# A nurse is preparing to administer 1 unit of PRBCs. Which set of pre-administration practices is essential to prevent a fatal hemolytic reaction?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is preparing to administer 1 unit of PRBCs. Which set of pre-administration practices is essential to prevent a fatal hemolytic reaction?

## Option

1. Mix PRBCs with D5W to slow infusion
2. Two-RN bedside verification of client identity (two identifiers), product ABO/Rh, unit number, expiration, and crossmatch — using NS only, no other fluids in the line; start slowly and stay with the client for the first 15 minutes **✔ Correct answer**
3. One nurse silently checks the label
4. Administer all units within 1 hour regardless of monitoring

**Correct answer: 2**

## Explanation

Correct (2): Two-RN bedside verification required to prevent ABO incompatibility. Match: client two identifiers, blood product ABO/Rh, unit number, expiration, crossmatch results. Use NS ONLY (D5W causes hemolysis; LR contains Ca that clots). Start slowly, stay with client first 15 min — most severe reactions occur within 15 min. Each unit must be completed within 4 hours. (1,3,4) Dangerous.

## In-depth explanation

Memory Tip Transfusion 4 rules = "2-RN check, NS only, Start slow + watch 15 min, 4-hr max." Vitals pre, 15 min, 1 hr, end. Stop and assess for any reaction.

## Clinical scenario

Scenario Adult with symptomatic anemia ordered for 1 unit PRBCs. Unit retrieved from blood bank.

## Key concepts

- **Two-RN verification** — Bedside dual-nurse check of identity + product; ABO incompatibility prevention.
- **Compatible IV fluid** — NS only with blood products; D5W hemolyzes, LR clots.
- **Transfusion time limit** — Each unit must infuse within 4 hours to prevent bacterial growth.

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