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CCRN -- Immune/Hematology Questions and Correct Answers | Latest Update

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A 52-year-old man returns to the hospital 2 weeks after being discharged from an admission for upper gastrointestinal bleed. He has been vomiting bright red blood for the past 24 hours. Laboratory parameters reveal a hemoglobin of 6 g/dL and a hematocrit of 20%. Vital signs are blood pressure...

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2024 /2025 | © copyright | This work may not be copied for profit gain Excel!

CCRN -- Immune/Hematology Questions and
Correct Answers | Latest Update
A 52-year-old man returns to the hospital 2 weeks after being discharged from an

admission for upper gastrointestinal bleed. He has been vomiting bright red blood for the

past 24 hours. Laboratory parameters reveal a hemoglobin of 6 g/dL and a hematocrit of

20%. Vital signs are blood pressure 90/60 mm Hg; heart rate 120 beats/min and regular; and

respiratory rate 22 breaths/min and shallow. He has received two units of red blood cells

(RBCs) in the emergency department. The physician has ordered four more units of RBCs.

Which two lab values must be carefully monitored in this patient?

a. Calcium and potassium

b. BUN and Cr

c. Bilirubin and amylase

d. sodium and magnesium

✓ -:- a. Calcium and potassium

RATIONALE:

Patients receiving multiple transfusions must be monitored closely for hyperkalemia because

stored blood has a high potassium content resulting from aging and hemolysis of RBCs.

Hypocalcemia is a potential problem because citrate used as an anticoagulant in banked

1|P a g e | G r a d e A + | 2 0 2 0 2 5

,2024 /2025 | © copyright | This work may not be copied for profit gain Excel!

blood binds with calcium. This prevents clot formation and reduces the calcium level in the

banked blood.

TEST-TAKING STRATEGY:

Because the question relates to a patient receiving multiple units of banked blood, consider

which problems are related to this situation. The kidney can be affected by hemoglobinemia

in transfusion reactions, but symptoms of a transfusion reaction are not in this case study,

so eliminate option b. Option c might be considered later because hepatitis C (non-A/non-

B) can occur with multiple transfusions and would elevate bilirubin, but this would not be

evident acutely, so eliminate option c. Of the electrolytes listed in options a and d, the ones

that you should associate most with potential complications of blood transfusion are calcium

and potassium. Choose option a.

A 52-year-old patient with a history of alcoholism is admitted with massive esophageal

bleeding. After infusion of several liters of normal saline, the crossmatched blood is now

available. A nursing action that can prevent a transfusion reaction is to:

a. obtain a detailed transfusion history

b. monitor vs q15min after starting the transfusion

c. administer histamines before initiating the blood transfusion

2|P a g e | G r a d e A + | 2 0 2 0 2 5

, 2024 /2025 | © copyright | This work may not be copied for profit gain Excel!

d. check the patient's identification and blood type w/the blood identification and type

carefully

✓ -:- d. check the patient's identification and blood type w/the blood

identification and type carefully

RATIONALE:

To prevent a transfusion reaction, the nurse must ensure that the correctly typed and

crossmatched blood is administered.

TEST-TAKING STRATEGY:

The key phrase is to prevent a transfusion reaction. Option a would help to identify the

patient who would be more likely to have a transfusion reaction. Option b would aid in

early detection of a transfusion reaction. Option c would decrease the severity of a

transfusion reaction should it occur. Only ensuring that the correct blood is given to the

correct patient will prevent a reaction. Choose option d.

A 50-year-old patient is transferred to the critical care unit from the emergency

department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction

to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his

3|P a g e | G r a d e A + | 2 0 2 0 2 5

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