A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse plan to take?

A. Administer the unit of packed RBCs over 1 hr is incorrect. Packed red blood cells should be transfused over 2–4 hours per unit to prevent fluid overload and allow for safe monitoring for transfusion reactions. Administering too quickly increases the risk of circulatory overload and adverse reactions. B. Initiate venous access with a 21-gauge needle is incorrect. A larger bore needle (18–20 gauge) is preferred for blood transfusions to allow the red blood cells to flow easily without hemolysis. Smaller needles can cause RBC damage and slow the transfusion. C. Use Y tubing with 0.9% sodium chloride when administering the transfusion is correct. Y tubing allows simultaneous administration of packed RBCs and normal saline, which is the only compatible IV fluid. Other fluids (like dextrose or lactated Ringer’s) can cause hemolysis or clotting. The Y tubing also facilitates proper monitoring of the transfusion. D. Obtain the client's first set of vital signs 1 hr after initiating the transfusion is incorrect. Vital signs should be obtained immediately before starting the transfusion, 15 minutes after initiation, and periodically thereafter. Early monitoring helps detect acute transfusion reactions promptly.