A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)

A. Check the blood product's compatibility with the client's blood type: Before administering packed red blood cells (RBCs) or any blood product, it is crucial to ensure that the blood product matches the client's blood type and is compatible. This is done to prevent transfusion reactions and ensure safe administration.

B. Prime the client's primary IV tubing with lactated Ringer's: While it is important to prime the IV tubing with an appropriate solution before starting the transfusion, this action does not directly indicate prior to the start of the infusion.

C. Check that the client has a small gauge IV catheter in place: Having an appropriate size and functioning IV catheter in place is important for administering blood products, but this action does not specifically indicate prior to the start of the infusion.

D. Confirm the identity of the client with the blood bank technician: Confirming the client's identity is an essential step in ensuring that the correct blood product is administered to the correct client. However, this action is typically done before the blood product is prepared and delivered to the client's location, rather than immediately before starting the infusion.

A. Avoid pinching the skin when injecting the needle:

This instruction is not specific to the use of a prefilled, multidose pen for insulin administration. Pinching the skin may be necessary for some injection techniques but is not directly related to the use of a prefilled pen.

B. Use pen needles that have a safe-needle protection device attached.

Using pen needles with a safe-needle protection device attached ensures safe handling and disposal of the needle after use, reducing the risk of accidental needlestick injuries. These devices help prevent accidental needlesticks by covering the needle after use, reducing the risk of transmission of bloodborne pathogens.

C. Use the dominant hand to recap the needle before removing it from the pen device:

Recapping needles is not recommended as it increases the risk of needlestick injuries. Additionally, the use of the dominant hand for recapping is not essential and may not be safe practice.

D. Remove the needle from the pen device before placing the needle in a sharps container:

It's crucial to dispose of needles safely in a sharps container immediately after use without removing the needle from the pen device. Removing the needle before disposal increases the risk of needlestick injuries. The entire pen needle unit, including the needle, should be disposed of intact into an appropriate sharps container to minimize the risk of injury to healthcare workers and others handling the waste.