CRNI Blood Component Transfusion Questions and Answers

Question 1

A patient receiving a unit of packed red blood cells (PRBCs) begins to complain of flank pain, chills, and shortness of breath 20 minutes after the transfusion was initiated. The CRNI notes the patient's temperature has risen to 101.5°F (38.6°C). What is the CRNI's PRIORITY action?

Accepted Answer

Stop the transfusion immediately and disconnect the tubing.

Answer

The patient is exhibiting classic signs of an acute hemolytic transfusion reaction (AHTR), a life-threatening emergency. The absolute first priority is to stop the infusion of the incompatible blood to prevent further hemolysis and end-organ damage. After stopping the transfusion, the nurse should maintain IV access with normal saline, notify the provider and blood bank, and monitor the patient closely.

Question 2

A CRNI is preparing to administer a blood component. Which intravenous solution is the only one considered compatible for priming blood administration tubing and infusing concurrently with packed red blood cells?

Accepted Answer

0.9% Sodium Chloride

Answer

0.9% Sodium Chloride (Normal Saline) is the only solution compatible with blood components. It is an isotonic solution that will not damage the red blood cells. Dextrose solutions (like D5W) can cause hemolysis, and solutions containing calcium (like Lactated Ringer's) can chelate the citrate anticoagulant in the blood product, leading to clot formation in the tubing.

Question 3

An elderly patient with a history of congestive heart failure is receiving a unit of PRBCs. The nurse assesses the patient and notes new onset of a dry cough, dyspnea, and bilateral crackles in the lung bases. The patient's blood pressure is 160/92 mmHg, an increase from 134/80 mmHg pre-transfusion. The CRNI should suspect which transfusion-related complication?

Accepted Answer

Transfusion-Associated Circulatory Overload (TACO)

Answer

The patient's clinical presentation, including dyspnea, crackles, cough, and hypertension, in the context of a history of heart failure, is classic for Transfusion-Associated Circulatory Overload (TACO). This occurs when the patient's cardiovascular system is unable to manage the additional fluid volume from the transfusion. TRALI typically presents with hypotension, not hypertension.

Question 4

To mitigate the risk of a febrile non-hemolytic transfusion reaction (FNHTR) in a patient who has a history of such reactions, which type of blood component modification is most appropriate?

Accepted Answer

Leukoreduced

Answer

Febrile non-hemolytic transfusion reactions are primarily caused by cytokines released from donor leukocytes (white blood cells) that accumulate during storage. Leukoreduction is the process of filtering out these leukocytes from the blood component before transfusion, thereby significantly reducing the risk of FNHTR. Irradiation prevents graft-versus-host disease, and washing removes plasma proteins to prevent severe allergic reactions.

Question 5

A CRNI is at the bedside with another licensed nurse to perform the final verification before starting a blood transfusion. They discover that the medical record number on the blood bag's compatibility tag does not exactly match the medical record number on the patient's identification band. What is the most appropriate action?

Accepted Answer

Do not start the transfusion and immediately return the unit to the blood bank.

Answer

The bedside verification by two licensed professionals is the final critical safety check to prevent a potentially fatal ABO incompatible transfusion. Any discrepancy, no matter how small, is an absolute contraindication to starting the transfusion. The unit must not be spiked or administered and should be returned immediately to the blood bank for resolution of the discrepancy.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Blood Component Transfusion Questions and Answers