Five minutes after initiating a transfusion of packed red blood cells (PRBCs), a client complains of headache and chills. Which action should the nurse take first?

A. Epinephrine is the primary treatment for an anaphylactic reaction, but it should only be administered after the nurse has stopped the offending agent and assessed the patient. Administering it before stopping the transfusion would allow more potentially incompatible blood to enter the patient's circulation. The nurse must follow the sequence of the nursing process, beginning with the immediate removal of the cause of the reaction. B. Assessing vital signs is a necessary step in the evaluation of a transfusion reaction, but it must occur after the infusion has been stopped. Chills and a headache are early indicators of potentially severe reactions, such as an acute hemolytic or febrile non-hemolytic reaction. Delaying the cessation of the transfusion to take a blood pressure reading increases the total volume of incompatible blood the patient receives. C. The first and most critical action when any transfusion reaction is suspected is to stop the transfusion immediately to minimize the exposure to the blood product. This prevents further entry of antigens or incompatible cells into the patient's bloodstream, which could escalate the severity of the immune response. Once the line is stopped and disconnected, the nurse can then proceed to provide supportive care and further assessment. D. Notifying the provider is a required step in the management of a transfusion reaction, but it is not the first priority. The nurse must first ensure the patient's safety by stopping the blood and assessing their current clinical status to provide an accurate report to the provider. Timely communication is essential for obtaining new orders, but it never supersedes the immediate action of stopping a dangerous infusion.