護理師正在照顧一位接受輸血的病人。輸血開始 15 分鐘後，病人出現寒顫、下背痛與發燒。護理師應採取哪些行動？（選所有適合的）
A nurse is caring for a client receiving a blood transfusion. Fifteen minutes after the start of the transfusion, the client develops chills, lower back pain, and a fever. Which actions should the nurse take? (Select all that apply.)
- AStop the transfusion immediately✓ 正解立即停止輸血
- BSlow the infusion rate and monitor the client減慢輸注速率並監測病人
- CDisconnect the tubing and hang normal saline with new tubing✓ 正解斷開管路並更換新管路掛上生理食鹽水
- DNotify the physician and the blood bank✓ 正解通知醫師和血庫
- EAdminister diphenhydramine as a preventative measure作為預防措施給予 Diphenhydramine
病人出現寒顫、下背痛（典型的腰痛）和發燒，極可能是發生了「溶血性輸血反應」（Hemolytic Transfusion Reaction）。這是極度危險的醫療急症。第一步必須立即停止輸血（A），絕不能只是減慢速度（B）。為了維持靜脈管路暢通以便急救給藥，必須換上「整組全新」的管路並滴注生理食鹽水（C），不可使用原有的輸血管路，以免殘留血液繼續進入體內。隨後必須立即通知醫師與血庫（D）。E 是錯誤的，在發生嚴重反應時應先搶救，且 Diphenhydramine 主要用於輕微過敏反應，而非溶血性反應。整個流程的核心是：止損、維持通路、通報。
The symptoms of chills, lower back pain, and fever suggest an acute hemolytic transfusion reaction, which is a medical emergency requiring immediate action. The nurse must stop the transfusion immediately to prevent further harm and keep the vein open by disconnecting the blood tubing and starting a new line with normal saline. It is critical to notify the physician and the blood bank promptly for investigation and further orders.
美國 NCLEX 嚴格要求「換新管路（New tubing）」掛 NS；台灣部分實務中，護理師可能直接關掉血袋並用原管路的側管（Y型管）跑 NS，但這在 NCLEX 中是錯的，因為會把殘血沖進去。