Module 13: Blood Administration

Identify the transfusion reactions that result in immediate cessation of the transfusion. (Select all that apply.) a) Hemolytic reaction b) Allergic reaction c) GVHD d) Non-hemolytic reaction e) Circulatory overload f) Hyperkalemia g) Hypocalcemia h) Hypothermia

a) Hemolytic reaction b) Allergic reaction d) Non-hemolytic reaction

A patient has type O+ blood. Which of the following blood types can the patient receive? a) A+ b) B- c) O- d) AB+ e) None of these

c) O-

The nurse is preparing to administer a unit of packed red blood cells to a patient with a history of anemia. Which is the best question the nurse should ask the patient before explaining the procedure? a) "Are you a Jehovah's Witness?" b) "Have you ever had a blood transfusion before?" c) "Do you have any allergies?" d) "Are you aware of the risks associated the receiving a blood transfusion?"

b) "Have you ever had a blood transfusion before?"

Identify the IV needle gauge typically recommended to infuse blood products in an adult: a) 16-G b) 18-G c) 22-G d) 24-G

b) 18-G Rationale: The 18-G gauge needle is the recommended gauge for planned blood infusions.

A bus accident occurred in a rural area. Several patient taken to the local hospital required blood transfusions resulting in a decreased supply of whole blood. One patient is blood type B. The blood bank sends type O- RBCs. What is the nurse's best action? a) Return the blood to the blood bank. b) Administer the type O blood. c) Begin IV fluids until type B blood is obtained. d) Complete an incident report.

b) Administer the type O blood.

The patient has type AB+ blood. Which statement, if made by the patient, would require correction? a) "I can safely receive blood from any blood type of group." b) "I can only donate blood to another AB+ type individual." c) "It is preferable for me to receive AB+ type blood." d) "I should not receive type A-, B-, or O- blood."

d) "I should not receive type A-, B-, or O- blood."

A patient is to receive an autologous blood transfusion. The patient tells the nurse he is afraid to receive someone else's blood because of the possibility of contracting a disease. What is the nurse's best response? a) "You can request allogeneic blood transfusion instead." b) "We can give you Benadryl before the transfusion to help prevent transmission." c) "I can contact the health care provider to see if platelets could be used rather than blood." d) "The autologous blood is your own blood that is transfused."

d) "The autologous blood is your own blood that is transfused."

The initial infusion rate and total infusion time for blood products are: a) 5mL/min; 30 minutes b) 10mL/min; 2 hours c) 30mL/min; 4 hours d) 2mL/min; 4 hours

d) 2mL/min; 4 hours Rationale: The infusion rate is 2mL/min (or 20 gtt/min using macrodrip of 10 gtt/mL) for the initial 15 minutes. All blood products need to be infused within 4 hours of initiating transfusion.

Why might dysrhythmias and a reduction in core body temperature occur in a recently transfused patient? a) An air embolism b) Volume overload c) Hypocalcemia d) Rapid administration of non-warmed blood products

d) Rapid administration of non-warmed blood products Rationale: Rapid administration of non-warmed solutions may result in iatrogenic hypothermia.

A febrile transfusion reaction typically occurs when the patient's antibodies react to transfused: a) FFP b) RBCs c) Corticosteroids d) WBCs

d) WBCs

What may happen if lactated Ringer's, electrolytes, or other calcium containing solutions are administered concurrently with blood products? a) Calcium binds to citrate resulting in hypocalcemia. b) Electrolyte imbalance occurs due to upsetting the sodium to calcium balance. c) Serum protein concentrations reduce d) Hyperchloremic metabolic acidosis occurs

a) Calcium binds to citrate resulting in hypocalcemia. Rationale: Cardiac dysrhythmias, hypotension, and tingling indicate hypocalcemia, which occurs when citrate (used as a preservative for some blood products) binds to the patient's calcium. For this reason it is recommended that blood product administration occur separately from most other IV fluids (except normal saline).

Why is warming a unit a blood products in a microwave and/or under hot water from the tap is contraindicated? a) It destroys the blood product b) It makes the blood product too hot to infuse and as it cools is coagulates c) Preparation of blood products is the blood bank's responsibility

a) It destroys the blood product Rationale: Use of microwaves and/or hot water destroys blood products because the heat they generate cannot be adequately moderated to protect blood products from damage.

The nurse is transfusing a large amount of blood to a trauma patient. The nurse knows to observe the patient for: a) Hypotension and cardiac dysrhythmias b) Headache and muscle pain c) Crackles in the lungs and increased central venous pressure d) Wheezing and chest pain

a) Hypotension and cardiac dysrhythmias

What do the most life-threatening transfusion reactions result from? a) Incorrect identification of patients b) Failure to type and cross match blood c) The patient not knowing their blood type d) Allergic response to a plasma protein in donor's blood

a) Incorrect identification of patients

Which blood product places a patient at a higher risk of fluid overload after transfusion? a) Whole blood b) Red blood cells c) Platelets d) Leukocyte-poor RBCs e) Cryoprecipitate

a) Whole blood Rationale: A unit of whole blood is 450-500 mL. Other blood products are substantially less volume.

Which transfusion reaction results from administering ABO incompatible blood? a) Febrile reaction b) Allergic reaction c) Hemolytic reaction d) Graft-versus-host disease

c) Hemolytic reaction

A nurse is preparing to administer a unit of packed red blood cells. The patient has an IV of D51/2 NS infusing. What IV solution should the nurse use to infuse the unit of packed RBCs? a) D51/2 NS b) D5W c) Normal Saline d) Lactated Ringer's

c) Normal Saline Rationale: Normal saline should be used for priming the blood tubing and in between the infusion of any other solutions and the packed red blood cells.

What is the primary reason that blood products should be administered through a large-bore IV catheter? a) Large-bore IV catheters prevent blood product hemolysis as the product passes through the catheter into the blood stream. b) Large-bore IV catheters allow a more consistent rate of administration than smaller catheters. c) Large-bore IV catheters are used because of blood products are viscous. d) Large-bore IV catheters are used so that flushing the line prior to and after blood product infusion is easier.

a) Large-bore IV catheters prevent blood product hemolysis as the product passes through the catheter into the blood stream. Rationale: Using a large-bore catheter reduces the risk of blood product hemolysis, especially when administering red blood cells. Protecting blood products from destruction during administration is the primary reason large-bore catheters are used. The consistency of the rate of infusion may be affected by many factors independent of catheter size.

It is acceptable practice to transfuse medications with blood components. a) True b) False

b) False Rationale: The only solution that may be transfused with blood products is normal saline. All other IV fluids and/or medications should be administered independent from blood product administration. For example 5% dextrose or Ringer's lactate can result in hemolysis and/or cause coagulation of the donor blood.

A patient is Rh(D) negative. A patient is to receive a transfusion of plasma. The blood bank sends Rh(D) positive plasma. What should the nurse do? a) Use the blood product supplied because Rh(D) positive plasma may be safely transfused to Rh(D) negative patients b) Send the blood product back to the blood bank because Rh(D) positive plasma should not be transfused to Rh(D) negative patients. c) Send a sample of the patient's blood to the blood bank for repeat Rh typing before administering plasma. d) Contact the health care provider for further pretransfusion orders.

a) Use the blood product supplied because Rh(D) positive plasma may be safely transfused to Rh(D) negative patients.

Identify the blood component that elevates hematocrit by 3% and hemoglobin by 1 g/dL when one unit is administered. (Select all that apply.) a) Whole blood b) Red blood cells c) Platelets d) Plasma e) Cryoprecipitate

a) Whole blood b) Red blood cells

Compatibilities for ABO type for donor and recipient are required for which blood products? (Select all that apply.) a) Whole blood b) Red blood cells c) Platelets d) Plasma

a) Whole blood b) Red blood cells c) Platelets d) Plasma

A nurse has received orders to transfuse 2 units of packed red blood cells. What information is necessary for the nurse to know regarding the patient's present IV? a) Location of the insertion site. b) Gauge of the IV catheter. c) When the tubing was last changed. d) Why the patient required IV fluids.

b) Gauge of the IV catheter. Rationale: The nurse needs to be sure the gauge of the catheter is large enough to instill blood without damaging the blood cells. A 14-24 gauge short peripheral catheter may be used with an adult, however a pressure bag may be necessary with a 24 gauge IV catheter.

It is acceptable practice to place blood into refrigerators/freezers located in patient care areas. a) True b) False

b) False Rationale: Standard refrigerators/freezers located in patient care areas are unable to ensure accurate temperature regulation of blood products. For this reason they should never be used to store blood products.

The patient states, "I don't know my blood type, I just know that I'm a universal donor." The nurse correctly interprets this statement inferring that the patient most likely has which blood type? a) AB+ b) O- c) A+ d) AB- e) O+

b) O-

The advantages of using this type of autologous blood donation include: it contains more viable RBCs than stored blood; it has a normal pH; and it contains more 2, 3-DPG than other types of blood donations. a) Preoperative b) Perioperative c) Hemodilution d) Allogeneic

b) Perioperative

When do adverse reactions from blood transfusions usually occur? a) After the first hour of the transfusion b) Within the first 15 minutes of the transfusion c) One hour after the transfusion has been completed d) Upon completion of the transfusion

b) Within the first 15 minutes of the transfusion

Identify the blood component that can be stored for up to 5 days at room temperature. a) Whole blood b) Red blood cells c) Platelets d) Plasma e) Cryoprecipitate

c) Platelets

A trauma patient has received 6 units of red blood cells. Plasma and platelets are now prescribed. What is the primary reason the nurse changes the blood administration tubing between PRBC, platelets, and/or plasma? a) Blood tubing must be changed every 6 units b) Plasma is unable to pass through tubing that has previously filtered red blood cells c) Platelets should run through tubing different than the tubing used for RBCs. d) Blood tubing must be changed every hour.

c) Platelets should run through tubing different than the tubing used for RBCs. Rationale: Fibrin strands and debris in the filter may trap platelets.

What should the nurse do first if a patient receiving a blood transfusion develops a skin rash, edema, and wheezing? a) Discard the blood bag and tubing b) Slow the rate of the transfusion c) Stop the transfusion immediately d) Reassess the patient in 10 minutes

c) Stop the transfusion immediately

A patient is Rh(D) positive. The patient is to receive a unit of RBC. The blood bank sends Rh(D) negative RBCs. What is the nurse's best action? a) Send the blood product back to the blood bank because Rh(D) negative RBCs should not be transfused to Rh(D) positive patients. b) Ask the patient whether they have ever been exposed to Rh(D) negative blood before. c) Request a unit of AB+ blood be sent from the blood bank for the patient. d) Use the blood product supplied because Rh(D) negative RBCs may be safely transfused to Rh(D) positive patients.

d) Use the blood product supplied because Rh(D) negative RBCs may be safely transfused to Rh(D) positive patients.

Identify the blood component that decreases microvascular bleeding during surgery and does not require ABO/Rh testing. a) Whole blood b) Red blood cells c) Platelets d) Plasma e) Cryoprecipitate

e) Cryoprecipitate