Blood Types And Blood Therapy
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? Preoperative. Perioperative. Correct Hemodilution. Allogeneic.
Perioperative blood contains more viable RBCs and 2,3-DPG than stored forms of blood. In addition, the pH is normal.
Why is warming a unit of blood products in a microwave or under hot water from the tap contraindicated? It destroys the blood product. Correct It makes the blood product too hot to infuse and as it cools it coagulates. Preparation of blood products is the blood bank's responsibility. It can create a leak in the blood packaging
Use of microwaves or hot water destroys blood products because the heat generated cannot be adequately moderated to protect blood products from damage.
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 6 units. Plasma is unable to pass through tubing that has previously filtered red blood cells. Platelets should run through tubing different than tubing used for RBCs. Correct Blood tubing must be changed every hour.
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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.
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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−. Correct A+. AB−. O+.
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What are the initial infusion rate and total infusion time for blood products? 5 mL/min; 30 minutes. 10 mL/min; 2 hours. 30 mL/min; 4 hours. 2 mL/min; 4 hours. Correct
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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. Correct 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 are used so that flushing the line before and after blood product infusion is easier
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What is the primary reason for meticulous care to avoid human error in transfusion therapy? Human error can lead to life-threatening transfusion reactions. Correct 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.
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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. Slow the rate of the transfusion. Stop the transfusion immediately. Correct Reassess the patient in 10 minutes.
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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.) Whole blood. Correct Red blood cells. Correct Platelets. Plasma. Cryoprecipitate
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.
Which transfusion reaction results from administering ABO-incompatible blood? Febrile reaction. Allergic reaction. Hemolytic reaction. Correct Graft-versus-host disease.
Administration of the wrong blood type results in a hemolytic reaction and can be life threatening.
When do adverse reactions from blood transfusions usually occur? After the first hour of the transfusion. Within the first 15 minutes of the transfusion. Correct One hour after the transfusion has been completed. Upon completion 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.
Which of the following would be an early indication of an adverse transfusion reaction? Increase in body temperature. Correct Hypertension. Bradycardia. Feelings of faintness.
An elevation in temperature or heart rate is one of the first signs that a person is having an adverse reaction to a transfusion.
A patient has type O+ blood. Which of the following blood types can the patient receive? A+. B−. O−. Correct AB+. None of these.
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.
What may happen if lactated Ringer's, electrolytes, or other calcium-containing solutions are administered concurrently with blood products? Calcium binds to citrate resulting in hypocalcemia. Correct Electrolyte imbalance occurs as a result of upsetting the sodium-to-calcium balance. Serum protein concentrations reduce. Hyperchloremic metabolic acidosis occurs.
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 might dysrhythmias and a reduction in core body temperature occur in a recently transfused patient? An air embolism. Volume overload. Hypocalcemia. Rapid administration of nonwarmed blood products. Correct
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.
A febrile nonhemolytic transfusion reaction typically occurs when the patient's antibodies react to transfused: Fresh frozen plasma (FFP). Red blood cells (RBCs). Corticosteroids. White blood cells (WBCs). Correct
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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. D5W. Normal saline. Correct Lactated Ringer's.
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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? "You can request an allogeneic blood transfusion instead." "We can give you Benadryl before the transfusion to help prevent transmission." "I can contact the health care provider to see if platelets could be used rather than blood." "The autologous blood is your own blood that is transfused." Correct
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Identify the IV catheter gauge typically recommended to infuse blood products in an adult. 16 gauge. 18 gauge. Correct 22 gauge. 24 gauge.
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Identify the transfusion reactions that result in immediate cessation of the transfusion. (Select all that apply.) Hemolytic reaction. Correct Allergic reaction. Correct GVHD. Febrile, nonhemolytic reaction. Correct Hyperkalemia.
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It is acceptable to transfuse Rh(D)-negative RBCs to Rh(D)-positive patients.
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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? "Are you a Jehovah's Witness?" "Have you ever had a blood transfusion before?" Correct "Do you have any allergies?" "Are you aware of the risks associated with receiving a blood transfusion?"
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Which blood product places a patient at a higher risk of fluid overload after transfusion? Whole blood. Correct Red blood cells (RBCs). Platelets. Leukocyte-poor RBCs. Cryoprecipitate.
A unit of whole blood is 450 to 500 mL. Other blood products are substantially less volume.
Identify the blood component that decreases microvascular bleeding during surgery and does not require ABO/Rh testing. Whole blood. Red blood cells. Platelets. Plasma. Cryoprecipitate. Correct
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.
The nurse is transfusing a large amount of blood to a trauma patient. The nurse knows to observe the patient for: Hypotension and cardiac dysrhythmias. Correct Headache and muscle pain. Crackles in the lungs and increased central venous pressure. Wheezing and chest pain.
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
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? Use the blood product supplied because Rh(D)-positive plasma may be safely transfused to Rh(D)-negative patients. Correct 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.
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.
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? Inform the patient he will have to wait until his blood transfusion is complete and provide nonpharmacological methods of pain relief. 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. Administer the morphine sulfate intramuscularly this one time. Initiate a second VAD and administer the morphine sulfate. Correct
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.
