Question

The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.)

a) Administer diuretics as prescribed.
b) Place the patient in an upright position with the feet dependent.
c) Discontinue the transfusion.
d) Administer oxygen.
e) Continue the infusion but slow the rate down.

Answer 1

If a patient has a severe reaction to a blood transfusion, the nurse should discontinue the transfusion, administer oxygen, and administer diuretics if prescribed.

Step-by-step explanation:

If a patient has a severe reaction to a blood transfusion, there are several necessary actions for the nurse to take. Firstly, the nurse should discontinue the transfusion immediately to prevent further complications. Secondly, the nurse should administer oxygen to help the patient breathe and stabilize their condition. Lastly, the nurse should administer diuretics as prescribed, if ordered by the doctor, to help remove excess fluid and reduce the strain on the patient's cardiovascular system.