# A client is receiving red blood cells through one administration set. A new order is written for 3% sodium chloride. Which action is appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522669&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client is receiving red blood cells through one administration set. A new order is written for 3% sodium chloride. Which action is appropriate?

## Option

1. Piggyback the 3% sodium chloride into the blood tubing below the filter.
2. Pause the blood and flush the same tubing with the hypertonic solution.
3. Mix the hypertonic solution into the red-cell bag before restarting it.
4. Use a separate verified line and administration set and monitor sodium and neurologic status. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Three-percent sodium chloride should not be administered through the same set as whole blood or cellular blood components. It requires separate verified access and close electrolyte and neurologic monitoring.

## In-depth explanation

Quick answer
Keep hypertonic saline separate from cellular blood administration.

Why this is correct
Hypertonic saline has a high osmolar load and can cause serious sodium, fluid, and neurologic complications if used without controlled administration and monitoring.

Easy analogy or mental picture
Treat every infusion as a controlled clinical system: verify the product and access, recognize a changing cue, stop preventable exposure, stabilize the client, and confirm the response.

Memory hook
Product, access, compatibility, infusion cue, protective action, and reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate infusion-related harm while preserving vascular access and the ordered diagnostic evidence.

Why the other choices are wrong
Options that restart a suspect product, bypass a safety device, force an occluded tube, or delay reassessment can convert a reversible warning into serious harm.References
1DailyMed: 3% Sodium Chloride InjectionHypertonicity, electrolyte and neurologic monitoring, and prohibition on using the same administration set with cellular blood components

## Clinical scenario

Blood product, nutrition, and intravenous-fluid safety review
Verify the product, prescription, route, access device, filter or tubing, compatibility, baseline findings, emerging adverse cues, response plan, and measurable follow-up.

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