Blood
During rapid resuscitation of a trauma patient, the blood filter has become clogged. What is the most appropriate intervention? A. Squeeze the filter. B. Use a rapid infuser. C. Flush the IV line with a 0.9% sodium chloride solution. D. Change the filter.
D. Rationale: A clogged filter must be changed to facilitate effective blood transfusion. Squeezing the filter and flushing the IV line do not help unclog the filter. A rapid infuser may be used to transfuse blood but does not help when a filter is clogged.
What blood product might be considered for administration to a neutropenic patient with a severe bacterial infection who is not responding to antibiotics? A. Platelets B. Albumin C. Granulocytes D. Cryoprecipitate
C. Rationale: Granulocytes are white blood cells and aid in fighting infection by surrounding and killing bacteria. They may be considered for a neutropenic patient with infection. Platelets aid in clotting. Albumin is helpful for volume expansion, and cryoprecipitate is administered for those with deficiencies in specific clotting factors.
A patient with O+ blood received A+ blood. The patient is at risk for? A. Febrile transfusion reaction B. None: O+ and A+ are compatible blood types C. Hemolytic transfusion reaction D. Allergic transfusion reaction
The answer is C. O+ and A+ are NOT compatible blood types. Patients with O+ can only receive blood from others with O blood. This patient is at risk for a hemolytic reaction. This is where the immune system is killing the donors RBCs. The antibodies in the recipient's blood match the antigens on the donor's blood cells....the patient has been mistyped!!
Your patient needs 1 unit of packed red blood cells. You've completed all the prep and the blood bank notifies you the patient's unit of blood is ready. You send for the blood and the transporter arrives with the unit at 1200. You know that you must start transfusing the blood within _________. A. 5 minutes B. 15 minutes C. 30 minutes D. 1 hour
The answer is C. The blood must be started within 30 minutes.
Before initiating the blood transfusion, you obtain the patient's baseline vital signs, which are: heart rate 100, blood pressure 115/72, respiratory rate 18, and temperature 100.8'F. Your next action is to:* A. Administer the blood transfusion as ordered. B. Hold the blood transfusion and reassess vital signs in 1 hour. C. Notify the physician before starting the transfusion. D. Administer 200 mL of the blood and then reassess the patient's vital signs.
The answer is C. The patient has an elevated temperature. Any temperature greater than 100'F (before the administration of the blood) the physician should be notified.
What blood type is known as the "universal recipient"? A. Type A B. Type B C. Type AB D. Type O
The answer is C. Type AB is known as the universal recipient.
A donor has AB- blood. Which patient or patients below can receive this type of blood safely? A. A patient with O- blood. B. A patient with A- blood. C. A patient with B- blood. D. A patient with AB- blood.
The answer is D. Donors with AB type blood can only donate to others who have the AB type blood, in this case AB- blood. However, they are the universal recipients in that they can receive blood for every blood type but can only donate to their same exact blood type.
A patient who needs a unit of packed red blood cells is ordered by the physician to be premeditated with oral diphenhydramine and acetaminophen. You will administer these medications? A. 15 minutes before starting the transfusion B. Immediately after starting the transfusion C. Right before starting the transfusion D. 30 minutes before starting the transfusion
The answer is D. For ORAL medications you will administer the medications 30 minutes before starting the transfusion.
What solution or solutions below are compatible with red blood cells? A. Normal Saline B. Dextrose Solutions C. Any medications with normal saline D. No solutions are compatible with blood
The answer is A. Only NORMAL SALINE is compatible with blood.
A patient is receiving 1 unit of packed red blood cells. The unit of blood will be done at 1200. The patient is scheduled to have IV antibiotics at 1000. As the nurse you will: A. Stop the blood transfusion and administer the IV antibiotic, and when the antibiotic is done resume the blood transfusion. B. Administer the IV antibiotic via secondary tubing into the blood transfusion's y-tubing. C. Hold the antibiotic until the blood transfusion is done. D. Administer the IV antibiotic as scheduled in a second IV access site.
The answer is D. If any IV medications will be needed while the blood is transfusing, the nurse will need to start another IV access site. The nurse would NEVER administer the IV antibiotic in the same tubing as the blood product or stop the transfusion. Remember blood is time sensitive and must be transfused within 4 hours. Also, holding the antibiotic is not correct because antibiotics are time sensitive as well and must be administered at the scheduled time to maintain blood levels.
What is one of the indications for the administration of cryoprecipitate? A. To replace clotting factors for patients who have factor VIII or factor XIII deficiencies B. To maintain normal colloid oncotic pressure C. To prevent transfusion-related GVH reactions D. To control bleeding due to thrombocytopenia
A. Rationale: Cryoprecipitated antihemophilic factor (cryoprecipitate) is given to control bleeding by replacing clotting factors in the presence of factor VIII or factor XIII deficiency, von Willebrand disease, hypofibrinogenemia, or disseminated intravascular coagulation. The primary function of colloid components such as albumen is to maintain normal colloid oncotic pressure. Irradiated blood products are cellular components that have been treated with radiation to prevent TAGVHD reactions in certain immunocompromised populations. Platelets are given to prevent or help control bleeding due to thrombocytopenia, dysfunctional platelet disorders, active platelet-related bleeding, or in cases where there is a serious risk of bleeding.
Which action should be performed to avoid the most common cause of fatal transfusion reactions? A. Establish vascular access. B. Have two qualified health care professionals check the blood component information and the patient's identification. C. Keep the blood refrigerated until the time of transfusion. D. Administer the blood over a 4-hour period.
B Rationale: The most common cause of fatal transfusion reactions is type mismatches due to clerical error, administration of blood to the wrong patient, or incorrect identification of the blood component. Having two qualified health care professionals check the blood component information and the patient's identification is the best way to avoid giving the wrong blood product to the wrong patient. Vascular access is required to administer blood products and does not influence transfusion reactions. All blood or blood components that are not used immediately should be returned to the blood bank or refrigerated until the time of transfusion and administered within 4 hours or less, but failure to adhere to these guidelines is not the most common cause of fatal transfusion reactions.
A TRALI is a serious complication that can occur with blood transfusions. What are the characteristics of TRALI? A. TRALI occurs within 1 to 2 hours of the transfusion, activates the complement cascade, and decreases histamine release. B. TRALI occurs anytime during the transfusion to 6 hours after transfusion, activates the complement cascade, and increases histamine release. C. TRALI occurs within 8 hours of the transfusion, activates the complement cascade, and increases histamine release. D. TRALI occurs within 8 hours of the transfusion, activates the complement cascade, and decreases histamine release.
B. Rationale: TRALI occurs anytime during the transfusion to 6 hours after transfusion. It manifests as noncardiogenic pulmonary edema. The reaction activates the complement cascade and histamine release, leading to increased pulmonary capillary permeability.
If a patient develops a skin rash, edema, and wheezing during a blood transfusion, what should the transfusionist do? A. Discard the blood bag and tubing. B. Decrease the rate of the transfusion. C. Stop the transfusion immediately. D. Reassess the patient in 10 minutes.
C. Rationale: Rash, edema, and wheezing are signs of an anaphylactic reaction, and the transfusion should be stopped immediately. The transfusionist should continuously monitor the patient while summoning assistance and anticipating epinephrine administration. The blood bag and tubing should be saved to return to the blood bank.
A patient is being treated for burns. The transfusionist anticipates administering albumin to achieve which goal? A. Facilitating blood coagulation B. Restoring factor VIII levels C. Treating acute hemorrhage D. Replacing and maintaining intravascular volume
D Rationale: Albumin is used to maintain normal colloid oncotic pressure and therefore intravascular volume. It does not contain factor VIII, RBCs, or clotting components.
After running an FFP infusion slowly for the first 15 minutes to watch for any transfusion reactions, what should the transfusionist do next? A. Complete the infusion over 6 hours. B. Run the infusion wide open until completed. C. Decrease the infusion to a rate of 10 ml/hr. D. Increase the infusion rate as desired.
D. Rationale: Assuming that no transfusion reaction is observed within the first 15 minutes, the transfusionist should reassess vital signs and increase the infusion rate as desired. Most blood products, including FFP, should be infused within 4 hours or less.
Why are infusions of blood products started slowly? A. A slow start allows adequate time for platelets to thaw. B. A slow start allows adequate time for removing an air bubble in the tubing C. A slow start allows adequate time to obtain baseline vital signs. D. Adverse reactions can occur with exposure to small amounts of blood products.
D. Rationale: Transfusion reactions can be life threatening and occur with exposure to even a small amount of blood; therefore, transfusions should be started slowly unless the patient's condition requires a rapid, life-sustaining transfusion. Platelets should be stored at room temperature, and never refrigerated or frozen. The presence of an air bubble should be noted and corrected during priming of the blood tubing and before connection of the administration set. Baseline vital signs should be obtained before initiation of the transfusion.
Red blood cells are very vital for survival. Which statement below is NOT correct about red blood cells?* A. "Red blood cells help carry oxygen throughout the body with the help of the protein hemoglobin." B. "Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems." C. "Red blood cells help remove carbon dioxide from the body." D. "Red blood cells are suspended in the blood's plasma."
The answer B. Extreme loss of red blood cells leads to anemia which can cause a patient to experience shortness of breath (there is a decreased ability to carry oxygen throughout the body), tachycardia, fatigue, pale skin color etc. Suppressed immune system can be from LOW white blood cells, and clotting problems can be from LOW platelets.
According to the American Association of Blood Banks, what is the recommended hemoglobin level for a blood transfusion? A. 5-7 g/dL B. 7-8 g/dL C. 4-7 g/dL D. 9-10 g/dL
The answer is B. This is the recent recommendation for by the AABB (7-8 g/dL).
You've started the first unit of packed red blood cells on a patient. You stay with the patient during the first 15 minutes and: A. run the blood at 100 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. B. run the blood at 20 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. C. run the blood at 200 mL/min and then decrease the rate after 15 minutes, if tolerated by the patient. D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient.
The answer is D. The blood will be started on an infusion pump at 2 mL/min, and if the blood is tolerated by the patient, it will be increased AFTER 15 minutes. Remember the blood must be transfused within 2-4 hours....most bags are 250 to 300 mL. During the first 15 minutes is when the patient is most likely to have a transfusion reaction. Running the blood slowly during the first 15 minutes allows the patient to receive the LEAST amount of blood possible if a reaction does occur.
You're gathering supplies to start a blood transfusion. You will gather? A. PVC free tubing and dextrose B. Polyethylene-line tubing and 0.9% Normal Saline C. Y-tubing with in-line filter and dextrose D. Y-tubing with in-line and 0.9% Normal Saline
The answer is D. This is the type of tubing and solution you will use to transfuse blood. Normal Saline is the ONLY solution used to transfuse blood!!
What blood type is known as the "universal donor"? A. Type A B. Type B C. Type AB D. Type O
The answer is D. Type O is known as the universal donor.
Obtaining IV access is an important intervention before administering blood products. Which statement made by a new nurse indicates understanding of adequate IV access? A. "I should not use a 25-G IV catheter for rapid infusion of cellular components." B. "Larger gauge needles are optimal for slow rates of infusion." C. "I will use a 14- to 18-G IV catheter for rapid infusion of a cellular component." D. "Smaller gauge needles allow for rapid rates of infusion."
C. Rationale: When planning to infuse products containing cellular components (i.e., RBCs or WBCs), a 14- to 18-G catheter is used for rapid administration of product. Elective administration may be given with small catheters. Needles and IV catheters used for infusion of cellular components may be as small as 25-G.
As the nurse you know that there is a risk of a transfusion reaction during the administration of red blood cells. Which patient below it is at most RISK for a febrile (non-hemolytic) transfusion reaction?* A. A 38 year old male who has received multiple blood transfusions in the past year. B. A 42 year old female who is immunocompromised. C. A 78 year old male who is B+ that just received AB+ blood during a transfusion. D. A 25 year old female who is AB+ and just received B+ blood.
The answer is A. A febrile transfusion reaction is where the recipient's WBCs are reacting with the donor's WBCs. This causes the body to build antibodies. It is most COMMON in patients who have received blood transfusion in the past. Option B is at risk for GvHD (graft versus host disease). Option C is wrong because this places the patient at risk for a hemolytic transfusion reaction (not febrile). The patient is receiving incompatible blood. However, option D is not the patient at MOST risk compared to option A. Note the patient is receiving compatible blood. Note the patient is receiving compatible blood in this option.
A patient started receiving their first unit of blood at 1000. It is now 1010 and the patient is reporting itching, chills, and a headache. In addition, the patient's temperature is now 99.8'F from 98'F. Your next nursing action is: A. Stop the transfusion B. Notify the physician C. Decrease the rate of the transfusion D. Reassure the patient that this is normal and will resolve in 30 minutes. .
The answer is A. The patient is possibly having a transfusion reaction. FIRST, the nurse should STOP the transfusion and then disconnect the IV tubing at the access site and replace it with NEW tubing. In addition, have normal saline infusing to keep the vein open. THEN the nurse will notify the physician and blood bank
Before starting a blood transfusion the nurse will perform a verification process with __________. This will include? A. any available personnel; physician's order, patient's identification, blood bank's information, expiration date of blood B. licensed personnel only (another RN); physician's order, patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, assess the bag of blood for damage or abnormal substances C. blood bank; patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, bag of blood for damage or abnormal substances D. licensed personnel only (another RN); blood compatibility, physician order, expiration date
The answer is B. The nurse will verify with another licensed personnel (another RN) the physician's order, patient's identification and blood bank's information, patient's blood type and donor's type along with the Rh factor, expiration date, assess the bag for damage or abnormal substances BEFORE starting the transfusion.
You're providing care to a 36 year old male. The patient experienced abdominal trauma and recently received 2 units of packed red blood cells. You're assessing the patient's morning lab results. Which lab result below demonstrates that the blood transfusion was successful? A. Hemoglobin level 7 g/dL B. Platelets 300,000 µl C. Hemoglobin level 15 g/dL D. Prothrombin Time 12.5 seconds
The answer is C. Hemoglobin levels are used to assess the effectiveness of a blood transfusion. A normal Hgb level for a MALE is 14 to 18 g/dL. For a FEMALE, the level is 12 to 16 g/dL.
After spiking the blood component bag and filling the drip chamber to cover the filter, the transfusionist observes air bubbles in the drip chamber. Which action should be taken next? A. Infuse the blood component with no filter in the line. B. Tap the filter chamber lightly. C. Leave the existing air bubbles in the line. D. Change the entire tubing.
B. Rationale: Tapping the filter chamber lightly causes the air bubbles to dissipate as they rise in the drip chamber. Blood component is never administered without a filter or with visible air bubbles in the line. There is no need to change the entire tubing and waste the blood component that is already in it when tapping will eliminate the problem.
A patient is ordered to receive 2 units of packed red blood cells. The first unit was started at 1400 and ended at 1800. You send for the other bag of red blood cells. As the nurse you know it is priority to: A. obtain signed informed consent for the second unit of blood from the patient B. obtain a new y-tubing set for this unit of blood C. type and crossmatch the patient D. hang a new bag of dextrose to transfuse with the blood
The answer is B. The patient has already received 1 unit of blood and another unit is needed. It took 4 hours for the first unit to transfuse and the nurse needs to obtain new y-tubing for the next unit of blood. Y-tubing sets are only good for 4 hours. Some hospitals require new tubing sets with each unit transfusion or after 4 hours....always check your hospital's protocol.
Your patient is having a transfusion reaction. You immediately stop the transfusion. Next you will: A. Notify the physician. B. Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. C. Collect urine sample. D. Send the blood tubing and bag to the blood bank.
The answer is B. This question wants to know your NEXT nursing action. AFTER stopping the transfusion, the nurse will DISCONNECT the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. This will limit any more blood from entering the patient's system. THEN the nurse will notify the MD and blood bank.
Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction: A. Sweating B. Chills C. Hives D. Poikilothermia E. Tinnitus F. Headache G. Back pain H. Pruritus I. Paresthesia J. Shortness of Breath K. Nausea
The answers are A, B, C, F, G, H, J, and K. As the nurse you want to educate the patient to report signs and symptoms associated with blood transfusion reactions, which would include: sweating, chills, hives, headache, back pain, pruritus (itching), shortness of breath, and nausea.
A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has B+ blood. As the nurse you know the patient can receive what type of blood? Select all that apply: A. B- B. A+ C. O- D. B+ E. O+ F. A- G. AB+ H. AB-
The answers are A, C, D and E. The patient must receive blood from either a donor that has O or B blood. Since the patient is B+ (Rh factor is positive), they can receive both negative or positive blood. So, the patient can receive B-, B+, O-, and O+ blood.
