One Hour After Starting a Unit of Packed Red Blood $\degree$

Multiple Choice

One hour after starting a unit of packed red blood cells, a nurse observes that a patient receiving the transfusion is reporting flank pain and has a temperature of 101.8 $\degree$ F (38.8 $\degree$ C) .The nurse's first action should be to:

A) Assess the patient for signs of rash, hives, or angioedema.
B) Confirm that the name on the label on the blood transfusion matches the patient's armband.
C) Medicate the patient with acetaminophen that is ordered prn for pain or fever.
D) Stop the transfusion and maintain IV access with normal saline.