ATI Blood Administration Test

1. A nurse is caring for a client who is about to receive a unit of packed RBC’s and states, “This is my third unit of blood today. I don’t want to get some disease from all this blood.” Which of the following responses should the nurse make? a. It is impossible for you to get an infection from donor blood b. Donated blood is carefully screened for infectious diseases c. The U.S. blood supply is among the safest in the world d. Why not ask your doctor about other treatment options Answer: b 2. A nurse is preparing to initiate the transfusion of a unit of packed RBC’s to a client. After the unit of blood has arrived, which of the following procedures will help the nurse protect the client against the possibility of a blood group incompatibility? a. Comparing the ID numbers on the blood unit with those on the order form and the client’s wristband b. Obtaining a blood sample from the client for typing and crossmatching c. Giving a prescribed pre-medication 30 minutes prior to starting the transfusion d. Observing the client for 15-30 minutes after the transfusion is initiated Answer: a 3. A nurse is caring for a client who is receiving a blood transfusion and reports itching. The nurse observes areas of urticaria on the client’s skin. Which of the following actions should the nurse take? a. Administer prescribed antipyretic b. Stop the blood transfusion c. Reevaluate the client in 15 minutes d. Apply a warm compress to the affected areas Answer: b 4. Which of the following actions should a nurse take prior to starting a blood transfusion? a. Establish intravenous access with a 22 gauge needle b. Prime an infusion set with lactated Ringer’s solution c. Ensure that informed consent has been obtained from the client d. Suggest that the client consider autologous transfusion Answer: c 5. A platelet transfusion is indicated for a patient who a. Has a systemic infection b. Has thrombocytopenia c. Is in hypovolemic shock d. Has hemolytic anemia Answer: b 6. A nurse is preparing a blood transfusion for a client who has type A blood. The nurse should know that the client can safely receive blood group O because a. Type O blood contains no A antigens b. Type A blood contains O antibodies c. Type O blood contains no A antibodies d. Type A blood contains O antigens Answer: a 7. A nurse started a transfusion of packed RBC’s for a client 1 hour ago. The client has suddenly developed shaking chills, muscle stiffness, and a temperature of 38.6 C (101.5 F). The client appears flushed and reports a headache and “nervousness.” The nurse should identify that the client has most likely developed which of the following types of transfusion reaction? A. Septic B. Acute hemolytic C. Allergic D. Febrile nonhemolytic Answer: d 8. When administering a transfusion of packed red blood cells, it is important to a. Allow the blood to warm to room temperature for 1 hour b. Make sure the entire unit is transfused within 4 hours c. Begin the blood transfusion at a rate of 10 mL/hr d. Change the blood tubing after every unit infused Answer: b 9. A nurse is providing education to a client who has a prescription for a blood transfusion. Which of the following statements should the nurse include in the teaching? a. I will check your vital signs every 15 minutes throughout the blood transfusion b. I might have a nursing assistant check on you periodically during the transfusion c. If you have no adverse effects in the first 15-30 minutes, you will not have any adverse effects later d. You must immediately report any symptoms like chills, nausea, or itching Answer: d 10. A client who is anticipating total hip replacement is considering autologous transfusion. When teaching this client about autologous transfusion, it is important to emphasize that a. It reduces the risk of mismatched blood b. A hemoglobin level about 9.5 mg/dL is required to receive this transfusion c. There is no need to test the blood for infectious diseases d. Donations can be made every other day Answer: a