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    Ati lpn paediatrics proctored exam

    When the patient experiences apprehension and urticaria while receiving a blood transfusion, the nurse:

    Explanation & Rationale

    A. Slows the transfusion and takes the patient's vital signs: Slowing the transfusion still allows exposure to the allergen. Transfusion should be stopped immediately. B. Observes the child for further transfusion reactions: Waiting is unsafe; action is required immediately. C. stops the transfusion, allows normal saline solution to run slowly, and notifies the charge nurse. These are classic signs of an allergic transfusion reaction. The nurse must stop the transfusion immediately, keep the IV line open with normal saline, and notify the charge nurse or provider. D. Stops what he or she is doing and obtains the patient's history: Immediate intervention is critical; history can be reviewed after stabilizing the patient.

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