Question 1

Transfusion therapy is the intravenous ( IV ) administration of which of the following? (Select all that apply.)

Accepted Answer

Transfusion therapy or blood replacement is the IV administration of whole blood, its components, or plasma-derived product for therapeutic purposes.

Question 2

What is the purpose of administering a transfusion? (Select all that apply.)

Accepted Answer

Transfusions are used to restore intravascular volume with whole blood or albumin, to restore the oxygen-carrying capacity of blood with RBCs, and to provide clotting factors and/or platelets.Although increasing blood volume may increase blood pressure, increasing blood pressure is not a primary objective of transfusion.

Question 3

The patient is scheduled to receive a blood transfusion.Preadministration laboratory tests are run to assess the level of which component in the patient's blood?

Accepted Answer

When blood is stored, there is continual destruction of RBCs, which releases potassium from the cells into the plasma.If blood is transfused rapidly, transient elevated potassium levels may occur before the potassium is reabsorbed and put the patient at risk.

Question 4

When a patient's adverse reaction to a blood transfusion is differentiated, which of the following signs/symptoms indicates the presence of an anaphylactic response?

Accepted Answer

Observe the patient for wheezing, chest pain, and possible cardiac arrest.All of these are indications of an anaphylactic reaction.Be alert to patient complaints of headache or muscle pain in the presence of a fever.Both may be indicative of a febrile nonhemolytic reaction.Observe patients receiving massive transfusions for mild hypothermia, cardiac dysrhythmias, hypotension, and hypocalcemia.Cold blood products can affect the cardiac conduction system, resulting in ventricular dysrhythmias.Other cardiac dysrhythmias, hypotension, and tingling may indicate hypocalcemia, which occurs when citrate (used as a preservative for some blood products) combines with the patient's calcium.Crackles in the bases of lungs and rising central venous pressure (CVP) are indications of circulatory overload.

Question 5

The patient is brought to the emergency department after a motor vehicle accident and has lost a large volume of blood.The patient's blood type is AB.Which blood type may this patient safely receive in transfusion?

Accepted Answer

People with type AB blood have neither antibody and therefore can receive all blood types.

Question 6

The patient is to receive 2 units of packed RBCs.The units are cold, and the nurse is concerned that this could lead to dysrhythmias and/or a reduction in core temperature.What action may the nurse take to prevent this?

Accepted Answer

In emergency situations, rapid transfusion of cold blood may lead to dysrhythmias and a reduction in core temperature.Sometimes a blood warmer machine is used for large transfusions of greater than 50 mL/kg/hr or in patients with cold agglutinins.Heating blood products in a microwave or with hot water is dangerous and may destroy blood cells.Blood must be given within a prescribed time frame.Allowing the blood to come to room temperature before administration would decrease the time available for administration.

Question 7

For how long may blood preserved with CPD be stored (unfrozen) before use?

Accepted Answer

When preserved with citrate, phosphate, and dextrose a unit of blood has a shelf life of 21 days (unfrozen).

Question 8

The patient has been home from the hospital for 10 days.On the last day of his hospitalization, he received 2 units of packed RBCs.This morning, he noticed that his skin had a yellow tint to it and his temperature was elevated.Which reaction might this patient be experiencing?

Accepted Answer

Symptoms of a delayed hemolytic reaction usually begin 2 to 14 days after the transfusion and include unexplained fever, unexplained decrease in Hgb/Hct, increased bilirubin levels, and jaundice.Symptoms of an acute hemolytic reaction usually begin within 15 minutes of transfusion initiation and include severe pain in the kidney area and chest, increased temperature (up to 105° F), increased heart rate, and increased sensation of heat and pain along the vein receiving blood, as well as chills, low back pain, headache, nausea, chest or back pain, chest tightness, dyspnea, bronchospasm, anxiety, hypotension, vascular collapse, disseminated intravascular coagulation, and possibly death.Symptoms of a nonhemolytic febrile reaction begin between 30 minutes after initiation and 6 hours after completion of transfusion and include fever greater than 1° C above baseline, flushing, chills, headache, and muscle pain; they occur most frequently in immunosuppressed patients.Symptoms of an acute severe allergic reaction usually begin within 5 to 15 minutes of initiation of transfusion and include coughing, nausea, vomiting, respiratory distress, wheezing, hypotension, loss of consciousness, and possible cardiac arrest.

Question 9

The patient is scheduled to receive 1 unit of packed RBCs.She has small, fragile veins, and a 22-gauge intravenous (IV) patent catheter is in place.What should the nurse do?

Accepted Answer

In emergency situations that require rapid transfusions, a large-gauge cannula is preferred; however, transfusions for therapeutic indications may be infused with cannulas ranging from 20 to 24 gauge.Large-gauge cannulas (18 or 20 gauge) promote rapid flow of blood components.16-Gauge catheters are used frequently in surgery, but not usually on acute care units.Blood must be transfused within 4 hours.Use of smaller-gauge cannulas, such as 24 gauge, often requires the blood bank to divide the unit so that each half can be infused within the allotted time or requires the use of pressure-assisted devices.

Question 10

The specific blood product used for replacement of clotting factors and fibrinogen is:

Accepted Answer

Cryoprecipitate replaces factors VIII and XIII, von Willebrand's factor, and fibrinogen.It also replaces red cell mass and plasma volume and is expected to raise hemoglobin by 1 g/100 mL and hematocrit by 3% in a nonhemorrhaging adult.Using cryoprecipitate is the preferred method of replacing red blood cell mass.

Question 11

An appropriate technique for the nurse to implement for a blood transfusion is to:

Accepted Answer

After the blood has infused, clear the IV line with 0.9% normal saline and discard the blood bag according to agency policy.Medication should never be injected into the same IV line as a blood component because of the risk of contaminating the blood product with pathogens and the possibility of incompatibility.A separate IV line must be maintained if the patient requires IV infusion (total parenteral nutrition, pain control) during the transfusion.A unit of blood should not hang for longer than 4 hours because of the danger of bacterial growth.Check the appearance of blood product for leaks, bubbles, clots, or a purplish color.Do not transfuse blood if its integrity is compromised.Blood serves as a medium for bacteria.

Question 12

What primary intervention should a nurse who is preparing a blood transfusion perform?

Accepted Answer

Correctly verify the product and identify the patient with a person considered qualified by your agency.Strict adherence to verification procedures before administration of blood or blood components reduces the risk of administering the wrong blood to the patient.Clerical errors are the cause of most hemolytic transfusion reactions.Y tubing is used to facilitate maintenance of IV access in case a patient will need more than 1 unit of blood.However, the focus here is on prevention of possible blood reactions.Use of Y tubing will not prevent a blood reaction.Normal saline is compatible with blood products, unlike solutions that contain dextrose, which causes coagulation of donor blood.However, strict adherence to verification procedures before administration of blood or blood components reduces the risk of administering the wrong blood to the patient.Empty the urine drainage collection container or have the patient void.If a transfusion reaction occurs, a urine specimen containing urine produced after initiation of the transfusion will be sent to the laboratory.

Question 13

The patient has received a total of 7 units of blood over the past 8 hours.The nurse assesses the patient's laboratory test results.Which of the following would be an expected complication?

Accepted Answer

When blood is stored, there is continual destruction of RBCs, which releases potassium from the cells into the plasma.If blood is transfused rapidly, transient hyperkalemia may occur before the potassium is reabsorbed.Blood that is preserved with citrate phosphate dextrose (CPD) contains a high concentration of citrate ions.The excess citrate may combine with the ionized calcium in the recipient's blood, resulting in transient low ionized calcium levels.Patients receiving multiple transfusions should be assessed for iron overload.

Question 14

The patient is receiving a unit of packed RBCs.Fifteen minutes into the procedure, he complains of severe kidney pain, and his temperature increases by 3° F.The nurse stops the transfusion immediately, suspecting that which of the following reactions is occurring?

Accepted Answer

Symptoms of an acute hemolytic reaction usually begin within 15 minutes of transfusion initiation and include severe pain in the kidney area and chest, increased temperature (up to 105° F), increased heart rate, and a sensation of heat and pain along the vein receiving blood, as well as chills, low back pain, headache, nausea, chest or back pain, chest tightness, dyspnea, bronchospasm, anxiety, hypotension, vascular collapse, disseminated intravascular coagulation, and possibly death.Symptoms of a delayed hemolytic reaction usually begin 2 to 14 days after the transfusion and include unexplained fever, an unexplained decrease in hemoglobin/hematocrit (Hgb/Hct), increased bilirubin levels, and jaundice.Symptoms of a nonhemolytic febrile reaction begin between 30 minutes after initiation and 6 hours after completion of transfusion and include fever greater than 1° C above baseline, flushing, chills, headache, and muscle pain; they occur most frequently in immunosuppressed patients.Symptoms of an acute severe allergic reaction usually begin within 5 to 15 minutes of initiation of transfusion and include coughing, nausea, vomiting, respiratory distress, wheezing, hypotension, loss of consciousness, and possible cardiac arrest.

Question 15

The nurse is administering blood.What should the nurse do to detect a blood reaction as quickly as possible?

Accepted Answer

Remain with the patient during the first 15 minutes of a transfusion.Most transfusion reactions occur within the first 15 minutes of a transfusion.The initial flow rate during this time should be 2 mL/min, or 20 gtt/min.Initially infusing a small amount of blood component minimizes the volume of blood to which the patient is exposed, thereby minimizing the severity of a reaction.Monitor the patient's vital signs at 5 minutes, at 15 minutes, and every 30 minutes until 1 hour after transfusion or per agency policy.Frequent monitoring of vital signs will help to quickly alert the nurse to a transfusion reaction.

Question 16

The nurse is caring for a patient who needs a blood transfusion.The patient has been tested and was found to have blood type O.The nurse knows this means that which antigen is present on the surface of the red blood cells?

Accepted Answer

When neither A nor B antigens are present, the blood group is type O.When the type A antigen is present, the blood group is type A.When the type B antigen is present, the blood group is type B.When both A and B antigens are present, the blood group is type AB.

Question 17

The patient is to receive 1 unit of packed RBCs.The nurse obtains the blood from the blood bank and returns to the unit to find that the patient has been taken to radiology for a CT scan and is expected to return in about an hour.What should the nurse do?

Accepted Answer

Initiate the blood transfusion within 30 minutes of the time of release from the blood bank.If you cannot do this because the patient is in the bathroom or the physician has to be notified of an elevated temperature, immediately return the blood to the blood bank, and retrieve it when you can administer it.

Question 18

The nurse is preparing to administer a unit of blood to a patient using blood tubing.On the blood product side of the Y tubing, she will hang blood.What will she hang on the other side of the Y tubing?

Accepted Answer

Normal saline is compatible with blood products, unlike solutions that contain dextrose, which causes coagulation of donor blood.

Question 19

The nurse is administering 1 unit of packed red blood cells as ordered by the primary care provider.While the nurse is measuring vital signs 15 minutes after starting the transfusion, the patient complains of chills and back pain.What is the nurse's first action?

Accepted Answer

The nurse's first priority is to stop the blood transfusion.To keep the intravenous site patent, normal saline can be infused at a keep-open rate, but the tubing must be changed to avoid administering more blood as the saline flushes the blood from the tubing.If the tubing is not changed, additional blood will be administered, and the possible transfusion reaction will increase.The charge nurse or the primary care provider should be notified only after the patient has been assessed.

Question 20

A nurse is concerned about the type of blood that a patient is to receive.A patient with an O blood type may safely receive which type of blood?

Accepted Answer

People with type O blood have both A and B antibodies and therefore can receive only type O blood.People with type A blood have anti-B antibodies and therefore can receive only type A blood.People with type B blood have anti-A antibodies and therefore can receive only type B blood.People with type AB blood have neither antibody and therefore can receive all blood types.

Quiz 29: Blood Transfusions