病人正在進行輸血，出現蕁麻疹與搔癢，護理師的首要行動為何？
A client is receiving blood transfusion and starts to develop hives and itching. What is the nurse's first action?
- AStop the transfusion immediately✓ 正解立即停止輸血
- BNotify the healthcare provider通知醫療提供者
- CSlow the transfusion rate減慢輸血速度
- DAdminister an antihistamine給予抗組織胺
輸血反應（Transfusion Reaction）處理的首要原則是「停止輸血（Stop the transfusion）」。蕁麻疹與搔癢屬於過敏反應（Allergic reaction）的徵兆，若不及時中斷，可能惡化為嚴重的全身性過敏反應（Anaphylaxis），威脅生命。護理師必須先移除輸血源，再維持靜脈通路暢通。
The nurse's first action must be to stop the transfusion immediately to prevent further exposure to the allergen and potential progression to anaphylaxis. Hives and itching indicate an allergic reaction, and continuing the infusion, even at a slower rate, poses a serious safety risk. After stopping the transfusion, the nurse should maintain IV access with normal saline and notify the healthcare provider.
台美皆嚴格遵守輸血指引。美國臨床常見做法為：發現反應後立即停止輸血，更換一套含生理食鹽水（Normal Saline）的輸液管路以維持管路暢通（KVO），並將血袋連同管路送回血庫檢驗。