Blood Transfusion (30 Questions)

1. You are caring for Mr. David Lamontagne, a 68-year-old patient diagnosed with anemia, scheduled to receive a transfusion of two units of packed red blood cells (PRBCs). You have just returned from the blood bank with the first unit.

Your assigned RN colleague is on a scheduled one-hour break and not available. A Licensed Practical Nurse (LPN) is present at the nurses’ station and offers to assist with the required double verification before the transfusion.

Question:
Can the LPN verify the blood product with you (the RN) before administration? *
2. Pierre Lefevre, a 74-year-old male with a history of congestive heart failure and chronic anemia, started receiving a blood transfusion 45 minutes ago. The nurse enters the room to assess him and notes that Pierre is flushed and dyspneic. Upon further assessment, the nurse auscultates the presence of crackles in the lung bases.

Question:
Mr. Lefevre is most likely experiencing which complication of blood transfusion therapy? *
3.1 Marie-Claire Dubois, a 58-year-old patient, is scheduled to receive a blood transfusion following surgery for gastrointestinal bleeding. You are reviewing blood bank supplies and note that the only available unit is AB+.

Question:
Which of the following patients can safely receive AB+ blood? *
3.2 She requires two units of packed red blood cells, and each unit contains 275 mL.

The LPN delivered the first unit at 12:45 PM, and you began the transfusion at 1:00 PM, following protocol to infuse the blood at 60 mL/h for the first 15 minutes to monitor for any transfusion reaction.

By 1:15 PM, there were no adverse reactions, and you are now ready to increase the rate to ensure the first unit is completed by 3:30 PM.

Question:
What should be the adjusted infusion rate (in mL/h) to ensure the transfusion is completed on time? *
3.3 At 1:30 PM, she reports feeling hot and flushed. Shortly after, she begins to experience intense itching, generalized hives (urticaria) on her arms and chest, and mild shortness of breath. Her face appears flushed, and she becomes anxious.

Vital signs:
Temperature: 38.1°C
Heart rate: 106 bpm
Blood pressure: 100/60 mmHg
Respirations: 24/min
Oxygen saturation: 94% on room air

Question:
What is the most appropriate action at this time? *
3.4 The following medical orders are in the chart:
-Diphenhydramine 25 mg IV PRN for allergic symptoms
-Acetaminophen 650 mg PO PRN for fever
-Notify physician for any transfusion reaction
-Send blood product and tubing to the lab if a reaction is suspected
-Collect urinalysis and serum hemolysis panel if needed

Question:
What is your next priority intervention? *
4. Mr. Dufresne, 67, is receiving a unit of packed red blood cells for symptomatic anemia following GI bleeding. The transfusion started 20 minutes ago. You remain at the bedside for the initial monitoring period. You note that his temperature increased from 37.1°C to 38.2°C, and he reports “feeling cold.” His BP remains stable at 128/76 mmHg, and no rash or dyspnea is observed. The transfusion tubing appears intact, and the blood bank label matches his ID.

Question:
What is the priority nursing action? *
5. Ms. Gauthier, 82, has heart failure (EF 32%) and is receiving a transfusion for anemia. The unit has been running for 1 hour. She now reports shortness of breath and a new cough. Auscultation reveals crackles at both lung bases, and her O2 saturation has dropped from 97% to 91%. The IV is running through a 20-gauge catheter with saline KVO.

Question:
What is the priority intervention? *
6. You prepare to transfuse a unit of RBCs to Mrs. Lamy, 40, hospitalized for symptomatic anemia. Another nurse comes to verify the blood. During the checks, you notice the hospital number on the blood bag differs by one digit from the patient’s ID bracelet. The patient is feeling anxious and wants the transfusion started quickly because she feels tired and dizzy.

Question:
What should the nurse do? *
7. Mr. Côté is scheduled to receive a transfusion for chronic kidney-related anemia. On assessment, you note that his IV site is slightly swollen with mild redness. The line flushes with resistance, and the patient reports discomfort. The transfusion is due to start in 10 minutes.

Question:
What is the nurse’s priority action? *
8. Mrs. Tremblay is prepared for a platelet transfusion before a surgical procedure. You have the correct blood product and have performed all verifications. When reviewing the chart, you notice that no baseline vital signs were documented within the last hour. The patient is stable and eager to proceed with surgery preparations.

Question:
What should the nurse do next? *
9. Mr. Samson is receiving RBCs for postoperative blood loss. Thirty minutes into the transfusion, he develops a rash on his chest and arms, but no dyspnea, wheezing, or hypotension. His vitals are stable. He says the itching is “very bothersome” but he otherwise feels fine.

Question:
What should the nurse do? *
10. You discharge Ms. Nguyen, who received a blood transfusion two days ago. She is now stable and ready for home. The physician instructs you to provide teaching about possible delayed hemolytic reactions. She asks what she should watch for in the coming days.

Question:
Which symptom should the nurse emphasize? *
11. Mr. Labelle is preparing for a transfusion. A student nurse assisting you asks whether she can prime the IV tubing with D5W because normal saline is running low on the unit. The patient already has an IV of D5W infusing at a slow rate for hydration.

Question:
What is the correct response? *
12. Ms. Renaud, 59, is scheduled to receive 1 unit of RBCs for symptomatic anemia. A new graduate is preparing the equipment and brings a regular IV tubing set with a 10-drop macrodrip chamber. The primary IV solution is normal saline and is running at 75 mL/hr. The blood product will arrive from the blood bank in 5 minutes. The new graduate asks if the tubing she selected is appropriate for the transfusion.

Question:
What instruction should the nurse give? *
13. Mr. Archambault, 72, is scheduled to receive platelets. The blood product arrives on the unit while you are assisting another patient with a fall. The transfusion cannot be started immediately. Your colleague places the platelets on the counter at room temperature, waiting for you to begin the infusion. You walk in and see that the product was delivered 25 minutes ago.

Question:
What is the appropriate action? *
14. Mrs. De Souza, 38, with A-positive blood type, is scheduled for an RBC transfusion post-hemorrhage. A student nurse asks whether she can transfuse O-positive blood if A-positive blood is unavailable in the moment. The blood bank technician confirms that both units are on hand, but asks which one should be requested.

Question:
What is the correct decision? *
15. Mr. Pelletier, 61, is receiving his second unit of RBCs for postoperative anemia. The transfusion started 2 hours ago and is running at the prescribed rate. During a routine check, you observe that he is slightly flushed and feels warm, with a temperature increase from 36.8°C to 37.4°C. His vital signs are otherwise unchanged, and he denies itching, chills, or discomfort. He is sitting comfortably and talking with his family.

Question:
What is the most appropriate action? *
16. Mrs. Landreville, 76, received 1 unit of RBCs for anemia. The transfusion completed successfully with no complications. The patient feels less fatigued and wants to rest. The nursing student assisting you asks what must be documented immediately after the transfusion is completed.

Question:
Which information is essential to include? *
17. Mr. Lavoie, 70, is receiving 1 unit of RBCs for chronic anemia related to CKD. The transfusion started 3 hours ago, running slowly because he reported mild anxiety earlier. The unit still has approximately 120 mL remaining. He is stable, watching TV, and denies any symptoms. The order allows transfusion over 4 hours maximum. You calculate that, at the current rate, the infusion will exceed the allowed timeframe by about 20 minutes.

Question:
What should the nurse do? *
18. Ms. Choquette, 55, has a history of mild allergic reactions during previous transfusions. The provider orders diphenhydramine 25 mg PO as a premedication. During preparation, a student nurse suggests starting the transfusion first and administering the medication “if symptoms appear later.” The medication has not yet been given, and the blood is ready at the bedside.

Question:
What is the correct nursing action? *
19. Mr. Morin, 29, is being transfused after a traumatic splenic injury with significant blood loss. He is pale, tachycardic, and receiving oxygen. The physician orders 2 units of RBCs to help stabilize him. A new nurse asks whether the blood must go through a blood warmer. The patient is not hypothermic and is not receiving blood rapidly through pressure devices.

Question:
What should the nurse answer? *
20. You’re preparing to transfuse RBCs to Mrs. Allard, 63, after a hysterectomy. The blood unit arrives from the blood bank, but just as you receive it, the patient is urgently transported to ultrasound for suspected internal bleeding. The care team tells you she will be gone approximately 40 minutes. The blood unit is currently at room temperature in your hands.

Question:
What should the nurse do? *
21. Mr. Dupont, 50, is receiving RBCs for anemia. The transfusion has been running for 1 hour without any symptoms. He suddenly tells you he needs to use the bathroom urgently. He can ambulate with assistance. The transfusion is running on a pole with a pump. There are no signs of reactions, and his vitals are stable.

Question:
What is the most appropriate nursing action? *
22. Ms. Delaney, 44, is admitted for severe anemia due to uterine fibroids. The physician has ordered 1 unit of RBCs. When you go to verify the patient’s chart, you notice that the consent form for blood transfusion is blank. The patient tells you she “remembers signing something earlier this morning,” but there is no documentation and no signed form in the chart or electronic record. The blood product is already prepared by the blood bank and ready to be delivered.

Question:
What should the nurse do first? *
23. Mr. Forest, 73, is receiving IV antibiotics (ceftriaxone) through a running primary IV line. The physician orders 1 unit of RBCs for symptomatic anemia. The patient only has one patent IV site. The unit of blood will arrive shortly, and the medication is still infusing. The student nurse asks whether the transfusion can run through the same line as long as both fluids are piggybacked together.

Question:
What is the correct nursing action? *
24. Mme. Roseline Dupont, 58 years old, was admitted for community-acquired pneumonia and has been receiving IV ceftriaxone every 24 hours through a single peripheral IV line (#20 gauge) in the left forearm. Her condition has recently worsened; she is now pale, fatigued, and short of breath on minimal exertion. Blood work shows her hemoglobin has dropped to 68 g/L, and the physician has prescribed one unit of packed red blood cells (PRBCs) to be transfused within the next two hours.

At this moment, her scheduled dose of IV ceftriaxone is infusing, and it must continue to completion to ensure therapeutic coverage. The unit of PRBCs has already arrived on the unit. Mme. Dupont is hemodynamically stable, afebrile, and shows no signs of transfusion reaction or access complications. Her only IV is currently occupied with the antibiotic infusion.

Question:
As the nurse, what is the priority action? *
25. Mrs. Habib, 31, is admitted with severe postpartum anemia (Hgb 63 g/L). She is pale, weak, and dizzy. A transfusion is started, and she appears stable. Thirty minutes later, the physician requests that the unit be completed within 2 hours due to OR scheduling for another procedure. You calculate the current rate and determine it will take 3.5 hours at the present speed. The patient has no symptoms of a reaction and maintains stable vitals.

Question:
What should the nurse do? *
26. Mr. Rousseau, 57, is about to receive his first blood transfusion. He is stable but anxious, asking what he should watch for once the transfusion begins. You prepare to start the unit and want to teach him which symptoms he must report immediately during the infusion.

Question:
What symptom should you emphasize as requiring urgent reporting? *
27. Mr. Giroux, 66, is receiving RBCs through a standard blood administration set with a filter. After 45 minutes, you notice that the transfusion has slowed significantly, even though the pump rate has not changed. The drip chamber shows difficulty in maintaining flow, and the patient remains asymptomatic. You inspect the tubing and suspect that the filter is becoming clogged due to the viscosity of the product.

Question:
What should the nurse do? *