2024 /2025 | © copyright | This work may not be copied for profit gain Excel!
CCRN -- Immune/Hematology Questions and
Correct Answers | Latest Update
A 52-year-old man returns to the hospital 2 weeks after being discharged from an
admission for upper gastrointestinal bleed. He has been vomiting bright red blood for the
past 24 hours. Laboratory parameters reveal a hemoglobin of 6 g/dL and a hematocrit of
20%. Vital signs are blood pressure 90/60 mm Hg; heart rate 120 beats/min and regular; and
respiratory rate 22 breaths/min and shallow. He has received two units of red blood cells
(RBCs) in the emergency department. The physician has ordered four more units of RBCs.
Which two lab values must be carefully monitored in this patient?
a. Calcium and potassium
b. BUN and Cr
c. Bilirubin and amylase
d. sodium and magnesium
✓ -:- a. Calcium and potassium
RATIONALE:
Patients receiving multiple transfusions must be monitored closely for hyperkalemia because
stored blood has a high potassium content resulting from aging and hemolysis of RBCs.
Hypocalcemia is a potential problem because citrate used as an anticoagulant in banked
1|P a g e | G r a d e A + | 2 0 2 0 2 5
,2024 /2025 | © copyright | This work may not be copied for profit gain Excel!
blood binds with calcium. This prevents clot formation and reduces the calcium level in the
banked blood.
TEST-TAKING STRATEGY:
Because the question relates to a patient receiving multiple units of banked blood, consider
which problems are related to this situation. The kidney can be affected by hemoglobinemia
in transfusion reactions, but symptoms of a transfusion reaction are not in this case study,
so eliminate option b. Option c might be considered later because hepatitis C (non-A/non-
B) can occur with multiple transfusions and would elevate bilirubin, but this would not be
evident acutely, so eliminate option c. Of the electrolytes listed in options a and d, the ones
that you should associate most with potential complications of blood transfusion are calcium
and potassium. Choose option a.
A 52-year-old patient with a history of alcoholism is admitted with massive esophageal
bleeding. After infusion of several liters of normal saline, the crossmatched blood is now
available. A nursing action that can prevent a transfusion reaction is to:
a. obtain a detailed transfusion history
b. monitor vs q15min after starting the transfusion
c. administer histamines before initiating the blood transfusion
2|P a g e | G r a d e A + | 2 0 2 0 2 5
, 2024 /2025 | © copyright | This work may not be copied for profit gain Excel!
d. check the patient's identification and blood type w/the blood identification and type
carefully
✓ -:- d. check the patient's identification and blood type w/the blood
identification and type carefully
RATIONALE:
To prevent a transfusion reaction, the nurse must ensure that the correctly typed and
crossmatched blood is administered.
TEST-TAKING STRATEGY:
The key phrase is to prevent a transfusion reaction. Option a would help to identify the
patient who would be more likely to have a transfusion reaction. Option b would aid in
early detection of a transfusion reaction. Option c would decrease the severity of a
transfusion reaction should it occur. Only ensuring that the correct blood is given to the
correct patient will prevent a reaction. Choose option d.
A 50-year-old patient is transferred to the critical care unit from the emergency
department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction
to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his
3|P a g e | G r a d e A + | 2 0 2 0 2 5
CCRN -- Immune/Hematology Questions and
Correct Answers | Latest Update
A 52-year-old man returns to the hospital 2 weeks after being discharged from an
admission for upper gastrointestinal bleed. He has been vomiting bright red blood for the
past 24 hours. Laboratory parameters reveal a hemoglobin of 6 g/dL and a hematocrit of
20%. Vital signs are blood pressure 90/60 mm Hg; heart rate 120 beats/min and regular; and
respiratory rate 22 breaths/min and shallow. He has received two units of red blood cells
(RBCs) in the emergency department. The physician has ordered four more units of RBCs.
Which two lab values must be carefully monitored in this patient?
a. Calcium and potassium
b. BUN and Cr
c. Bilirubin and amylase
d. sodium and magnesium
✓ -:- a. Calcium and potassium
RATIONALE:
Patients receiving multiple transfusions must be monitored closely for hyperkalemia because
stored blood has a high potassium content resulting from aging and hemolysis of RBCs.
Hypocalcemia is a potential problem because citrate used as an anticoagulant in banked
1|P a g e | G r a d e A + | 2 0 2 0 2 5
,2024 /2025 | © copyright | This work may not be copied for profit gain Excel!
blood binds with calcium. This prevents clot formation and reduces the calcium level in the
banked blood.
TEST-TAKING STRATEGY:
Because the question relates to a patient receiving multiple units of banked blood, consider
which problems are related to this situation. The kidney can be affected by hemoglobinemia
in transfusion reactions, but symptoms of a transfusion reaction are not in this case study,
so eliminate option b. Option c might be considered later because hepatitis C (non-A/non-
B) can occur with multiple transfusions and would elevate bilirubin, but this would not be
evident acutely, so eliminate option c. Of the electrolytes listed in options a and d, the ones
that you should associate most with potential complications of blood transfusion are calcium
and potassium. Choose option a.
A 52-year-old patient with a history of alcoholism is admitted with massive esophageal
bleeding. After infusion of several liters of normal saline, the crossmatched blood is now
available. A nursing action that can prevent a transfusion reaction is to:
a. obtain a detailed transfusion history
b. monitor vs q15min after starting the transfusion
c. administer histamines before initiating the blood transfusion
2|P a g e | G r a d e A + | 2 0 2 0 2 5
, 2024 /2025 | © copyright | This work may not be copied for profit gain Excel!
d. check the patient's identification and blood type w/the blood identification and type
carefully
✓ -:- d. check the patient's identification and blood type w/the blood
identification and type carefully
RATIONALE:
To prevent a transfusion reaction, the nurse must ensure that the correctly typed and
crossmatched blood is administered.
TEST-TAKING STRATEGY:
The key phrase is to prevent a transfusion reaction. Option a would help to identify the
patient who would be more likely to have a transfusion reaction. Option b would aid in
early detection of a transfusion reaction. Option c would decrease the severity of a
transfusion reaction should it occur. Only ensuring that the correct blood is given to the
correct patient will prevent a reaction. Choose option d.
A 50-year-old patient is transferred to the critical care unit from the emergency
department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction
to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his
3|P a g e | G r a d e A + | 2 0 2 0 2 5
