— 藥理與非經腸給藥 · EASY · MCQ —
一位接受輸血的病人出現蕁麻疹、搔癢與潮紅。護理師的優先處置為何？
A client receiving a blood transfusion develops hives, itching, and flushing. What is the nurse's priority action?
- AStop the transfusion immediately✓ 正解立即停止輸血
- BSlow the rate of the transfusion減慢輸血速率
- CNotify the laboratory personnel通知實驗室人員
- DAdminister the prescribed antihistamine給予處方之抗組織胺
— Explanation · 中文詳解 —
出現過敏反應的徵兆時，必須立即停止輸血以切斷過敏原來源。此處為典型的過敏性輸血反應（Allergic reaction）。一旦停止輸血，護理師應使用生理食鹽水保持管路暢通，並通知醫師處理。僅減慢速度或給藥無法徹底解決持續接觸過敏原的風險。
The nurse must immediately stop the blood transfusion upon observing signs of an allergic reaction, such as hives and itching, to prevent further exposure to the allergen and ensure client safety.
✦ 台美臨床差異
美台對於輸血不良反應的緊急處理流程（Stop, Maintain access, Notify）原則完全一致。