Module 11: Blood Therapy

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

"I should not receive type A−, B−, or O− blood." An individual with type AB+ blood can receive blood from any group (with AB being preferable) and can only donate blood to another AB+ type individual. They are known as universal recipients.

What are the initial infusion rate and total infusion time for blood products? 30 mL/min; 4 hours. 5 mL/min; 30 minutes. 2 mL/min; 4 hours. 10 mL/min; 2 hours.

2 mL/min; 4 hours. The infusion rate is 2 mL/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.

A patient who is classified as a universal recipient has what blood type? AB+. O−. AB−. O+.

AB+. A person with AB+ blood can receive A+, A−, B+, B−, O+, O−, AB+, or AB− type blood and is referred to as a universal recipient.

On inspection, a unit of blood from the blood bank has several blood clots clinging to the bag. What is the nurse's best course of action? Administer the blood through the blood filter in the blood tubing. Add citrate phosphate dextrose (CPD) to the blood. Shake the bag to break the clots up into smaller pieces. Notify the blood bank.

Notify the blood bank. The blood bank will need to prepare an alternate bag for transfusion.

Identify the blood component that can be stored for up to 5 days at room temperature. Plasma. Red blood cells. Whole blood. Platelets. Cryoprecipitate.

Platelets. Platelets may be stored up to 5 days at room temperature.

After transfusion of several units of blood, a patient continues to bleed. What should the nurse anticipate the health care provider will order? Whole blood. Albumin. Red blood cells. Platelets.

Platelets. Platelets are transfused when it appears that a clotting issue exists.

A patient has a low hemoglobin and hematocrit values. The nurse would expect the health care provider to order a transfusion of which of the following? Clotting factors. FFP. RBCs. Platelets.

RBCs. A transfusion of RBCs should increase a patient's hemoglobin and hematocrit values.

Why might dysrhythmias and a reduction in core body temperature occur in a recently transfused patient? An air embolism. Hypocalcemia. Rapid administration of nonwarmed blood products. Volume overload.

Rapid administration of nonwarmed blood products. Rapid administration of nonwarmed solutions may result in iatrogenic hypothermia. An air embolism may result in symptoms related to heart attack or stroke. A volume overload may result in shortness of breath and edema. Hypocalcemia may result in muscle twitching and numbness of the extremities, which should resolve as blood passes through the liver.

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? "Have you ever had a blood transfusion before?" "Are you aware of the risks associated with receiving a blood transfusion?" "Are you a Jehovah's Witness?" "Do you have any allergies?"

"Have you ever had a blood transfusion before?" This is the best question to elicit information without creating fear before patient teaching.

The nurse is initiating a blood transfusion of packed RBCs. At what rate should the infusion initially be set? 15 mL/min. 20 mL/min. 10 mL/min. 2 mL/min.

2 mL/min. Initial flow rate during the first 15 minutes of a transfusion should be 2 mL/min or 20 gtt/min (using macrodrip of 10 gtt/mL). Then regulate to health care provider's orders.

The nurse is preparing to infuse a blood transfusion rapidly for a patient who experienced significant blood loss in a motor vehicle accident. Which gauge of IV cannula would be best for the nurse to choose? 22 to 24 gauge. 28 gauge. 26 gauge. 18 to 20 gauge.

18 to 20 gauge. Large-gauge cannulas (18 or 20 gauge) promote rapid flow of blood components and are preferred in emergency situations.

The nurse initiates a blood transfusion of packed RBCs at 0800. The unit of blood should not hang beyond: 1000. 1400. 2000. 1200.

1200. A blood transfusion should be completed within 4 hours to reduce the risk of bacterial growth.

How long should the nurse stay with the patient after initiating a blood transfusion? 5 to 10 minutes. 15 minutes. 1 hour.

15 minutes. Most transfusion reactions occur within the first 15 minutes. Until the transfusion is completed.

Identify the IV catheter gauge typically recommended to infuse blood products in an adult. 24 gauge. 22 gauge. 18 gauge. 16 gauge.

18 gauge. An 18-gauge IV catheter is the recommended gauge for planned blood infusions. A 16-gauge IV catheter is most often used during major surgery, trauma, and obstetric emergencies. A 22-gauge IV catheter is the recommended gauge for use in the elderly and children. A 24-gauge IV catheter is the recommended gauge for pediatric and neonate applications.

A bus accident occurred in a rural area. Several patients 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? Return the blood to the blood bank. Begin intravenous (IV) fluids until type B blood is obtained. Administer the type O blood. Complete an incident report.

Administer the type O blood. It is acceptable to provide group O RBCs to all patients. This often occurs in emergency situations before blood typing can be performed, and blood banks will often substitute group O RBCs for other blood types if their supply is low.

The nurse checks the health care provider's orders to determine if there are any pretransfusion medications to be administered. Which of the following would the nurse most likely expect to administer? Antibiotic (e.g., ciprofloxacin). Antihistamine (e.g., diphenhydramine). Analgesic (e.g., morphine sulfate). Diuretic (e.g., furosemide).

Antihistamine (e.g., diphenhydramine). Premedications such as an antihistamine or antipyretic may be ordered, especially if the patient demonstrated previous transfusion sensitivity.

A hemorrhaging patient has type B+ blood and is need of a transfusion of whole blood as soon as possible. The blood bank sends type O− blood. What is the nurse's best action? Realize the patient is a universal recipient and begin the transfusion. Do not administer the blood and complete an incident report. Begin the process of verification to transfuse the blood. Send the blood back to the blood bank and request B+ blood.

Begin the process of verification to transfuse the blood. The patient's blood type is compatible with O− blood and therefore the patient can receive it. (Type O+, B+, or B− would also be acceptable.) The nurse should begin the procedure for verification to transfuse the blood. Waiting for B+ may take unnecessary time. Type AB+ is the universal recipient.

The nurse initiates a blood transfusion at 0800. When would an acute hemolytic transfusion reaction most likely occur? 2 to 4 hours after completion. By 0815. By 0830. 2 to 14 days after completion.

By 0815. Most transfusion reactions occur within the first 15 minutes of a transfusion.

What may happen if lactated Ringer's, electrolytes, or other calcium-containing solutions are administered concurrently with blood products? Serum protein concentrations reduce. Calcium binds to citrate resulting in hypocalcemia. Electrolyte imbalance occurs as a result of upsetting the sodium-to-calcium balance.

Calcium binds to citrate resulting in hypocalcemia. 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). Hyperchloremic metabolic acidosis occurs.

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

Cryoprecipitate. Cryoprecipitate decreases microvascular bleeding during surgical procedures. Cryoprecipitate is indicated if the patient is bleeding and the fibrinogen level is less than 100 mg/dL. Plasma.

Which of the following may result from rapid infusion of blood without the use of a blood warmer? (Select all that apply.) Itching. Dysrhythmias. Flank pain. Decreased core body temperature. Feelings of faintness.

Dysrhythmias. Decreased core body temperature. Rapid transfusion of cold blood may lead to dysrhythmias and a reduction of core temperature. Flank pain and itching may be indications of a transfusion reaction. Feelings of faintness may be due to blood loss.

What is the primary reason for meticulous care to avoid human error in transfusion therapy? When errors occur, blood products are wasted, leading to a blood shortage. Patients may become confused regarding their blood type. Preventing human error reduces health care costs. Human error can lead to life-threatening transfusion reactions.

Human error can lead to life-threatening transfusion reactions. Incorrect patient identification and incorrect labeling of blood lead to the administration of incompatible blood and cause life-threatening transfusion reactions.

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

Hypotension and cardiac dysrhythmias. Hypotension and cardiac dysrhythmias are the initial reactions to massive transfusions. Mild hypothermia, hypocalcemia, and hemochromatosis (iron overload) may also occur in patients receiving massive transfusions.

Which of the following would be an early indication of an adverse transfusion reaction? Increase in body temperature. Hypertension. Feelings of faintness. Bradycardia.

Increase in body temperature. An elevation in temperature or heart rate is one of the first signs that a person is having an adverse reaction to a transfusion.

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

Red blood cells. Whole blood. A unit of whole blood should elevate hematocrit by 3% and hemoglobin by 1 g/dL in a nonhemorrhaging adult. A unit of red blood cells is expected to raise Hgb and Hct levels the same amount as whole blood.

The nurse obtains the blood from the blood bank and is called away to see another patient. Twenty minutes later the nurse realizes she will be unable to initiate the transfusion at this time. What is the nurse's best action? Have nursing assistive personnel (NAP) initiate the transfusion under the nurse's verbal direction. Put the blood in the agency's refrigerator. Return the blood to the blood bank. Discard the blood appropriately and retrieve another one when able to administer it.

Return the blood to the blood bank. If the nurse cannot initiate the blood transfusion within 30 minutes from time of release from the blood bank, the nurse should immediately return the blood to the blood bank and retrieve it when able to administer it.

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

Stop the transfusion immediately. These are signs of an allergic reaction. Stop the transfusion immediately and connect normal saline-primed tubing at the vascular access device (VAD) to prevent any subsequent blood from infusing from tubing.

Which of the following would be one of the first signs of an adverse reaction to a blood transfusion? Hypertension. Tachycardia. Disseminated intravascular coagulation (DIC). Hypothermia.

Tachycardia. An elevation in temperature or heart rate is one of the first signs that a person is having an adverse reaction to a transfusion. Some patients also experience marked hypotension if a severe reaction occurs. DIC is a later sign of a hemolytic transfusion reaction.

A febrile nonhemolytic transfusion reaction typically occurs when the patient's antibodies react to transfused: White blood cells (WBCs). Fresh frozen plasma (FFP). Red blood cells (RBCs). Corticosteroids.

White blood cells (WBCs). A febrile transfusion reaction is caused by a patient's antibodies responding to antigens present on transfused leukocytes (WBCs) or platelets in a donor's blood.

It is acceptable practice to place blood into refrigerators or freezers located in patient care areas. True False

False 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 nurse is inspecting a unit of platelets prior to administering it to the patient. What should the nurse expect to see? Appears cloudy, light green in color. Appears clear, light pink, or straw in color. Contains many air bubbles. Contains aggregates of cells.

Appears clear, light pink, or straw in color. Air bubbles, clots, or discoloration indicate bacterial contamination or inadequate anticoagulation of the stored component and are contraindications for transfusion of that product. Thawed fresh frozen plasma (FFP) should be yellow, light green, or light orange in color and clear in appearance. A unit of platelets should appear clear and straw or light pink in color. It is normal for cryoprecipitate to be cloudy.

A patient has a pretransfusion hemoglobin value of 6 g/dL and a hematocrit value of 18%. Two units of RBCs are transfused. Four hours after completing the transfusion, what would the nurse expect the patient's hemoglobin and hematocrit values to be? Hemoglobin of 7 g/dL and hematocrit of 26%. Hemoglobin of 8 g/dL and hematocrit of 24%. Hemoglobin of 9 g/dL and hematocrit of 26%. Hemoglobin of 9 g/dL and hematocrit of 21%.

Hemoglobin of 8 g/dL and hematocrit of 24%. The nurse would expect the hemoglobin to increase by 2 g/dL and the hematocrit by 6% after transfusion of 2 units.

Which transfusion reaction results from administering ABO-incompatible blood? Allergic reaction. Hemolytic reaction. Graft-versus-host disease. Febrile reaction.

Hemolytic reaction. Administration of the wrong blood type results in a hemolytic reaction and can be life threatening.

The patient is receiving a unit of whole blood. The patient complains of pain from the surgical site. The patient has an order for morphine 2 mg IV push every hour as needed. What is the nurse's best action? Initiate another IV access and administer the morphine as ordered. Temporarily stop the blood transfusion, flush the tubing with normal saline, administer the morphine, and restart the transfusion. Administer the morphine IV push in the port closest to the patient of the blood administration tubing. Wait until the transfusion is complete and then administer the morphine as ordered.

Initiate another IV access and administer the morphine as ordered. Never inject medication into the same IV line with a blood component because of the risk for contaminating the blood product with pathogens and the possibility of incompatibility. If IV medications need to be administered during the transfusion, a second IV site is necessary.

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

It destroys the blood product. Use of microwaves or hot water destroys blood products because the heat generated cannot be adequately moderated to protect blood products from damage.

A young female trauma patient requires immediate massive blood transfusion on arrival to the emergency department. The nurse should administer: O+ red blood cells (RBCs). Typed and crossmatched blood. Type-specific blood. O− whole blood.

O− whole blood. Although it is preferable to wait for typing and crossmatching to occur, in an emergency O− blood can be administered until blood typing and matching can occur. O− blood is desired in the premenopausal female patient. If this patient were a man or a postmenopausal woman, it would be acceptable to use O+ blood in this situation.

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? AB+. O−. A+. AB−. O+.

O−. People with type O− blood are considered universal donors because they lack antigens to cause an immunologic response with any of the other blood types.

The nurse initiates a blood transfusion and monitors the patient for signs of a transfusion reaction. Five minutes into the transfusion, which would be cause for concern? Temperature 98.6 °F. Patient complains of feeling tired and sleepy. Patient complains of flank pain and chills. Systolic blood pressure increases by 4 mm Hg from baseline.

Patient complains of flank pain and chills. Flank pain and chills are signs of an acute hemolytic reaction. The patient may also complain of chest pain, dyspnea, and pain along the vein receiving blood. The patient is likely to be hypotensive and tachycardic. Fatigue is a symptom that often accompanies anemia.

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

Use the blood product supplied because Rh(D)-negative RBCs may be safely transfused to Rh(D)-positive patients. It is acceptable to transfuse Rh(D)-negative RBCs to Rh(D)-positive patients.

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

Whole blood. A unit of whole blood is 450 to 500 mL. Other blood products are substantially less volume.

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

Within the first 15 minutes of the transfusion. Adverse reactions typically occur during the first 15 minutes. This is why the transfusion is started slowly and why it is so important for the nurse to intensely monitor the patient in the first 15 minutes.

Identify the transfusion reactions that result in immediate cessation of the transfusion. (Select all that apply.) Febrile, nonhemolytic reaction. Allergic reaction. GVHD. Hemolytic reaction. Hyperkalemia.

Febrile, nonhemolytic reaction. Allergic reaction. Hemolytic reaction. Hemolytic, allergic, and febrile, nonhemolytic reactions, as well as infectious disease transmission, are life-threatening reactions that require immediate cessation of the transfusion.

When preparing to administer red blood cells, the nurse notes that lactated Ringer's solution is hanging on the patient's intravenous (IV) pole. The most appropriate action before administering the blood product is to cease administering the lactated Ringer's solution and flush the line with: Heparin. 5% dextrose. Histamine. Normal saline solution.

Normal saline solution. It is contraindicated to transfuse any substance that might bind to the citrate in the red blood cells. By flushing with normal saline the nurse reduces the likelihood that citrate will bind to the calcium in the lactated Ringer's solution.

The nurse obtains the patient's vital signs prior to initiating a blood transfusion. The patient's vital signs are B/P 114/78, T 100.3 °F, P 88, R 20. What is the nurse's most appropriate action? Administer antipyretic and antihistamine and initiate the transfusion. Continue to monitor the patient's vital signs, and if the temperature is higher than 101 °F, administer antipyretic. Record the vital signs and initiate the blood therapy slowly. Notify the health care provider of the pretransfusion vital signs.

Notify the health care provider of the pretransfusion vital signs. If patient is febrile (temperature greater than 100 °F [37.8 °C]), notify health care provider before initiating transfusion.

Which of the following types of autologous blood donations has the advantages of containing more viable RBCs than stored blood, having a normal pH, and containing higher levels of a chemical that increases the oxygen-carrying capacity of hemoglobin than other types of blood donations? Allogeneic. Hemodilution. Preoperative. Perioperative.

Perioperative. Perioperative blood contains more viable RBCs and 2,3-DPG than stored forms of blood. In addition, the pH is normal.

A nurse is preparing to administer a unit of packed red blood cells. The patient has an IV of D5½NS infusing. What IV solution should the nurse use to infuse the unit of packed RBCs? D5½NS. Normal saline. Lactated Ringer's. D5W.

Normal saline. 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.

A patient has type O+ blood. Which of the following blood types can the patient receive? AB+. A+. B−. O−.

O- An individual's blood type determines the antigens present on the red blood cells (RBCs). In this particular case the patient lacks antigens on their RBCs and may receive either O− or O+ type blood. None of these.

A postoperative patient is receiving a unit of packed red blood cells and requests pain medication for a pain level of 8. Upon review, the nurse sees the patient may have 3 mg of morphine sulfate IV push. What is the nurse's best action? Administer the morphine sulfate intramuscularly this one time. Stop the blood transfusion, flush the port closes to the insertion site with normal saline, administer the morphine, flush with normal saline, and restart the blood infusion. Initiate a second VAD and administer the morphine sulfate. Inform the patient he will have to wait until his blood transfusion is complete and provide nonpharmacological methods of pain relief.

Initiate a second VAD and administer the morphine sulfate. Never inject medication into the same IV line with a blood component because of the risk for contaminating the blood product with pathogens and the possibility of incompatibility. If IV medications need to be administered during the transfusion, a second IV site is necessary.

What is the benefit of using a large-bore intravenous (IV) catheter for administering blood products? Large-bore IV catheters promote rapid flow of blood components. Large-bore IV catheters are used so that flushing the line before and after blood product infusion is easier. Large-bore IV catheters allow a more consistent rate of administration than smaller catheters. Large-bore IV catheters are necessary when a pressure bag is being used.

Large-bore IV catheters promote rapid flow of blood components. An 18- to 20-gauge catheter is appropriate for the general population. A large-bore IV catheter (i.e., 14 to 16 gauge) is used when rapid infusion is required. The consistency of the rate of infusion may be affected by many factors independent of catheter size. A pressure bag may be used when a small-bore cannula (e.g., 24 gauge) is the vascular access device (VAD).

Compatibilities for ABO type for donor and recipient are required for which blood products? (Select all that apply.) Plasma. Colloid components (e.g., albumin) Platelets. Whole blood. Red blood cells.

Plasma. Platelets. Whole blood. Red blood cells. All of the blood products listed should be blood typed before use to avoid life-threatening complications. Cryoprecipitate and colloid components (such as albumin) do not require ABO or Rh typing.

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 packed RBCs (PRBCs), platelets, and/or plasma? Blood tubing must be changed every hour. Platelets should run through tubing different than tubing used for RBCs. Plasma is unable to pass through tubing that has previously filtered red blood cells. Blood tubing must be changed every 6 units.

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

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? The autologous blood is your own blood that is transfused. I can contact the health care provider to see if platelets could be used rather than blood. We can give you Benadryl before the transfusion to help prevent transmission. You can request an allogeneic blood transfusion instead.

The autologous blood is your own blood that is transfused. Patients who have a concern about transfusion-related reactions or transmission of disease find positive advantages in autologous transfusion, where their own blood is transfused. An allogeneic blood transfusion is from other donors and is a greater risk for transmission of disease. Some patients who have a history of frequent transfusion may require premedication with diphenhydramine (Benadryl) to combat acquired sensitivities. It will not prevent disease transmission. Platelets may be from a single donor or multiple donors. Platelets would not be "safer" in regard to disease transmission than an autologous transfusion of the patient's own 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? Send the blood product back to the blood bank because Rh(D)-positive plasma should not be transfused to Rh(D)-negative patients. Send a sample of the patient's blood to the blood bank for repeat Rh typing before administering plasma. Contact the health care provider for further pretransfusion orders. Use the blood product supplied because Rh(D)-positive plasma may be safely transfused to Rh(D)-negative patients.

Use the blood product supplied because Rh(D)-positive plasma may be safely transfused to Rh(D)-negative patients. It is acceptable to transfuse Rh(D)-positive plasma to Rh(D)-negative patients because the Rh(D)-antigens are associated with RBCs rather than plasma.