ATI Blood Administration: Comprehensive Nursing Study Guide
Covering Safe Blood Transfusion Practices, Blood Components and
Products, Pre-Transfusion Assessments, Step-by-Step Administration
Procedures, Vital Sign Monitoring, Transfusion Reaction Recognition
and Management, Patient Safety Protocols, Nursing Interventions,
Clinical Skills Review, and NCLEX-RN Exam Preparation Strategies
1. A nurse is preparing to administer a blood transfusion. Which of the following
actions should the nurse take first?
A. Obtain the client's baseline vital signs.
B. Verify the provider's prescription for the blood product.
C. Check the client's blood type with another nurse.
D. Prime the IV tubing with 0.9% sodium chloride.
Answer: B. Verify the provider's prescription for the blood product.
Rationale: Before any procedure, the nurse must first verify the provider's order
to ensure the correct blood product, dose, and route are prescribed. This is the
foundational step to prevent errors. Checking the prescription precedes all other
actions.
2. A nurse is preparing to administer packed RBCs to a client. Which of the
following actions is essential to verify before starting the infusion?
A. Check the client's blood pressure every 15 minutes.
B. Verify the client's blood type and crossmatch with another licensed nurse.
C. Ensure the client has a patent IV line.
D. Administer prescribed premedications.
Answer: B. Verify the client's blood type and crossmatch with another licensed
nurse.
Rationale: The final verification of the client's identity, blood type, and the unit's
compatibility is the most critical safety step to prevent ABO incompatibility and a
fatal hemolytic reaction. This two-person verification is a standard safety
protocol.
3. A client is to receive a blood transfusion. The nurse should obtain which of
the following from the client before the transfusion?
A. A signed informed consent.
,B. A blood sample for type and crossmatch.
C. A baseline set of vital signs.
D. All of the above.
Answer: D. All of the above.
Rationale: All three actions are required before a blood transfusion. Informed
consent is a legal requirement, a type and crossmatch ensures compatibility, and
baseline vital signs provide a reference for monitoring for a reaction.
4. When performing the two-person verification at the bedside, which of the
following should the nurses compare?
A. The patient's room number with the blood bag label.
B. The patient's name and medical record number with the blood bag label and
order form.
C. The patient's diagnosis with the prescribed blood product.
D. The patient's date of birth with the blood bag expiration date.
Answer: B. The patient's name and medical record number with the blood bag
label and order form.
Rationale: Two patient identifiers (name and medical record number) must be
matched against the information on the blood bag label and the provider's order
form to ensure the right blood is given to the right patient.
5. The nurse is preparing to administer a unit of blood. The blood bank has sent
a unit of O-negative blood for a client who is A-positive. What action should the
nurse take?
A. Administer the blood as O-negative is the universal donor.
B. Return the blood to the bank and request A-positive blood.
C. Check the client's consent form for a special request.
D. Call the provider to clarify the order.
Answer: A. Administer the blood as O-negative is the universal donor.
Rationale: Type O-negative blood has no A, B, or Rh antigens and can be safely
given to clients of any blood type. For an A-positive client, O-negative blood is
compatible.
6. The nurse is reviewing a client's laboratory results before a transfusion.
Which of the following results is the best indicator that the client may benefit
,from a transfusion of packed red blood cells?
A. Platelet count of 50,000/mm³
B. Hemoglobin level of 7.2 g/dL
C. White blood cell count of 12,000/mm³
D. Hematocrit of 45%
Answer: B. Hemoglobin level of 7.2 g/dL.
Rationale: A low hemoglobin level (typically < 7-8 g/dL) is a primary indication for
a packed red blood cell transfusion to improve the blood's oxygen-carrying
capacity.
7. A nurse is preparing to administer a blood transfusion. Which of the following
IV solutions should the nurse use to prime the blood administration set?
A. 5% Dextrose in Water (D5W)
B. 0.9% Sodium Chloride (Normal Saline)
C. Lactated Ringer's (LR)
D. 0.45% Sodium Chloride (Half Normal Saline)
Answer: B. 0.9% Sodium Chloride (Normal Saline).
Rationale: Only 0.9% sodium chloride is compatible with blood products. Other
solutions like D5W or LR can cause hemolysis or clotting of the blood due to their
calcium content or hypotonicity.
8. The nurse is inspecting a unit of packed RBCs before administration. Which of
the following findings indicates the unit should NOT be transfused?
A. The unit is at room temperature.
B. The unit has a few small air bubbles.
C. The unit appears cloudy and has a purple discoloration.
D. The unit is labeled with the client's name.
Answer: C. The unit appears cloudy and has a purple discoloration.
Rationale: Cloudiness, purple color, white particulate matter, or clumping in the
blood bag are signs of contamination or hemolysis. The unit must be returned to
the blood bank immediately and not administered.
9. A nurse is preparing to administer a blood transfusion. The client asks, "What
is the most important thing I should do during the transfusion?" What is the
nurse's best response?
, A. "You should remain still to prevent the IV from dislodging."
B. "You should immediately report any symptoms like chills, itching, or shortness
of breath."
C. "You should drink plenty of fluids to prevent dehydration."
D. "You should notify me if you feel the need to use the bathroom."
Answer: B. "You should immediately report any symptoms like chills, itching, or
shortness of breath."
Rationale: The client must be educated to report subjective symptoms (chills,
nausea, itching, chest/back pain) immediately, as these can be early signs of a
transfusion reaction. This allows for prompt intervention.
10. The nurse is preparing the blood administration set. What is the first step?
A. Open the roller clamp to prime the tubing.
B. Spike the 0.9% sodium chloride bag.
C. Close all clamps on the Y-tubing.
D. Attach the tubing to the patient's IV site.
Answer: C. Close all clamps on the Y-tubing.
Rationale: Before spiking any bags, the nurse must ensure all clamps on the Y-
type administration set are closed to prevent accidental fluid flow and maintain a
sterile field.
11. A nurse is preparing a blood transfusion for a client. The client has a history
of allergic reactions to transfusions. Which of the following premedications is
most likely to be prescribed?
A. Furosemide (Lasix)
B. Acetaminophen (Tylenol)
C. Diphenhydramine (Benadryl)
D. Meperidine (Demerol)
Answer: C. Diphenhydramine (Benadryl).
Rationale: Diphenhydramine is an antihistamine and is commonly prescribed as a
premedication to prevent or minimize mild allergic reactions to blood products.
12. The nurse is about to initiate a blood transfusion. The client's baseline vital
signs are: BP 118/72, HR 88, RR 16, Temp 98.6°F (37°C). How soon after starting
the transfusion should the nurse plan to reassess the client's vital signs?
Covering Safe Blood Transfusion Practices, Blood Components and
Products, Pre-Transfusion Assessments, Step-by-Step Administration
Procedures, Vital Sign Monitoring, Transfusion Reaction Recognition
and Management, Patient Safety Protocols, Nursing Interventions,
Clinical Skills Review, and NCLEX-RN Exam Preparation Strategies
1. A nurse is preparing to administer a blood transfusion. Which of the following
actions should the nurse take first?
A. Obtain the client's baseline vital signs.
B. Verify the provider's prescription for the blood product.
C. Check the client's blood type with another nurse.
D. Prime the IV tubing with 0.9% sodium chloride.
Answer: B. Verify the provider's prescription for the blood product.
Rationale: Before any procedure, the nurse must first verify the provider's order
to ensure the correct blood product, dose, and route are prescribed. This is the
foundational step to prevent errors. Checking the prescription precedes all other
actions.
2. A nurse is preparing to administer packed RBCs to a client. Which of the
following actions is essential to verify before starting the infusion?
A. Check the client's blood pressure every 15 minutes.
B. Verify the client's blood type and crossmatch with another licensed nurse.
C. Ensure the client has a patent IV line.
D. Administer prescribed premedications.
Answer: B. Verify the client's blood type and crossmatch with another licensed
nurse.
Rationale: The final verification of the client's identity, blood type, and the unit's
compatibility is the most critical safety step to prevent ABO incompatibility and a
fatal hemolytic reaction. This two-person verification is a standard safety
protocol.
3. A client is to receive a blood transfusion. The nurse should obtain which of
the following from the client before the transfusion?
A. A signed informed consent.
,B. A blood sample for type and crossmatch.
C. A baseline set of vital signs.
D. All of the above.
Answer: D. All of the above.
Rationale: All three actions are required before a blood transfusion. Informed
consent is a legal requirement, a type and crossmatch ensures compatibility, and
baseline vital signs provide a reference for monitoring for a reaction.
4. When performing the two-person verification at the bedside, which of the
following should the nurses compare?
A. The patient's room number with the blood bag label.
B. The patient's name and medical record number with the blood bag label and
order form.
C. The patient's diagnosis with the prescribed blood product.
D. The patient's date of birth with the blood bag expiration date.
Answer: B. The patient's name and medical record number with the blood bag
label and order form.
Rationale: Two patient identifiers (name and medical record number) must be
matched against the information on the blood bag label and the provider's order
form to ensure the right blood is given to the right patient.
5. The nurse is preparing to administer a unit of blood. The blood bank has sent
a unit of O-negative blood for a client who is A-positive. What action should the
nurse take?
A. Administer the blood as O-negative is the universal donor.
B. Return the blood to the bank and request A-positive blood.
C. Check the client's consent form for a special request.
D. Call the provider to clarify the order.
Answer: A. Administer the blood as O-negative is the universal donor.
Rationale: Type O-negative blood has no A, B, or Rh antigens and can be safely
given to clients of any blood type. For an A-positive client, O-negative blood is
compatible.
6. The nurse is reviewing a client's laboratory results before a transfusion.
Which of the following results is the best indicator that the client may benefit
,from a transfusion of packed red blood cells?
A. Platelet count of 50,000/mm³
B. Hemoglobin level of 7.2 g/dL
C. White blood cell count of 12,000/mm³
D. Hematocrit of 45%
Answer: B. Hemoglobin level of 7.2 g/dL.
Rationale: A low hemoglobin level (typically < 7-8 g/dL) is a primary indication for
a packed red blood cell transfusion to improve the blood's oxygen-carrying
capacity.
7. A nurse is preparing to administer a blood transfusion. Which of the following
IV solutions should the nurse use to prime the blood administration set?
A. 5% Dextrose in Water (D5W)
B. 0.9% Sodium Chloride (Normal Saline)
C. Lactated Ringer's (LR)
D. 0.45% Sodium Chloride (Half Normal Saline)
Answer: B. 0.9% Sodium Chloride (Normal Saline).
Rationale: Only 0.9% sodium chloride is compatible with blood products. Other
solutions like D5W or LR can cause hemolysis or clotting of the blood due to their
calcium content or hypotonicity.
8. The nurse is inspecting a unit of packed RBCs before administration. Which of
the following findings indicates the unit should NOT be transfused?
A. The unit is at room temperature.
B. The unit has a few small air bubbles.
C. The unit appears cloudy and has a purple discoloration.
D. The unit is labeled with the client's name.
Answer: C. The unit appears cloudy and has a purple discoloration.
Rationale: Cloudiness, purple color, white particulate matter, or clumping in the
blood bag are signs of contamination or hemolysis. The unit must be returned to
the blood bank immediately and not administered.
9. A nurse is preparing to administer a blood transfusion. The client asks, "What
is the most important thing I should do during the transfusion?" What is the
nurse's best response?
, A. "You should remain still to prevent the IV from dislodging."
B. "You should immediately report any symptoms like chills, itching, or shortness
of breath."
C. "You should drink plenty of fluids to prevent dehydration."
D. "You should notify me if you feel the need to use the bathroom."
Answer: B. "You should immediately report any symptoms like chills, itching, or
shortness of breath."
Rationale: The client must be educated to report subjective symptoms (chills,
nausea, itching, chest/back pain) immediately, as these can be early signs of a
transfusion reaction. This allows for prompt intervention.
10. The nurse is preparing the blood administration set. What is the first step?
A. Open the roller clamp to prime the tubing.
B. Spike the 0.9% sodium chloride bag.
C. Close all clamps on the Y-tubing.
D. Attach the tubing to the patient's IV site.
Answer: C. Close all clamps on the Y-tubing.
Rationale: Before spiking any bags, the nurse must ensure all clamps on the Y-
type administration set are closed to prevent accidental fluid flow and maintain a
sterile field.
11. A nurse is preparing a blood transfusion for a client. The client has a history
of allergic reactions to transfusions. Which of the following premedications is
most likely to be prescribed?
A. Furosemide (Lasix)
B. Acetaminophen (Tylenol)
C. Diphenhydramine (Benadryl)
D. Meperidine (Demerol)
Answer: C. Diphenhydramine (Benadryl).
Rationale: Diphenhydramine is an antihistamine and is commonly prescribed as a
premedication to prevent or minimize mild allergic reactions to blood products.
12. The nurse is about to initiate a blood transfusion. The client's baseline vital
signs are: BP 118/72, HR 88, RR 16, Temp 98.6°F (37°C). How soon after starting
the transfusion should the nurse plan to reassess the client's vital signs?
