— 生理適應 · MEDIUM · MCQ —
病人出現輸血反應，護理師的首要行動為何？
A client is experiencing a transfusion reaction. What is the nurse's first action?
- ACheck the client's vital signs檢查病人的生命徵象
- BStop the transfusion✓ 正解停止輸血
- CFlush the line with saline以生理食鹽水沖洗管路
- DNotify the provider通知醫師
— Explanation · 中文詳解 —
輸血反應（Transfusion reaction）可能引發嚴重的過敏或溶血性反應，威脅病人生命。當發生疑似反應（如發燒、寒顫、背痛、低血壓、紅疹）時，護理師的首要行動是立即停止輸血，以切斷過敏原或不相容血液的輸入。接著需以生理食鹽水（Normal saline）維持靜脈管路暢通，並回報醫師，保留血袋與輸血管路送回檢驗室核對。
The nurse's first action during a suspected transfusion reaction is to stop the infusion immediately to prevent further exposure to the incompatible blood or allergen. After stopping the transfusion, the line should be flushed with normal saline using new tubing to maintain venous access without introducing more blood. Subsequent steps include assessing vital signs, notifying the provider, and retaining the blood bag for laboratory analysis.