A nurse is preparing to administer a unit of packed red blood cells (PRBCs) to a client who has anemia. Which is the priority action?

A. Verification of blood compatibility and client identity must be performed by 2 licensed healthcare providers, such as 2 registered nurses or a nurse and a physician. Assistive personnel (AP) do not have the legal scope of practice or the clinical licensure required to perform this high-stakes safety double-check. Relying on an unlicensed individual for this verification violates safety protocols and increases the risk of a catastrophic hemolytic reaction. B. Teaching the client about the signs and symptoms of a transfusion reaction is an essential nursing responsibility to ensure the client can report early warning signs like itching or chest pain. However, this education does not take priority over the collection of objective baseline physiological data. Teaching is a proactive measure, but it cannot replace the immediate need for a physical assessment to establish the patient's pre-transfusion status. C. Obtaining baseline vital signs, including temperature, heart rate, and blood pressure, is the priority action to establish a reference point for the client's pre-transfusion physiological status. This allows the nurse to accurately identify subsequent changes that may indicate an acute transfusion reaction or fluid volume overload. Without these baseline parameters, it is clinically difficult to determine if a post-start fever or tachycardic episode is a new development or a preexisting condition. D. Blood administration tubing must be primed only with 0.9% sodium chloride (normal saline), as it is the only compatible fluid that prevents hemolysis of the red blood cells. Using a hypotonic solution like 0.45% sodium chloride would cause the red blood cells to swell and burst due to osmotic pressure differences. Priming with an incorrect solution is a procedural error that would render the unit of blood unusable and potentially harm the patient.