A nurse is planning care for a child who has neutropenia due to leukemia. Which of the following interventions should the nurse include in the plan of care?

A. State Nurse Practice Act: The State Nurse Practice Act defines the legal scope of practice for nurses within that state, including permissible tasks, delegation guidelines, and licensure requirements. Consulting it ensures that the nurse acts within legal and professional boundaries.

B. Verbal direction from the nurse manager: While guidance from a manager can clarify expectations, it does not supersede legal regulations or define the nurse’s authorized scope of practice. Following only verbal instructions without legal backing may place the nurse at risk of practicing outside their scope.

C. Institutional policies and procedures: Policies provide guidance on how tasks should be performed safely within a facility, but they do not define the nurse’s legal scope of practice. These should be used in conjunction with state regulations, not as the primary authority.

D. Written prescription from the provider: A provider’s order indicates what care is needed for the client but does not grant a nurse legal authority to perform tasks outside their scope of practice. The nurse must ensure the action is permitted under state law before implementation.

A. Prime the tubing with 0.9% sodium chloride: Blood products must be administered with 0.9% sodium chloride to prevent hemolysis. Priming the tubing with saline ensures compatibility and maintains patency, allowing safe and effective transfusion without compromising the integrity of red blood cells.

B. Attach a single-line administration set: Blood transfusions require a specialized Y-type or filtered tubing to reduce the risk of clots, debris, and air embolism. Using a single-line set without a filter could allow microaggregates to enter the circulation.

C. Use tubing that does not have a filter in the drip chamber: A filter is essential for removing clots, debris, and cellular aggregates from the blood product. Administering blood without a filter increases the risk of complications such as emboli and febrile reactions.

D. Use an IV catheter that is at least 24-gauge: A 24-gauge catheter is too small for safe transfusion of blood products. A larger-bore catheter, typically 18–20 gauge, is recommended to allow adequate flow and prevent hemolysis or catheter rupture during transfusion.