Blood Transfusion Q and A
QUESTIONS
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.
2. A client is receiving packed red blood cells intravenously through a double-lumen peripherally inserted central catheter (PICC) line. During the transfusion, the nurse receives a new prescription to begin amphotericin B IVPB. What is the nurse's best action?
A. Administer amphotericin B through the unused lumen of the PICC line
B. Insert a peripheral IV line to begin infusion of amphotericin B
C. Interrupt the blood transfusion to infuse amphotericin B, then resume after infusion
D. Wait 1 hour after transfusion finishes before administering amphotericin B
3. 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 38.2°C. 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.
4. 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.
5. 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
6. 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
7. 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.
8. 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
9. 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
10. 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-
11. A nurse has an order to transfuse a unit of packed red blood cells to a client but does not currently have an IV line inserted when obtaining supply to start IV infusion the nurse selects an Angiocatheter with the size of:
A.18 gauge
B.21 gauge
C.22 gauge
D.24 gauge
12. The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy?
A. Bacteriemia.
B. Hypovolemia.
C. Fluid overload
D. Transfusion reaction
13. A client has experienced a rash with pruritus during previous blood transfusions. The client asks the nurse whether it is safe to receive another transfusion. In formulating a response, the nurse incorporates the understanding that which medication will most likely be prescribed before the transfusion is begun?
A. Ibuprofen (Motrin)
B. Acetaminophen (Tylenol)
C. Diphenhydramine (Benadryl)
D. Acetylsalicylic Acid (ASA Aspirin)
14. 52-year-old woman is admitted with a new diagnosis of gastrointestinal (GI) bleed. The physician has ordered the client to receive 2 units of packed red blood cells (PRBCs) for a hemoglobin (Hgb) of 6.8g/dL. The nurse begins the infusion of the first unit at 100mL/hr. Firfteen minutes after the start of the infusion, the client complains that she is feeling chilled, is short of breath, and is experiencing lumbar pain rated 8 on a 1-10 scale. Which of the following should be the nurse's FIRST action.
A. Obtain vital signs and notify the physician of potential reaction
B. Slow the infusion to 75mL/hr and reassess in 15 minutes
C. Stop the infusion and run normal saline (NS) to keep the vein open (KVO)
D. Administer PRN pain medication as ordered, apply oxygen at 2 L/min, and provide an additional blanket
15. The nurse is preparing to initiate a blood transfusion. The client has a peripheral intravenous infusion in their left arm that the physician has ordered not be slowed or rate reduced. The nurse prepares to start another line in the right arm. The client asks the nurse to use the existing site to avoid the trauma of having another line started. Which of the following statements by the nurse is correct?
A. "That will be fine"
B. "I will need to infuse the blood through a separate IV line."
C. "I will let the physician know about your preferences."
D. "We will need to assess the line before I can make a determination about your request."
16. You are taking care of a patient in the medical ward who has heart failure and a hemoglobin level of 87 g/L. A blood transfusion has been prescribed and is currently in progress, expected to finish in an hour. The doctor has requested a coronary angiography, and an appointment has been scheduled for the exam in 30 minutes.
Q: What should you do?
A. Wait until the transfusion is finished and postpone the coronary angiography.
B. Stop the transfusion 30 minutes before its completion to send the patient for the coronary angiography.
C. Accompany the patient to the exam to monitor the transfusion and keep it running until it finishes.
D. Increase the transfusion rate so it finishes in 30 minutes.
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ANSWERS
B. obtain a new y-tubing set for this unit of blood. 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.
D. Wait 1 hour after transfusion finishes before administering amphotericin B A/B. Although starting a peripheral IV line or using the unused lumen of the peripherally inserted central catheter line would prevent mixing the drug with the blood products, it would not help distinguish the onset of potentially fatal sequela from either component C. Transfusions should not be interrupted after initiation except in cases of transfusion-related reactions or fluid overload. In addition, interrupting and restarting transfusions increases the risk for infection. Blood products should be transfused within 4 hours of removal from refrigeration. D. At least one hour should be allowed between completion of a blood transfusion and administration of amphotericin B. The adverse effects of a transfusion-related reaction and an adverse reaction from amphotericin B are similar, and the observation time allows the nurse to distinguish the triggering event if symptoms develop.
C. Notify the physician before starting the transfusion. The patient has an elevated temperature. Any temperature greater than 38°C (before the administration of the blood) the physician should be notified.
D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. 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.
A. Only NORMAL SALINE is compatible with blood.
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!
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.
C. The blood must be started within 30 minutes.
D. For ORAL medications you will administer the medications 30 minutes before starting the transfusion.
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.
A. The IV catheter used for a blood transfusion should be at least 18 or 19 gauge compared with the IV solution, blood has a thicker and stickier consistency, and use of an 18 or 19 gauge catheter will ensure that the bore of the catheter is large enough to prevent damage to the blood cells.
C. With fluid overload, the client has the presence of crackles in addition to dyspnea. An allergic reaction, a type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not complication of blood transfusions. With bacteriemia, the client would have fever, a symptom not presented.
C. An urticarial reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine such as diphenhydramine. Acetaminophen and ASA are analgesics and ibuprofen is a NSAID
C. The symptoms of feeling chilled, being short of breath, and having back pain coudl indicate an acute hemolytic reaction. This medical emergency requires swift action on the part of the nurse, including immediately discontinuing the infusion, flushing the IV site, and saving the unit of blood in question for testing.
B. A blood infusion must be administered via a separate IV line. The other responses indicate to the client their request is being considered.
C. Accompany the patient to the exam to monitor the transfusion and keep it running until it finishes. As a nurse, you should ensure continuous monitoring of the patient during both the transfusion and the procedure. By accompanying the patient, you can monitor for any adverse reactions and ensure the transfusion is completed safely. This aligns with both patient safety and adherence to the physician’s orders. A. Wait until the transfusion is finished and postpone the coronary angiography. While patient safety is a priority, postponing the procedure is not within the nurse's scope of decision-making. The physician has ordered both the transfusion and the coronary angiography, indicating the need for both interventions within a specific timeframe. B. Stop the transfusion 30 minutes before its completion to send the patient for the coronary angiography. Stopping the transfusion prematurely can be harmful as the patient may not receive the full benefit of the blood transfusion. Additionally, stopping and starting a transfusion increases the risk of infection and other complications. D. Increase the transfusion rate so it finishes in 30 minutes. Increasing the transfusion rate can lead to complications such as fluid overload, especially in a patient with heart failure. Blood transfusions should be administered at a controlled rate to ensure patient safety.
