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NCLEX-RN Blood transfusion reaction practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Blood transfusion reaction sits inside the Pharmacological and Parenteral Therapies category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Blood transfusion reaction sample questions

Question 1

A 72-year-old client in the medical-surgical unit is receiving a transfusion of packed red blood cells. Fifteen minutes after the infusion begins, the client reports chills, lower back pain, and feels warm. The client's vital signs are: blood pressure 90/58 mm Hg, heart rate 112/min, respiratory rate 24/min, temperature 38.9°C (102°F). The nurse's first action is to:

  1. A Stop the transfusion immediately and maintain intravenous access with 0.9% sodium chloride.
  2. B Administer diphenhydramine 50 mg intravenously as prescribed for allergic symptoms.
  3. C Slow the transfusion rate to 50 mL/hr and notify the healthcare provider immediately.
  4. D Obtain a urine specimen to check for hemoglobinuria before taking any further action.
Show the answer and explanation

Correct answer: A

The correct first action is to stop the transfusion immediately and maintain intravenous access with 0.9% sodium chloride because the client's symptoms (chills, back pain, fever, hypotension, tachycardia) suggest an acute hemolytic transfusion reaction, which can be life-threatening. The priority is to stop the infusion of the incompatible blood product and keep the vein open for emergency medications. Administering diphenhydramine (the option "Administer diphenhydramine 50 mg intravenously as prescribed for allergic symptoms." may be appropriate for allergic reactions but is not the first action and does not address the hemolytic process. Slowing the transfusion (the option "Slow the transfusion rate to 50 mL/hr and notify the healthcare provider immediately." would continue exposing the client to the offending blood product and is unsafe. Obtaining a urine specimen (the option "Obtain a urine specimen to check for hemoglobinuria before taking any further action." is important after stopping the transfusion but should not delay the immediate discontinuation of the blood.

Question 2

A 55-year-old client in the intensive care unit is receiving a transfusion of packed red blood cells. Fifteen minutes after the transfusion begins, the client develops chills, a temperature of 38.9°C, and lower back pain. The nurse suspects a febrile non-hemolytic transfusion reaction. Which action should the nurse take first?

  1. A Administer acetaminophen 650 mg orally and continue the transfusion at a slower rate.
  2. B Stop the transfusion immediately and maintain the intravenous line with 0.9% sodium chloride.
  3. C Notify the provider and obtain a blood culture from the client's peripheral vein.
  4. D Slow the transfusion rate to 50 mL/hr and administer diphenhydramine 25 mg intravenously.
Show the answer and explanation

Correct answer: B

Any suspected transfusion reaction is managed first by stopping the transfusion to limit exposure, and back pain also raises concern for hemolysis. The IV line is kept open with 0.9% sodium chloride through new tubing for medications or fluids.

Why the other options are wrong:
A: Continuing the transfusion, even slowly, keeps infusing the blood that is causing the reaction.
C: Notification and cultures are needed but come after the transfusion is stopped.
D: Slowing the rate continues exposure, and diphenhydramine treats allergic reactions, not febrile or hemolytic ones.

Question 3

A 52-year-old client in the surgical unit is receiving a transfusion of packed red blood cells. Fifteen minutes after the infusion starts, the client reports chills, lower back pain, and feels 'anxious.' The nurse assesses a temperature of 38.6°C (101.5°F), heart rate 110 beats/min, and blood pressure 90/58 mm Hg. Which action should the nurse take first?

  1. A Increase the transfusion rate to complete the infusion and monitor symptoms.
  2. B Stop the transfusion immediately and maintain IV access with normal saline.
  3. C Notify the healthcare provider and prepare to administer epinephrine.
  4. D Slow the transfusion rate and administer diphenhydramine 25 mg IV.
Show the answer and explanation

Correct answer: B

Chills, low back pain, anxiety, fever, tachycardia, and hypotension 15 minutes into a transfusion indicate an acute hemolytic reaction. The first action is to stop the transfusion and keep the IV open with normal saline through new tubing, then notify the provider and blood bank.

Why the other options are wrong:
A: Increasing the rate gives more incompatible blood and worsens the reaction.
C: The provider must be notified, but the blood must be stopped first; epinephrine is for anaphylaxis, which is not described.
D: Slowing the rate still delivers incompatible blood, and diphenhydramine does not stop hemolysis.

Question 4

A 55-year-old client in the medical-surgical unit is receiving a transfusion of packed red blood cells. Fifteen minutes after the transfusion begins, the client reports lower back pain and chills. The nurse notes a temperature of 100.8°F (38.2°C), heart rate 104 beats per minute, and blood pressure 98/60 mm Hg. What is the nurse's priority action?

  1. A Slow the transfusion rate and administer diphenhydramine 50 mg intravenously.
  2. B Increase the infusion rate of the transfusion to complete it faster and reduce symptoms.
  3. C Stop the transfusion immediately and maintain intravenous access with 0.9% sodium chloride.
  4. D Obtain a urine specimen and send it to the laboratory for hemoglobin analysis.
Show the answer and explanation

Correct answer: C

Low back pain, chills, fever, tachycardia, and hypotension 15 minutes into a transfusion suggest an acute hemolytic reaction. The priority is to stop the transfusion and keep the IV open with normal saline through new tubing, then notify the provider and blood bank.

Why the other options are wrong:
A: Slowing the rate still gives incompatible blood, and diphenhydramine does not stop hemolysis.
B: Increasing the rate delivers more incompatible blood and worsens the reaction.
D: A urine specimen is part of the workup, but it comes after the transfusion is stopped.

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