A nurse is planning to administer 2 units of packed RBCs to an older adult client who has anemia. Which of the following actions should the nurse plan to take? (Select all that apply.)

A. Packed red blood cells (PRBCs) should be infused within 2–4 hours, but in older adults and clients at risk for fluid overload, the infusion is often run more cautiously and typically completed within 2–3 hours per unit when possible. However, the key issue is that exceeding 4 hours increases the risk of bacterial contamination and transfusion-related complications. Therefore, while 4 hours is the absolute maximum, it is not always the safest planned rate for two consecutive units in an older adult. B. Sterile gloves are not required for blood administration setup. Aseptic (clean) technique is used when preparing and handling blood products and IV equipment. Sterile gloves are not necessary because the system is closed once blood is spiked and administered using standard blood tubing. C. Independent double-checking by two licensed nurses (or per facility policy) is required to ensure correct patient identification, blood type compatibility, unit number, and expiration date. This is a critical safety step to prevent hemolytic transfusion reactions, which can be life-threatening. D. Baseline respiratory assessment is essential, especially in older adults who are at increased risk for transfusion-associated circulatory overload (TACO). Documenting lung sounds before transfusion allows comparison if the client develops symptoms such as crackles, dyspnea, or hypoxia during or after the transfusion. E. Only 0.9% normal saline (0.9% sodium chloride) is compatible with blood products. Hypotonic solutions like 0.45% sodium chloride can cause hemolysis of red blood cells and are therefore contraindicated in blood administration.