breaths/min and pulse ox 82% on left lower extremity.   Based off the information gathered, what intervention should the nurse plan to prepare the patient for?

7. Situation: An infant is born with complications and the nurse notices the infant has bounding upper extremity pulses, cold feet, and severely diminished femoral pulses.  Vitals: Blood pressure 64/42 mmHg on right arm and 52/40 mmHg on the right leg, heart rate 158 bpm, temperature 98.6F, respirations 52 breaths/min and pulse ox 82% on left lower extremity.   Which of the following assessment findings should be reported to the provider? (select all that apply)

4. Situation A 65 year old male is admitted to the emergency department at 1600 for complaints of severe chest pain lasting two hours and shortness of breath on exertion.  He arrived via local ambulance and paramedics administered 325 mg ASA p.o. en-route to the hospital.  The patient reports history of hypertension and tobacco use. The patient also reports having no other prior symptoms.  Vitals 1630: Blood pressure 90/50 mmHg on left arm, heart rate 80 bpm, temperature 99.6F, respirations 20 breaths/min and pulse ox 92% on room air.   An ECG was obtained and reveals the following rhythm:  Doctor Orders: Oxygen via nasal cannula @ 2LPM Nitroglycerin 0.4 mg Insert PIV Draw labs: Troponin, CBC, Lipid Panel, CMP     Which nursing actions are appropriate based on the patient’s current condition?  (Select all that apply.) 

15. Situation A patient is on a med/surg floor originally admitted for pneumonia. The patient was administered oral metoprolol for the first time approximately one hour ago. The patient suddenly feels lightheaded, dizzy and weak. You assist the patient to bed and notify the doctor.  Vitals Blood pressure 76/38 mmHg, temperature 98.6F, respirations 18 breaths/min and pulse ox 95% on room air.   The doctors orders and EKG and the following rhythm is revealed:    Based off the EKG strip, the nurse knows that the patient is in which of the following heart rhythms?

The following laboratory results were obtained on a mother and her baby immediately following delivery of the neonate.  Examine the medical history and test results provided below to determine the MOST probable cause of HDFN?                  Mother:           O D Positive Antibody detection/screen results shown below. Cell I.S (Room Temp.) (PEG) AHG IgG-coated RBCs (Pcells) I 0 3+ TNP II 0 3+ TNP III 0 0 P                              TNP: Test Not Performed               Baby:              O D Positive                                     DAT: Positive (2+)                                     Hgb: 11.0 g/dL                                     HCT: 33%                                     Bilirubin: Total 5.6 mg/dL; Direct 1.2 mg/dL

Explain how you know that the correct antibodies have been identified. Include how the “Rule of 3” applies as well as calculated p-values in your explanation.  Students don’t need to show calculation but refer to the p-value in your answer.

A forty-eight year old female is undergoing chemotherapy for lung cancer. She is scheduled to receive two units of RBCs in the oncology clinic today.  While receiving her first unit of RBCs she begins to complain of intense pain at the site of infusion. The transfusion is immediately stopped and the blood bank is alerted of a suspected transfusion reaction.  Upon investigation it is noted that the patient is in shock and her temperature rose from 98.4oF to 102.8oF.  She is in DIC and renal failure, with large amounts of hemoglobin in her urine. Her DAT is negative at this time.  This patient is most likely experiencing what type of transfusion reaction?

A patient has a hemolytic transfusion reaction to red cells that were transfused 8 days ago.  What is the MOST likely cause of the reaction?

What is the first step in the initial blood bank investigation of a suspected transfusion reaction?