©SOPHIABENNETT@2024-2025 Monday, August 19, 2024 12:35 AM
RN Adult Med Surg Practice NCLEX 2024-2025
Exam Practice Questions and Answers
What are the findings for acute hemolytic transfusion reaction and time of
onset? - Answer✔️✔️-chills, fever, low-back pain, tachycardia, flushing,
hypotension, chest tightening or pain, tachypnea, nausea, anxiety,
hemoglobinuria, and impending sense of doom. Immediate or can manifest
during subsequent infusions.
What are the nursing actions for hemolytic transfusion reaction? -
Answer✔️✔️-1. Stop transfusion
2. Remove blood from IV access. AVOID infusing further blood products.
3. Initiate an infusion of 0.9% sodium chloride using new tubing
4. monitory vital signs and fluid status
5. Send the blood bag and admin set to lab for testing
Nurse is preparing to administer packed RBCs to a client who has Hgb of 6
g/dL. Which is the next action to perform during the first 15 minutes of the
transfusion? - Answer✔️✔️-Assess for hemolytic transfusion reaction
Page 1 of 6
, ©SOPHIABENNETT@2024-2025 Monday, August 19, 2024 12:35 AM
When can a febrile transfusion reaction happen after a client received blood
products? - Answer✔️✔️-Commonly occurs 2 hr after
Name the findings of febrile transfusion reaction - Answer✔️✔️-Anti-WBC
antibodies, chills (increase of 1·C (2·F) or greater from pretransfusion temp,
flushing, hypotension, tachycardia
A nurse is monitoring a client who began receiving a unit of packed RBCs
10 min ago. Which of the following findings should the nurse identify as an
indication of a febrile transfusion reaction? - Answer✔️✔️-Heart rate change
from 88/min to 120/min.
Client appears flushed
When can an "allergic" transfusion reaction happen? - Answer✔️✔️-During
or up to 24 hrs after
What would the nurse notice when a client has allergic transfusion reaction
to blood products? - Answer✔️✔️-Mild itching, urticaria, flushing
What nursing actions are performed for mild "allergic" reaction to blood
products? - Answer✔️✔️-Stop the transfusion
Maintain IV infusion w/ 0.9% sodium chloride
Administer antihistamine (diphenhydramine)
Page 2 of 6
RN Adult Med Surg Practice NCLEX 2024-2025
Exam Practice Questions and Answers
What are the findings for acute hemolytic transfusion reaction and time of
onset? - Answer✔️✔️-chills, fever, low-back pain, tachycardia, flushing,
hypotension, chest tightening or pain, tachypnea, nausea, anxiety,
hemoglobinuria, and impending sense of doom. Immediate or can manifest
during subsequent infusions.
What are the nursing actions for hemolytic transfusion reaction? -
Answer✔️✔️-1. Stop transfusion
2. Remove blood from IV access. AVOID infusing further blood products.
3. Initiate an infusion of 0.9% sodium chloride using new tubing
4. monitory vital signs and fluid status
5. Send the blood bag and admin set to lab for testing
Nurse is preparing to administer packed RBCs to a client who has Hgb of 6
g/dL. Which is the next action to perform during the first 15 minutes of the
transfusion? - Answer✔️✔️-Assess for hemolytic transfusion reaction
Page 1 of 6
, ©SOPHIABENNETT@2024-2025 Monday, August 19, 2024 12:35 AM
When can a febrile transfusion reaction happen after a client received blood
products? - Answer✔️✔️-Commonly occurs 2 hr after
Name the findings of febrile transfusion reaction - Answer✔️✔️-Anti-WBC
antibodies, chills (increase of 1·C (2·F) or greater from pretransfusion temp,
flushing, hypotension, tachycardia
A nurse is monitoring a client who began receiving a unit of packed RBCs
10 min ago. Which of the following findings should the nurse identify as an
indication of a febrile transfusion reaction? - Answer✔️✔️-Heart rate change
from 88/min to 120/min.
Client appears flushed
When can an "allergic" transfusion reaction happen? - Answer✔️✔️-During
or up to 24 hrs after
What would the nurse notice when a client has allergic transfusion reaction
to blood products? - Answer✔️✔️-Mild itching, urticaria, flushing
What nursing actions are performed for mild "allergic" reaction to blood
products? - Answer✔️✔️-Stop the transfusion
Maintain IV infusion w/ 0.9% sodium chloride
Administer antihistamine (diphenhydramine)
Page 2 of 6
