Editing Nursing Skills and Procedures – RN Practice Questions (section)

==Question 7==
Fifteen minutes into a transfusion of packed red blood cells, a client develops chills, a temperature increase of 1.5 degrees Celsius, flank pain, and dark red urine. After stopping the transfusion, which action should the nurse take '''next'''?
# Flush the existing blood tubing with 0.9 percent sodium chloride to keep the vein open.
# Disconnect the blood tubing and infuse 0.9 percent sodium chloride through new tubing.
# Administer the prescribed antipyretic and resume the transfusion at a slower rate.
# Send the blood bag to the laboratory and document the reaction.

'''Answer:''' 2 (B). Disconnect the blood tubing and infuse 0.9 percent sodium chloride through new tubing.

''Rationale:'' This is an acute hemolytic reaction. Vascular access must be maintained for fluid resuscitation to protect the kidneys, but flushing the existing tubing as in option 1 would push additional incompatible blood into the client. New tubing is required. Option 3 is contraindicated; a transfusion is never restarted after a suspected hemolytic reaction. Option 4 is necessary but follows stabilization of the client and maintenance of access.