Fifteen minutes after a blood transfusion begins, a patient develops fever, chills, flank pain and anxiety. Which action should the nurse take first?
Correct answer: B. Stop the transfusion and keep the IV line open with normal saline
- A. Slow the transfusion and reassess after 15 minutes
- B. Stop the transfusion and keep the IV line open with normal saline
- C. Administer the next prescribed unit using new tubing
- D. Give an antipyretic and continue the transfusion slowly
Explanation
These findings suggest an acute transfusion reaction, so the transfusion must be stopped immediately. The IV line is maintained with new tubing and normal saline while the provider and blood bank are notified; slowing the transfusion is unsafe.
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About Critical Care and Emergency Nursing
Covers rapid assessment and stabilisation of patients with airway obstruction, respiratory failure, shock, cardiac arrest, sepsis, poisoning and major electrolyte disturbances. It includes triage, the ABCDE approach, cardiopulmonary resuscitation, ventilator and monitor care, emergency medicines and distinguishing life-threatening deterioration from stable illness.
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