IV IV Nutrition & Blood Products 1 — Questions and Answers
Question 1: Which central vein placement is required for the administration of total parenteral nutrition (TPN) with dextrose concentrations greater than 10%?
- Basilic vein
- Cephalic vein
- Superior vena cava (Correct answer)
- Femoral vein
Correct answer: Superior vena cava
TPN with dextrose >10% requires central venous placement (tip at the superior vena cava–right atrial junction) to allow high-flow dilution and prevent thrombophlebitis.
Question 2: Before administering a unit of packed red blood cells (PRBCs), the nurse must verify the blood product with another licensed nurse. Which information must be matched?
- Only the patient's name and blood type
- Patient name, ID number, ABO/Rh type, unit number, expiration date, and any special processing requirements (Correct answer)
- Blood unit expiration date only
- Only the physician order and patient allergies
Correct answer: Patient name, ID number, ABO/Rh type, unit number, expiration date, and any special processing requirements
Pre-transfusion verification requires two licensed nurses to confirm patient identity, ABO/Rh compatibility, unit number, expiration date, and special processing to prevent hemolytic reactions.
Question 3: What is the maximum time a unit of packed red blood cells should hang and infuse once it leaves the blood bank?
- 2 hours
- 4 hours (Correct answer)
- 6 hours
- 8 hours
Correct answer: 4 hours
PRBCs must be infused within 4 hours of leaving the blood bank refrigerator; beyond this, bacterial proliferation risk rises significantly.
Question 4: Which IV solution is compatible for co-administration with packed red blood cells through a Y-type blood administration set?
- Lactated Ringer's solution
- 5% dextrose in water (D5W)
- Normal saline (0.9% NaCl) (Correct answer)
- Ringers with 5% dextrose
Correct answer: Normal saline (0.9% NaCl)
Only normal saline (0.9% NaCl) is compatible with blood products; dextrose solutions cause RBC hemolysis and calcium-containing solutions (LR) promote clotting.
Question 5: A patient receiving TPN develops hyperglycemia. Which nursing action is the first priority?
- Discontinue TPN immediately
- Notify the prescriber and monitor blood glucose per protocol; expect insulin order adjustment (Correct answer)
- Increase the TPN infusion rate to dilute the glucose concentration
- Administer oral glucose tablets to balance the IV glucose
Correct answer: Notify the prescriber and monitor blood glucose per protocol; expect insulin order adjustment
TPN-induced hyperglycemia requires notifying the prescriber for insulin adjustment and frequent glucose monitoring; abrupt TPN discontinuation can cause rebound hypoglycemia.
Question 6: Which filter is required when administering platelet transfusions?
- 0.2-micron in-line filter
- Standard 170–260 micron blood filter (Correct answer)
- 1.2-micron lipid-compatible filter
- No filter is needed for platelets
Correct answer: Standard 170–260 micron blood filter
Platelets must be transfused through a standard 170–260 micron blood filter to remove clots and debris; 0.2-micron filters trap platelets and are contraindicated.
IV IV Nutrition & Blood Products 1
Which central vein placement is required for the administration of total parenteral nutrition (TPN) with dextrose concentrations greater than 10%?