— 生理適應 · MEDIUM · MCQ —
護理師為病人執行輸血。下列哪項動作對於預防溶血性輸血反應最重要？
A nurse is administering blood transfusion to a client. Which action is most important to prevent a hemolytic transfusion reaction?
- ASlowly administer the blood for the first 15 minutes最初15分鐘緩慢輸注血液
- BCheck the expiration date of the blood bag檢查血袋的有效期限
- CVerify the patient's identity and blood type with another nurse✓ 正解與另一位護理師核對病人身份與血型
- DMonitor vital signs every 30 minutes每30分鐘監測生命徵象
— Explanation · 中文詳解 —
溶血性反應最常由人為錯誤導致（如輸錯血），透過雙人核對（Double-check）病人的身分與血型標籤是預防此類嚴重不良事件最核心的步驟。其他措施如緩慢輸注是為了在反應發生時降低暴露量，但核對正確才是預防根本。
Hemolytic reactions are most often caused by human error (such as transfusing the wrong unit), and a two-nurse verification of patient identity and blood type is the most essential step in preventing this serious adverse event. Other measures, such as slow initial infusion, are intended to limit exposure if a reaction occurs, but correct identification is the fundamental preventive measure.
✦ 台美臨床差異
美台對輸血前的雙人核對規定極嚴格，原則完全一致。