Blood Administration Video Quiz

A nurse is providing teaching to a client who is scheduled to receive one unit of packed RBCs. Which of the following information should the nurse include in the teaching?

"I will remain with you for the first 15 minutes of the transfusion process." The nurse should inform the client that he will remain with the client for the first 15 min of the transfusion. It is during the first 50 mL of the transfusion that a severe reaction is most likely to occur.

A nurse is preparing to administer one unit of packed RBCs to a client who has anemia. Which of the following actions should the nurse take?

Have a second nurse assist with comparing the client's identification information. It is the responsibility of the nurse who will be administering the blood product to enlist a second nurse to compare the client's identification with the information on the blood component bag.

A nurse is caring for a client who is receiving a unit of packed RBCs. The client states that he is experiencing flank pain and that it feels like his heart is racing. Which of the following types of transfusion reactions should the nurse identify the client is experiencing?

Hemolytic The nurse should identify the manifestations of flank pain and tachycardia as a hemolytic transfusion reaction. Other manifestations can include fever, chills, hypotension, apprehension, and reddish or brown urine.

A nurse is preparing to administer platelets to a client who has thrombocytopenia. Which of the following actions should the nurse take?

Use a transfusion set that has a short tubing and a small filter. The nurse should administer platelets with a special transfusion set that has a smaller filter and shorter tubing. If a standard blood administration set is used, the filter can trap the platelets and the longer tubing increases platelet adherence to the lumen.

A nurse is preparing to administer 2 units of packed RBCs to an older adult client. Which of the following actions should the nurse take?

Wait 2 hr between infusing the two units of packed RBCs. If possible, the nurse should wait 2 hr to elapse after the administration of the first unit of packed RBCs before beginning to infuse the second unit. This will decrease the client's risk of fluid overload.