Blood products NCLEX-RN Practice Questions

Blood Products NCLEX-RN Practice Questions help you master safe administration, monitoring, and complication management of blood components—critical skills for Pharmacological & Parenteral Therapies. This topic-wise set mirrors real NCLEX-RN scenarios so you can think like a nurse at the bedside: selecting the right product, verifying compatibility, setting up the line, recognizing transfusion reactions, and intervening quickly. You’ll work through nuanced cases on PRBCs, platelets, FFP, cryoprecipitate, albumin, and specialty-modified components (leukoreduced, irradiated, washed, CMV-negative). Questions also drill timing, rates, documentation, massive transfusion protocols, and evidence-based use of premedications. Designed for M. Pharma learners and RN candidates aiming for clinical depth, these 30 MCQs will refine decision-making and prioritize patient safety.

Q1. A symptomatic adult with hemoglobin 6.8 g/dL and tachycardia requires rapid correction of oxygen-carrying capacity. Which product is most appropriate?

• Fresh frozen plasma (FFP)
• Packed red blood cells (PRBCs)
• Platelet concentrate
• 25% albumin

Correct Answer: Packed red blood cells (PRBCs)

Q2. A patient on warfarin has an INR of 6.5 and intracranial hemorrhage. The most appropriate immediate reversal strategy is:

• Fresh frozen plasma alone
• Vitamin K alone
• Four-factor prothrombin complex concentrate plus vitamin K
• Cryoprecipitate infusion

Correct Answer: Four-factor prothrombin complex concentrate plus vitamin K

Q3. An adult oncology patient with platelets 7,000/µL and no active bleeding is to receive prophylactic transfusion. The best product is:

• Single-donor (apheresis) platelets
• Cryoprecipitate
• Packed red blood cells (PRBCs)
• Fresh frozen plasma

Correct Answer: Single-donor (apheresis) platelets

Q4. The nurse prepares the line for PRBC transfusion. Which solution is used to prime and flush the Y-tubing?

• 0.45% sodium chloride
• 0.9% sodium chloride
• Lactated Ringer’s
• 5% dextrose in water

Correct Answer: 0.9% sodium chloride

Q5. Ten minutes into a PRBC transfusion, the patient develops fever, chills, back pain, hypotension, and dark urine. What is the nurse’s first action?

• Administer acetaminophen and continue transfusion
• Slow the rate and reassess in 30 minutes
• Stop the transfusion and keep the IV line open with normal saline
• Notify the provider after the unit finishes

Correct Answer: Stop the transfusion and keep the IV line open with normal saline

Q6. A patient with prior febrile nonhemolytic transfusion reactions needs PRBCs today. Which strategy best prevents recurrence?

• Use washed PRBCs
• Use leukoreduced PRBCs
• Switch to O-negative blood regardless of type
• Give corticosteroids before transfusion only

Correct Answer: Use leukoreduced PRBCs

Q7. Within 2 hours of starting plasma, a patient develops acute hypoxemia, dyspnea, bilateral pulmonary infiltrates, and no signs of circulatory overload. Which reaction is most likely?

• Transfusion-associated circulatory overload (TACO)
• Allergic (mild urticarial) reaction
• Transfusion-related acute lung injury (TRALI)
• Delayed hemolytic reaction

Correct Answer: Transfusion-related acute lung injury (TRALI)

Q8. A frail older adult with heart failure requires PRBCs. Which action best reduces TACO risk?

• Infuse rapidly through a pressure device
• Administer between-unit diuretics and slow the infusion rate
• Use D5W carrier fluid to reduce osmotic load
• Warm the blood to 42°C for faster administration

Correct Answer: Administer between-unit diuretics and slow the infusion rate

Q9. A patient with IgA deficiency experienced anaphylaxis during a prior transfusion. What is the safest RBC product to order?

• Standard PRBCs
• Leukoreduced PRBCs
• Washed PRBCs from IgA-deficient donors
• FFP from any donor

Correct Answer: Washed PRBCs from IgA-deficient donors

Q10. Which modification of blood components most effectively reduces CMV transmission and febrile nonhemolytic reactions?

• Irradiation
• Leukoreduction
• Pathogen inactivation
• Washing

Correct Answer: Leukoreduction

Q11. Which patients require irradiated cellular components to prevent transfusion-associated graft-versus-host disease (TA-GVHD)?

• Patients with iron deficiency anemia
• Immunocompetent trauma patients
• Hematopoietic stem cell transplant recipients
• Healthy obstetric patients

Correct Answer: Hematopoietic stem cell transplant recipients

Q12. The nurse removes a unit of PRBCs from the blood bank. What is the maximum time allowed to complete infusion?

• 1 hour from pickup
• 2 hours from pickup
• 4 hours from pickup
• 6 hours from pickup

Correct Answer: 4 hours from pickup

Q13. When is the patient at greatest risk for severe acute transfusion reactions, requiring the nurse to remain at the bedside?

• First 15 minutes of the transfusion
• Middle hour of the transfusion
• Last 15 minutes of the transfusion
• One hour after transfusion completes

Correct Answer: First 15 minutes of the transfusion

Q14. Which is an appropriate indication for using a blood warmer during transfusion?

• Routine adult PRBC transfusion
• Massive transfusion with rapid infusion
• Mild anemia with stable vitals
• To prevent urticarial reactions

Correct Answer: Massive transfusion with rapid infusion

Q15. In a 70-kg adult, one apheresis platelet unit typically increases the platelet count by approximately:

• 5,000–10,000/µL
• 15,000–25,000/µL
• 30,000–60,000/µL
• 70,000–100,000/µL

Correct Answer: 30,000–60,000/µL

Q16. Which laboratory result most strongly indicates a need for cryoprecipitate?

• INR 2.1 with normal fibrinogen
• Fibrinogen 80 mg/dL with bleeding
• Platelets 25,000/µL without bleeding
• Hemoglobin 7.1 g/dL

Correct Answer: Fibrinogen 80 mg/dL with bleeding

Q17. Which is an appropriate indication for fresh frozen plasma (FFP)?

• Volume expansion in hypovolemia without coagulopathy
• Isolated fibrinogen deficiency
• Multiple coagulation factor deficiencies with active bleeding
• Chronic anemia without bleeding

Correct Answer: Multiple coagulation factor deficiencies with active bleeding

Q18. Which patient is the best candidate for 25% albumin infusion?

• Septic shock for initial fluid resuscitation
• Post-paracentesis in cirrhosis with large-volume fluid removal
• Routine correction of anemia
• Acute isolated thrombocytopenia

Correct Answer: Post-paracentesis in cirrhosis with large-volume fluid removal

Q19. In an emergency when type and crossmatch are unavailable, which is the best initial choice for a woman of childbearing potential?

• O positive PRBCs
• O negative PRBCs
• AB positive PRBCs
• A positive PRBCs

Correct Answer: O negative PRBCs

Q20. Which statement about administration sets for blood products is correct?

• Medications may be piggybacked into the Y-set above the filter
• Use a standard blood filter (about 170–260 microns) and no other IV fluids than 0.9% saline
• Lactated Ringer’s is preferred to avoid hemolysis
• Dextrose solutions are safe to run with blood components

Correct Answer: Use a standard blood filter (about 170–260 microns) and no other IV fluids than 0.9% saline

Q21. A massive transfusion protocol is initiated after trauma. Which component ratio is most commonly targeted?

• 2:1:1 (PRBC:FFP:Platelets)
• 1:1:1 (PRBC:FFP:Platelets)
• 1:2:1 (PRBC:FFP:Platelets)
• 3:1:0 (PRBC:FFP:Platelets)

Correct Answer: 1:1:1 (PRBC:FFP:Platelets)

Q22. At the bedside, which verification step is mandatory before starting a blood transfusion?

• Only the ordering provider verifies the unit in the chart
• Two licensed staff verify patient identity, ABO/Rh, unit number, expiration, and compatibility
• Patient verbally verifying their name is sufficient
• Matching diagnosis to product type alone is sufficient

Correct Answer: Two licensed staff verify patient identity, ABO/Rh, unit number, expiration, and compatibility

Q23. In an adult without active bleeding, one unit of PRBCs is expected to raise hemoglobin by approximately:

• 0.3 g/dL
• 1.0 g/dL
• 2.5 g/dL
• 3.5 g/dL

Correct Answer: 1.0 g/dL

Q24. During a rapid transfusion, the patient develops perioral tingling, hypotension, and prolonged QT on telemetry. Which cause is most likely?

• Hypermagnesemia from stored blood
• Citrate toxicity causing hypocalcemia
• Hypernatremia from saline carrier
• Hemolysis from cold agglutinins

Correct Answer: Citrate toxicity causing hypocalcemia

Q25. After multiple units of PRBCs, the patient’s ECG shows peaked T waves and widened QRS. Which transfusion-related issue is most likely?

• Hypokalemia from citrate binding
• Hyperkalemia from stored blood
• Hypocalcemia from citrate toxicity
• Hypernatremia from normal saline

Correct Answer: Hyperkalemia from stored blood

Q26. Several days after transfusion, a patient develops jaundice, falling hemoglobin, and a positive direct antiglobulin test. Which reaction is most likely?

• Acute hemolytic reaction
• Delayed hemolytic transfusion reaction
• TRALI
• TACO

Correct Answer: Delayed hemolytic transfusion reaction

Q27. Which patient requires CMV-negative blood components?

• Healthy adult undergoing elective hernia repair
• CMV-seronegative pregnant patient requiring transfusion
• Adult with controlled hypertension
• Patient with iron deficiency anemia

Correct Answer: CMV-seronegative pregnant patient requiring transfusion

Q28. Regarding premedication before transfusion (e.g., acetaminophen, diphenhydramine), current best practice is:

• Premedicate all patients to prevent any reaction
• Premedicate only those with a history of febrile or allergic transfusion reactions
• Use corticosteroids routinely for all PRBC transfusions
• Premedication eliminates the need for close monitoring

Correct Answer: Premedicate only those with a history of febrile or allergic transfusion reactions

Q29. Which statement about platelet storage and administration is correct?

• Store platelets refrigerated to reduce bacterial growth
• Platelets are stored at room temperature with agitation and typically infused over 30–60 minutes
• Platelets should be run with dextrose to prevent clumping
• Platelets must be infused through a 0.22-micron filter

Correct Answer: Platelets are stored at room temperature with agitation and typically infused over 30–60 minutes

Q30. Autologous blood donation reduces some transfusion risks. Which risk remains despite autologous use?

• Clerical/identification errors leading to wrong-patient transfusion
• Alloimmunization to donor antigens
• TRALI from donor antibodies
• Transfusion-transmitted CMV infection

Correct Answer: Clerical/identification errors leading to wrong-patient transfusion

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