Blood Therapy practice questions
A newly hired nurse is orienting to the orthopedic unit where postoperative blood collection and autotransfusion commonly occur. Which statement, if made by the nurse, indicates further instruction is necessary? A) "A Hemovac is used to collect the blood for autotransfusion." B) "The autotransfusion will end when bleeding stops or slows significantly." C) "Postoperative blood collection may also be performed on postoperative cardiac patients." D) "The amount of salvaged blood is generally small."
A
A patient arrives in the emergency department with a stab wound to the upper abdomen. Which of the following findings contraindicates autotransfusion of pleural blood? A) A wound 6 hours old B) Great vessel injury C) Diaphragmatic disruption D) Myocardial rupture
A
A patient has been donating blood in preparation for an autologous transfusion. Under which circumstance should the patient be prohibited from making another donation? A) The patient's Hct is 32%. B) It is 5 days from the patient's scheduled surgery. C) The patient's Hgb is 12 g/dL. D) The patient's blood pressure is 120/80.
A
A young female trauma patient requires immediate massive blood transfusion on arrival to the emergency department. The nurse should administer: A) O-negative whole blood B) Typed and cross matched blood C) Type-specific blood D) O-positive RBCs
A
On inspection, a unit of blood from the blood bank shows several blood clots clinging to the bag. The nurse's best course of action is: A) Notify the blood bank B) Administer the blood through the blood filter in the blood tubing C) Add citrate phosphate dextrose (CPD) to the blood D) Shake the bag to break the clots up into smaller pieces
A
The nurse initiates a blood transfusion at 0800. When would an acute hemolytic transfusion reaction most likely occur? A) By 0815 B) By 0830 C) 2-4 hours after completion D) 2 -14 days after completion
A
The nurse is initiating a blood transfusion of packed RBCs. At what rate should the infusion initially be set? A) 2 mL/min B) 10 mL/min C) 15 mL/min D) 20 mL/min
A
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? A) 18 to 20 gauge B) 22 to 24 gauge C) 26 gauge D) 28 gauge
A
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
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
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 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
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
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
Which of the following would be one of the first signs of an adverse reaction to a blood transfusion? A) Tachycardia B) Hypertension C) Hypothermia D) Disseminated intravascular coagulation (DIC)
A
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, B
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, B, C, D
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? 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
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? A) Send the blood back to the blood bank requesting B+ blood. B) Begin the process of verification to transfuse the blood. C) Do not administer the blood and complete an incident report. D) Realize the patient is the universal recipient and begin the transfusion.
B
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
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 the transfusion the nurse would expect the patient's hemoglobin and hematocrit values to be: A) Hemoglobin of 7 g/dL and hematocrit of 26% B) Hemoglobin of 8 g/dL and hematocrit of 24% C) Hemoglobin of 9 g/dL and hematocrit of 21% D) Hemoglobin of 9 g/dL and hematocrit of 26%
B
After transfusion of several units of blood, a patient continues to bleed. What should the nurse anticipate the health care provider to order? A) Albumin B) Platelets C) Whole blood D) Red blood cells
B
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
It is acceptable practice to place blood into refrigerators/freezers located in patient care areas. A) True B) False
B
It is acceptable practice to transfuse medications with blood components. A) True B) False
B
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
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
When preparing to administer red blood cells, the nurse notes that lactated Ringer's solution is hanging on the patient's IV pole. The most appropriate action prior to administering the blood product is to cease administering the lactated Ringer's solution and flush the line with: A) Histamine B) Normal saline solution C) Heparin D) 5% dextrose
B
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
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
How long should the nurse stay with the patient after initiating a blood transfusion? A) Until the transfusion is completed B) 5-10 minutes C) 15 minutes D) 1 hour
C
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
C
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? A) Analgesic (e.g., morphine sulfate) B) Antibiotic (e.g., ciprofloxacin) C) Antihistamine (e.g., diphenhydramine) D) Diuretic (e.g., furosemide)
C
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? A) Put the blood in the facility's refrigerator. B) Have the NAP initiate the transfusion under the nurse's verbal direction. C) Return the blood to the blood bank. D) Discard the blood appropriately and retrieve another one when able to administer it.
C
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 1 hour as needed. What is the nurse's best action? A) Administer the morphine IV push in the port closest to the patient of the blood administration tubing. B) Wait until the transfusion is complete and then administer the morphine as ordered. C) Initiate another IV access and administer the morphine as ordered. D) Temporarily stop the blood transfusion, flush the tubing with normal saline, administer the morphine, and restart the transfusion.
C
What is the most likely complication of an FFP transfusion? A) Sepsis B) Dehydration C) Fluid overload D) Thrombocytopenia
C
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
Which transfusion reaction results from administering ABO incompatible blood? A) Febrile reaction B) Allergic reaction C) Hemolytic reaction D) Graft-versus-host disease
C
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
While assessing a 49-year-old intubated patient, the nurse notes that the patient is pale, hypotensive, tachycardic, and has oliguria. The patient has a hemothorax on the right side and bilateral femur fractures. The chest tube has drained 350 mL over the previous 2 hours. The nurse knows that: A) This patient is hypovolemic from blood loss and is an appropriate candidate for autotransfusion B) The patient should begin receiving dopamine for his blood pressure and large amounts of fluid should be infused to facilitate increased urine output C) The patient is hypovolemic and a poor candidate for autotransfusion because of the increased risk of a transfusion reaction D) The patient requires decreased cardiac output to decrease his heart rate and compensate for hypovolemia
A
Why is warming a unit of 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 it coagulates C) Preparation of blood products is the blood bank's responsibility
A
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, B, D
A patient receiving an autotransfusion has an estimated blood loss of half of the patient's blood volume. The health care provider has ordered FFP. The nurse correctly understands that the primary rationale for using FFP is: A) To increase the hematocrit and hemoglobin levels B) To provide clotting factors and increase blood volume C) To replace the loss of platelets and clotting factors D) To prevent a transfusion reaction to the autologous blood
B
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? A) Temperature 98.6°F B) Patient complains of flank pain and chills C) Systolic blood pressure increases by 4 mmHg from baseline D) Patient complains of feeling tired and sleepy
B
The nurse initiates a blood transfusion of packed RBCs at 0800. The unit of blood should not hang beyond: A) 1000 B) 1200 C) 1400 D) 2000
B
The nurse is inspecting a unit of platelets prior to administering it to the patient. What should the nurse expect to see? A) Contains many air bubbles B) Appears clear, light pink in color C) Contains aggregates of cells D) Appears cloudy, light green in color
B
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 with receiving a blood transfusion?"
B
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? A) Record the vital signs and initiate the blood therapy slowly. B) Notify the health care provider of the pretransfusion vital signs. C) Continue to monitor the patient's vital signs and if the temperature is >101°F, administer antipyretic. D) Administer antipyretic and antihistamine and initiate the transfusion.
B
The patient is to have blood dilution (hemodilution) prior to surgery. The nurse is assessing the patient's understanding of the procedure. Which statement, if made by the patient, indicates further instruction is needed? A) "A unit of my blood will be removed before surgery and reinfused at the end of the operation." B) "A unit of my blood will be removed, diluted with IV fluids, and returned during surgery." C) "As soon as the blood is withdrawn I will receive IV fluids to restore my blood volume." D) "During surgery I will lose fewer RBCs than I would if I did not have the procedure."
B
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 has most likely has which blood type? A) AB+ B) O- C) A+ D) AB- E) O+
B
Which of the following patients is ineligible for autotransfusion? A) A trauma patient with bilateral hemothorax and splenic tear with an accumulation of more than 300 mL of blood in the collection chamber B) A patient admitted with a lower gastrointestinal bleed with copious amounts of blood coming from the rectum at a rate equal to or greater than 100 mL/hr C) A patient following an orthopedic procedure with a hemogloblin of 8 D) A patient recovering from a cardiovascular procedure who has a hematocrit of 24
B
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? A) FFP B) Platelets C) RBCs D) Clotting factors
C
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? A) D5½NS B) D5W C) Normal saline D) Lactated Ringer's
C
A febrile transfusion reaction typically occurs when the patient's antibodies react to transfused: A) FFP B) RBCs C) Corticosteroids D) WBCs
D
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
A patient is to have a perioperative blood collection for autotransfusion. The nurse would recognize which of the following measures is incorrect? A) Fluid aspirated from the surgical site is mixed with an anticoagulant solution. B) Care is taken when suctioning blood to reduce hemolysis of RBCs. C) Collected blood is washed and concentrated prior to reinfusion. D) Blood collected from a drainage tube is transfused unwashed to the patient.
D
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 an 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
A patient who is classified as a universal recipient has what blood type? A) O negative B) O positive C) AB negative D) AB positive
D
Signs of complication during autotransfusion would most likely be manifested as: A) Hypotension and hives B) Bradycardia and sudden increase of oral temperature C) Lower back pain and hypotension D) Blood oozing from all puncture sites and wounds
D
The initial infusion rate and total infusion time for blood products are: A) 5 mL/min; 30 minutes B) 10 mL/min; 2 hours C) 30 mL/min; 4 hours D) 2mL/min; 4 hours
D
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 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
When turning a patient with a right-sided hemothorax, 250 mL of dark blood pours into the chest tube container. The most important intervention is: A) Checking the chest tube system to confirm patency and calling for a chest x-ray immediately B) Assessing vital signs and emergently transfusing 2 units of packed red blood cells to treat hypovolemia C) Preparing for autotransfusion using a high-pressure rapid infuser to quickly infuse the blood D) Monitoring the patient closely, obtaining a blood sample for a hematocrit, and documenting the drainage
D
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