Question 1

A nurse is administering a blood transfusion to a client on the oncology unit. Which clinical manifestation indicates an acute hemolytic reaction to the blood?

Accepted Answer

Answer reason: Acute hemolytic reactions often present early with lumbar/flank pain from hemoglobinuria and renal involvement.

Question 2

A client with B-positive blood is scheduled for a whole blood transfusion. Which finding requires nursing intervention?

Accepted Answer

Answer reason: Blood must be administered with 0.9% normal saline only; dextrose solutions (e.g., D5 1/2 NS) can cause hemolysis and clotting. A two-week storage time is acceptable; Rh-negative blood is safe for an Rh-positive recipient; type O-positive blood can be compatible with a B-positive recipient when crossmatched.

Question 3

The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurse's initial action?

Accepted Answer

Answer reason: Crackles and distended neck veins during a transfusion indicate circulatory overload (TACO). The initial priority is to slow the transfusion to reduce further fluid accumulation, then notify the provider and anticipate diuretics. Stopping the transfusion and running saline are reserved for acute transfusion reactions (e.g., hemolytic or allergic).

Question 4

After a blood transfusion, a patient develops shortness of breath and crackles in the lungs. Which medication would the nurse expect to administer?

Accepted Answer

Answer reason: Dyspnea and lung crackles after a transfusion indicate transfusion-associated circulatory overload with pulmonary edema; treat with a loop diuretic such as furosemide to remove excess fluid.

Question 5

The nurse is caring for a client with sickle cell disease who is scheduled to receive a unit of packed red blood cells. Which of the following is an appropriate action for the nurse when administering the infusion?

Accepted Answer

Answer reason: Packed RBCs must be completed within 4 hours to prevent bacterial growth and hemolysis. Blood should not be stored in a unit refrigerator. Fever or chills suggest a transfusion reaction requiring stopping the transfusion. Vital signs are monitored per policy (e.g., before, 15 minutes after the start, and periodically), not every 15 minutes throughout.

Question 6

Which of the following are indications for exchange blood transfusion?

Accepted Answer

Answer reason: Exchange transfusion is indicated for severe hemolysis from Rh/ABO incompatibility, for acute bilirubin encephalopathy (kernicterus), regardless of level, and for severe hyperbilirubinemia in preterm infants at high TSB thresholds (e.g., around 20 mg/dL). Thus, all listed options are correct.

Question 7

Which type of blood administration set should the nurse use for a client requiring postoperative blood replacement?

Accepted Answer

Answer reason: Postoperative reinfusion of shed blood requires a special leukocyte-reduction filter to remove leukocytes and microaggregates, thereby reducing febrile reactions and embolic risk. Routine micron-mesh filters are for standard donor blood; microdrip and nonfiltered sets are inappropriate.

Question 8

A client is receiving a blood transfusion following surgery. In the event of a transfusion reaction, any unused blood should be?

Accepted Answer

Answer reason: During a suspected transfusion reaction, the remaining blood product and tubing are returned to the blood bank for investigation; they are not discarded.

Question 9

What is the amount of blood withdrawn during each transfusion?

Accepted Answer

Answer reason: Exchange transfusion is done in small repeated aliquots to maintain stability; the standard amount withdrawn (and replaced) each time is 10 mL.

Question 10

Which is a complication of blood transfusion?

Accepted Answer

Answer reason: Stored blood leaks potassium from RBCs; rapid or large transfusions can cause hyperkalemia. Other options are not typical: citrate causes hypocalcemia (not hypercalcemia), hyponatremia and increased serum albumin are not standard complications.

Question 11

A delayed transfusion-related complication is?

Accepted Answer

Answer reason: Iron overload develops after repeated transfusions and is a delayed complication, whereas circulatory overload, septicemia, and hypocalcemia are acute reactions occurring during or soon after transfusion.

Question 12

A blood transfusion should be completed within four hours to?

Accepted Answer

Answer reason: Blood products should not hang longer than 4 hours because room-temperature exposure increases the risk of bacterial proliferation. The limit is not aimed at preventing hemolytic reactions, fluid overload, or hypothermia.

Question 13

What are the criteria for blood that is transfused during therapy?

Accepted Answer

Answer reason: Transfused blood must be properly cross-matched for compatibility and stored between 1–6 °C, not at body temperature. Routine use of blood

Question 14

Which of the following drug is used during Exchange blood transfusion?

Accepted Answer

Answer reason: During exchange transfusion, citrate in stored blood can cause hypocalcemia; calcium gluconate is administered to counteract citrate toxicity and prevent tetany and arrhythmias.

Question 15

What is the amount of blood is Replace during each time of transfusion?

Accepted Answer

Answer reason: During neonatal exchange transfusion, blood is withdrawn and replaced in small aliquots to maintain hemodynamic stability—typically about 5 mL at a time.

Question 16

The choice of treatment for pathological jaundice, when Risk of kernicterus?

Accepted Answer

Answer reason: In severe hyperbilirubinemia with risk of kernicterus, the treatment of choice is exchange blood transfusion to rapidly reduce unconjugated bilirubin. Phototherapy is for moderate levels; antibiotics or oxygen do not address bilirubin levels.

Question 17

A patient with haemophilia is brought to the emergency department after injuring his knee; the nurse should anticipate the need to administer?

Accepted Answer

Answer reason: Hemophilia A is a deficiency of factor VIII; acute bleeding (e.g., hemarthrosis after knee injury) is treated with infusion of factor VIII concentrate. RBCs or platelets do not correct the clotting defect, and FFP is less preferred when specific concentrates are available.

Question 18

Which vessels use during Exchange blood transfusion commonly?

Accepted Answer

Answer reason: Exchange transfusion in neonates is usually performed via an umbilical vein catheter because it provides reliable central access with fewer complications than umbilical arteries or jugular access.

Question 19

To verify the age of blood cells in a blood, the nurse will check which of the following?

Accepted Answer

Answer reason: The age of stored blood is determined by its storage time; the unit’s expiration date indicates how old the blood cells are. Blood type, group, and identification number do not indicate age.

Question 20

A client with cancer received platelet infusions 24 hours ago. Which of the following assessment findings would indicate the most therapeutic effect from the transfusions?

Accepted Answer

Answer reason: Platelets improve hemostasis and reduce bleeding. A decrease in oozing from the IV site shows improved clotting. Hgb rise reflects RBC transfusion, WBC count is unrelated, and a low-grade fever is not a therapeutic effect.

Question 21

The nurse is working in the trauma unit of the emergency room when a 24-year-old female is admitted after an MVA. The client is bleeding profusely and a blood transfusion is ordered. Which would the nurse be prepared to administer without a type and crossmatch?

Accepted Answer

Answer reason: O negative packed RBCs are the universal donor and can be given in emergencies without prior type and crossmatch, especially appropriate for women of childbearing age. AB types are universal recipients, not donors, and O positive is not universally safe due to Rh factor.

Question 22

After a nurse determines that a client is having a transfusion reaction and stops the transfusion, what action should the nurse take next?

Accepted Answer

Answer reason: After stopping the transfusion, the nurse should maintain IV access with normal saline using new tubing to keep the vein open and allow medications if needed. D5W is incompatible with blood, the IV should not be removed, and culturing the catheter tip is not indicated.

Question 23

What is the highest priority nursing intervention for a newly admitted patient receiving a blood transfusion?

Accepted Answer

Answer reason: Frequent vital-sign monitoring detects early transfusion reactions, which is the highest-priority safety action during blood administration. Teaching and documentation are important but not as urgent; warming blood is not routine.

Question 24

What is the priority action for a nurse monitoring a 35-year-old male patient receiving a blood transfusion who has a respiratory rate of 24 and blood pressure of 90/60?

Accepted Answer

Answer reason: Signs of a potential transfusion reaction (hypotension, tachypnea) require the nurse to stop the blood immediately to prevent further exposure, then maintain IV with normal saline and notify the provider/blood bank.

Question 25

What is the most appropriate initial nursing action for a patient receiving a blood transfusion who starts to exhibit fever, chills, and back pain?

Accepted Answer

Answer reason: Fever, chills, and back pain indicate a possible acute transfusion reaction; the priority is to immediately stop the transfusion to prevent further hemolysis/exposure, then maintain IV with normal saline and notify the provider.

Question 26

What a sign of a blood transfusion reaction?

Accepted Answer

Answer reason: Acute hemolytic transfusion reactions commonly present with sudden low back/flank pain due to hemolysis and renal involvement; sleepiness is not typical, and itching or headache can occur but are less specific.

Question 27

A client is receiving a blood transfusion and experiences shortness of breath and chest pain. What is the nurse's immediate action?

Accepted Answer

Answer reason: Shortness of breath and chest pain during a transfusion indicate a possible acute transfusion reaction. The first priority is to stop the transfusion to prevent further exposure and harm.

Question 28

Which blood test should be performed before a blood transfusion?

Accepted Answer

Answer reason: Pretransfusion ABO/Rh typing with crossmatch ensures donor-recipient compatibility and prevents hemolytic reactions; the other tests are not required specifically to ensure transfusion compatibility.

Question 29

During a transfusion, the nurse observes that the patient is becoming anxious and has developed urticaria; what type of reaction does this suggest?

Accepted Answer

Answer reason: Urticaria (hives) with anxiety during transfusion is characteristic of a mild allergic transfusion reaction. Febrile non-hemolytic reactions present with fever/chills, and anaphylaxis involves severe respiratory distress and hypotension.

Question 30

Which blood product is primarily used to increase oxygen-carrying capacity in patients with anemia?

Accepted Answer

Answer reason: Packed RBCs provide hemoglobin to carry oxygen, correcting anemia. Platelets treat thrombocytopenia, FFP replaces clotting factors, and cryoprecipitate provides fibrinogen/vWF.

Question 31

Under which condition should platelets not be administered?

Accepted Answer

Answer reason: Platelets are stored and administered at room temperature with gentle agitation. A cold platelet bag indicates improper storage leading to dysfunction; therefore, do not administer.

Question 32

In which of the following conditions is blood transfusion contraindicated?

Accepted Answer

Answer reason: Transfusion increases intravascular volume and can precipitate circulatory overload, which is dangerous in congestive cardiac failure. The other conditions are potential indications for blood products, not contraindications.

Question 33

A client with an aplastic sickle cell crisis is receiving a blood transfusion and begins to complain of "feeling hot". Almost immediately, the client begins to wheeze. The nurse's first ACTION is to?

Accepted Answer

Answer reason: Wheezing and feeling hot during a transfusion indicate a possible transfusion reaction. The priority is to stop the blood immediately to prevent further exposure; then keep the line open with saline, notify the provider, monitor vitals, and send samples.

Question 34

Which woman is not a candidate for RhoGam?

Accepted Answer

Answer reason: Rho(D) immune globulin is given to unsensitized Rh‑negative mothers after exposure to Rh‑positive fetal blood (e.g., delivery of an Rh+ infant, miscarriage, stillbirth). It is not indicated when both mother and infant are Rh negative.

Question 35

The following is true of patients who have received blood transfusions?

Accepted Answer

Answer reason: Risk of transfusion-transmitted infections increases with the number of exposures; options stating no risk for components, no HIV risk before 1981, or that hepatitis cannot be transmitted are false.

Question 36

A client with severe anemia is to receive a unit of whole blood. In the event of a transfusion reaction, the first action by the nurse should be to?

Accepted Answer

Answer reason: At the first sign of a transfusion reaction, the priority is to stop the transfusion to prevent further exposure to the offending blood and keep the vein open with normal saline using new tubing. Other actions follow after stopping the transfusion.

Question 37

The physician has ordered 2 units of whole blood for a client following surgery. To provide for client safety, the nurse should?

Accepted Answer

Answer reason: A Y-type blood administration set with an in-line filter and normal saline is the correct, safe equipment for transfusing whole blood. Separate consent for each unit is unnecessary, tubing does not have to be changed for every single unit, and verification is done by two qualified staff members—not three.

Question 38

What is 1 unit of blood in millilitres?

Accepted Answer

Answer reason: A standard unit of whole blood collected for transfusion is approximately 500 mL (including anticoagulant).

Question 39

The best size cathlon for administration of a blood transfusion to a six year old is?

Accepted Answer

Answer reason: A 20-gauge catheter is preferred for school-aged children to infuse blood products at appropriate rates while minimizing hemolysis and being easier to insert than an 18-gauge. A 22-gauge may be too small for optimal flow.

Question 40

What laboratory test is often performed to confirm hemolytic transfusion reaction?

Accepted Answer

Answer reason: The direct antiglobulin (Coombs) test detects antibodies bound to red blood cells and is used to confirm immune-mediated hemolysis after a transfusion reaction. CBC and electrolytes are nonspecific; blood cultures evaluate infection, not hemolysis.

Question 41

A client with B negative blood requires a blood transfusion during surgery. If no B negative blood is available, the client should be transfused with?

Accepted Answer

Answer reason: For RBC transfusion, a B negative client can receive B− or O−. O negative is the universal donor for packed RBCs and is safe when B− is unavailable; Rh-positive or type A/AB blood would be incompatible.

Question 42

Which type of transfusion reaction is characterized by hemolysis due to ABO incompatibility?

Accepted Answer

Answer reason: ABO incompatibility triggers an acute hemolytic transfusion reaction with rapid intravascular hemolysis.

Question 43

The cardiac nurse is preparing to administer one unit of blood to a client. Which interventions should the nurse implement? Rank in order of priority?

Accepted Answer

Answer reason: Correct priority sequence: 5 → 4 → 3 → 2 → 1. First obtain informed consent, then obtain baseline assessment (vital signs, lungs, skin), next establish IV and prime Y-tubing with normal saline, verify the unit with another nurse at the bedside, and finally begin the transfusion slowly for the first 15 minutes while monitoring.

Question 44

The nurse is caring for a client with B-Thalassemia major. Which therapy is used to treat Thalassemia?

Accepted Answer

Answer reason: Beta-thalassemia major is managed with regular blood transfusions to maintain adequate hemoglobin; iron therapy is contraindicated and oxygen/IV fluids do not treat the underlying anemia.

Question 45

For which of the following mother-baby pairs should the nurse review the Coomb's test in preparation for administering Rho (D) immune globulin within 72 hours of birth?

Accepted Answer

Answer reason: Rho(D) immune globulin is indicated postpartum when an Rh-negative mother delivers an Rh-positive infant (and the mother is not already sensitized), so the nurse should review the Coombs test in this pairing.

Question 46

A 52 year-old client is being transfused with one unit of packed cells. A half hour after the transfusion was initiated, the client complains of chills and a headache. The FIRST action of the nurse should be?

Accepted Answer

Answer reason: Chills and headache shortly after starting a transfusion indicate a possible transfusion reaction. The priority is to stop the transfusion immediately to prevent further antigen exposure, then notify the provider and follow protocol.

Question 47

What is the maximum flow rate of blood transfusion in drops per minute?

Accepted Answer

Answer reason: Blood transfusions are typically infused at 10–20 gtt/min; the safe maximum is 20 drops per minute to deliver the unit within time limits while avoiding circulatory overload.

Question 48

How often can a donor give blood?

Accepted Answer

Answer reason: Whole blood donation is typically allowed at 12-week (3-month) intervals to permit recovery of hemoglobin and iron stores and ensure donor safety.

Question 49

A nurse has administered several blood transfusions over three days to a 12 year-old client with Thalassemia. What lab value should the nurse monitor closely during this therapy?

Accepted Answer

Answer reason: In thalassemia, transfusions aim to maintain hemoglobin around 9–10 g/dL to suppress ineffective erythropoiesis and prevent splenomegaly; therefore hemoglobin is the critical lab to monitor.

Question 50

How much does one unit of fresh RBC transfusion increase the hematocrit value?

Accepted Answer

Answer reason: One unit of packed RBCs typically increases hemoglobin by about 1 g/dL and hematocrit by roughly 3%, making 3–4% the best choice.

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