The nurse is reviewing the client's medical record. Exhibits The nurse is assisting with the care of the client prior to a blood transfusion. Which of the following actions should the nurse take? Select all that apply.

Rationale • Ensure the transfusion tubing is flushed with dextrose 5% in water: Flushing with D5W can cause hemolysis due to the hypotonicity and sugar content, leading to clumping or damage to red blood cells. Normal saline is the only acceptable fluid for flushing or administering with blood products to maintain cell integrity and avoid adverse reactions. • Obtain a large-bore IV catheter: A large-bore catheter, typically 18–20 gauge, is necessary to allow rapid infusion of blood and reduce the risk of hemolysis. It also minimizes resistance and facilitates effective delivery during emergencies like hypovolemic shock from GI bleeding. • Witness the client signing a consent for transfusion: Informed consent is a legal and ethical requirement prior to initiating a transfusion. The nurse must ensure that the client understands the purpose, benefits, and risks of the procedure, and the nurse may witness the client’s signature. • Ensure two nurses confirm the information on the blood label: Verifying the client's identity and blood product information by two licensed personnel prevents transfusion errors, such as ABO incompatibility. This is a critical safety measure and a standard facility protocol before starting the transfusion. • Explain to the client that transfusion reactions are not serious: Minimizing the risks of transfusion reactions is misleading and unsafe. Some reactions can be life-threatening, such as hemolytic or anaphylactic reactions. The nurse should provide accurate education about potential signs and encourage prompt reporting.