A client has severe anemia and will be receiving blood transfusions.The nurse prepares and begins the infusion.Ten minutes after the infusion has begun,the client develops tachycardia,chills,and low back pain.After stopping the transfusion,the nurse should:
A) Administer an antipyretic
B) Begin an infusion of epinephrine
C) Run normal saline through the blood tubing
D) Obtain and send a urine specimen to the laboratory

Question

Quizplus · Accepted Answer

After stopping the blood transfusion,the nurse should obtain and send a urine specimen to the laboratory to determine the presence of hemoglobin as a result of red blood cell (RBC)hemolysis.In an acute hemolytic reaction,management of the reaction does not include the administration of an antipyretic.The nurse should be prepared to administer emergency drugs,such as diuretics,per the health care provider's order.The nurse should not turn off the blood and simply turn on the normal saline that is connected to the Y-tubing set.This would cause blood remaining in the Y-tubing to infuse into the client.Even a small amount of mismatched blood can cause a major reaction.The nurse should run normal saline directly into the IV line (not through the blood tubing).

A Client Has Severe Anemia and Will Be Receiving Blood