# A 45-year-old client with anemia has a hemoglobin of 7.2 g/dL (72 g/L) and is scheduled for a blood transfusion. The client states, "I understand the risks of not having the transfusion, but I do not want it." Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505775&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A 45-year-old client with anemia has a hemoglobin of 7.2 g/dL (72 g/L) and is scheduled for a blood transfusion. The client states, "I understand the risks of not having the transfusion, but I do not want it." Which action should the nurse take first?

## Option

1. Notify the healthcare provider of the client's decision. **✔ Correct answer**
2. Ask the client to sign an against-medical-advice form.
3. Explain that the transfusion is necessary to prevent complications.
4. Request a psychiatric consultation to evaluate decision-making capacity.

**Correct answer: 1**

## Explanation

The client has demonstrated understanding of the risks and clearly refuses the transfusion. The nurse's first action is to notify the healthcare provider so that alternative plans can be discussed and the refusal can be documented. Asking the client to sign an against-medical-advice form is premature and may be perceived as coercive; the focus should be on communication and documentation. Explaining the necessity of the transfusion disregards the client's informed refusal and undermines autonomy. Requesting a psychiatric consultation is inappropriate because the client has shown decision-making capacity by understanding the risks and stating a clear choice.

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