Blood Transfusion Therapy

Place the following steps for the administration of a unit of packed red blood cells (PRBCs) in the correct order. 1 Verbally compare and correctly verify patient and blood product 2 Check appearance of blood for leaks, bubbles, clots, or purplish color 3 Prepare Y-tubing administration set with 0.9% normal saline solution (NSS) 4 Obtain baseline vital signs

4, 2, 1, 3

To decrease the incidence of Rh antigen transfer between mother and fetus, which medication is administered? ~ Methotrexate ~ Methylprednisone ~ RhoGam ~ Benadryl

RhoGam ~ RhoGam is given IM to the mother. RhoGam can suppress or destroy fetal Rh-positive blood cells that have passed from the fetal to the maternal circulation.

Onset of TRALI (transfusion-related acute lung injury) can occur within 6 hours of transfusion. ~ False ~ True

True ~ Onset of TRALI occurs within 6 hours of transfusion of a plasma-containing product, therefore, monitoring of patients during this critical time is essential.

A patient is to receive a blood transfusion. Which nursing action has the greatest impact on preventing a potential transfusion reaction? 1 Administering an antihistamine 15 minutes before the transfusion 2 Comparing the patient's identification bracelet with the blood bag label number 3 Ensuring that the patient knows his or her blood type 4 Obtaining the patient's previous transfusion history

2 ~ Comparing a patient's identification bracelet with the blood bag label number is the most important step to take.

Human leukocyte antigen (HLA) complications include: 1 Fetal hemolysis. 2 Transfusion-related acute lung injury (TRALI). 3 Rh incompatibility. 4 No reaction.

2 ~ HLAs are immunogenic antigens, which cause serious transfusion reactions such as TRALI. Fetal hemolysis and Rh incompatibility are not a direct result of HLAs.

Administration of blood and blood products can be delegated to the nursing assistive personnel (NAP). 1 True 2 False

2 ~ Only a registered nurse (RN) (or in some states a licensed practical nurse [LPN]) may administer blood or blood products; the task may not be delegated.

The nurse is preparing a blood transfusion infusion set. Which solution should be used to prime the tubing? 1 0.45% sodium chloride (NS) 2 Dextrose 5% in 0.45% sodium chloride (D5NS) 3 0.9% sodium chloride (normal saline [NS]) 4 Dextrose 5% in 0.9% sodium chloride (D5NS)

3 ~ Normal saline is the only intravenous solution that should be used with blood because of its isotonic quality. Dextrose solutions cause hemolysis of the red blood cells.

A patient with A− blood type needs a blood transfusion. Which blood types are appropriate for the patient to receive? 1 A+ or A− 2 A− or O+ 3 A− or O− 4 A+ or AB-

3 ~ Only negative blood types can be given to a patient with a negative blood type.

Anticoagulant preservative citrate-phosphate-dextrose-adenine (CPDA-1) maintains the shelf life for donated blood by how many days? 1 21 2 14 3 35 4 42

3 ~ The addition of adenine adds 35 days to the shelf life of the blood.

Blood obtained from the blood bank must be used within what time limit? ~ 10 minutes ~ 30 minutes ~ 60 minutes ~ 20 minutes

30 minutes ~ Because of the instability of blood and the controlled environment in which it must be stored, it must be used within 30 minutes or removal from that environment. Deterioration of cell components and accumulation of citrate ions opse risks to the patient.

One unit of PRBC can hang no longer than: ~ 3 hours. ~ 1 hour. ~ 2 hours. ~ 4 hours.

4 hours ~ Because of the instability of blood and of the preservatives used (dextrose), blood hanging for longer than 4 hours can become a medium for bacterial growth.

A patient receiving a blood transfusion begins having signs and symptoms of a transfusion reaction. In addition to stopping the transfusion and assessing vital signs, what else should the nurse do? 1 Hang a new infusion setup with D5W to maintain an access for medications 2 Finish infusing the blood remaining in the tubing and flush the tubing with the normal saline hanging on the Y-tubing 3 Keep the existing tubing patent with a dextrose solution in case diphenhydramine is needed 4 Hang a new infusion setup with normal saline to maintain an intravenous (IV) access

4 ~ It is essential to maintain an IV access, but you do not want the patient to receive any more of the current blood. Another blood administration set should be primed with a new bag of normal saline in case more blood needs to be given. Remember to keep the old blood bag and saline and the administration set and send them to the appropriate department per protocol for analysis.

During the administration of blood the health care provider orders intravenous (IV) antibiotics to be infused. The most appropriate intervention is to: 1 Stop the transfusion. 2 Piggyback into the transfusion. 3 Question the order. 4 Start a new IV site.

4 ~ No medications or solutions (other than 0.9% normal saline solution [NS]) are to be administered with blood. Blood should never be stopped to administer another medication or solution; therefore starting a new IV is the most appropriate action.

A patient is to receive blood that has been stored for a long period of time. Which recent laboratory value should the nurse check before administering the unit? 1 Sodium 2 Hematocrit 3 Hemoglobin 4 Potassium

4 ~ When blood is stored, there is continual destruction of red blood cells, which release potassium from the cells into the plasma. If blood is transfused rapidly, there may be transient hyperkalemia before the potassium is reabsorbed. The hematocrit and hemoglobin values would indicate whether a patient needs a blood transfusion. The sodium level is not relevant to this situation.

Which of the following is considered a primary cause of transfusion reactions? ~ Use of 0.9% NSS ~ Use of leukocyte reduction filter ~ Use of mislabeled unit ~ Use of Y tubing

Use of mislabeled unit ~ A mislabeled unit, which is considered a clerical error, is one of the main causes of transfusion reactions. Use of 0.9% NSS, Y tubing, or a leukocyte reduction filter does not cause but rather prevents transfusion reactions.