A client complains of a headache, nausea, and vomiting during a blood transfusion. Which one of the following actions should the nurse take immediately?
1. Check the vital signs.
2. Stop the blood transfusion.
3. Slow down the rate of blood flow.
4. Notify the health care provider and blood bank personnel.
ANS: 2
If a blood reaction is suspected, the nurse stops the blood transfusion immediately. The nurse should take the client's vital signs, but the initial action should be to stop the blood transfusion. Once the transfusion is stopped, the nurse could notify the health care provider and blood bank personnel.
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