護理師正為病人進行輸血。為降低輸血反應風險，應採取哪些措施？（選所有適合的）
A nurse is caring for a client who is receiving a blood transfusion. Which of the following actions should the nurse take to reduce the risk of a transfusion reaction? (Select all that apply.)
- AVerify the blood product with another nurse✓ 正解由另一位護理師驗證血液製品
- BAdminister the blood within 4 hours of removal from the blood bank✓ 正解在從血庫取出後4小時內輸注血液
- CStart the transfusion at a rapid rate for the first 15 minutes在前15分鐘內以快速速率開始輸血
- DRemain with the client for the first 15 minutes of the infusion✓ 正解在輸注開始的前15分鐘內留在病人身邊
- ECheck the client's vital signs before starting the transfusion✓ 正解在開始輸血前檢查病人的生命徵象
輸血護理關鍵在於確認安全與監測反應。雙人核對可避免給錯血，輸血需在 4 小時內完成以防細菌滋生，輸血初期需在床邊監測以防急性溶血反應，起始前測量生命徵象是為了建立基線，以便對照輸血後的變化。起始速率應緩慢，而非快速。
Key blood transfusion nursing focuses on confirming safety and monitoring for reactions. Two-nurse verification prevents giving the wrong blood; the transfusion must be completed within 4 hours to prevent bacterial growth; bedside monitoring during the early phase detects acute hemolytic reactions; and obtaining baseline vital signs before starting allows comparison with subsequent readings. The initial rate should be slow rather than rapid.
台美均嚴格執行雙人查核，但部分美國醫院已導入電子條碼辨識系統以降低人為錯誤。