A client who is receiving magnesium sulfate has a urine output of 20 mL/hr. Which of the following medications should the nurse expect to administer?

Choice A reason: Distended neck veins is not a manifestation of acute hemolytic reaction, but it may indicate fluid overload, which is another possible complication of blood transfusion. Fluid overload may occur when the blood volume or rate of infusion exceeds the client's circulatory capacity. Fluid overload may manifest as dyspnea, crackles, edema, hypertension, or tachycardia.

Choice B reason: Client report of low back pain is a manifestation of acute hemolytic reaction, which is a life-threatening condition that occurs when the donor blood is incompatible with the recipient's blood. Acute hemolytic reaction may occur within minutes or hours of the transfusion and may cause the destruction of the transfused red blood cells. Acute hemolytic reaction may manifest as fever, chills, low back pain, hemoglobinuria, hypotension, or shock.

Choice C reason: A productive cough is not a manifestation of acute hemolytic reaction, but it may indicate a respiratory infection, which is a potential risk of blood transfusion. Blood transfusion may transmit infectious agents, such as bacteria, viruses, or parasites, from the donor to the recipient. A productive cough may also be a sign of pulmonary edema, which may result from fluid overload or transfusion-related acute lung injury (TRALI).

Choice D reason: Client report of tinnitus is not a manifestation of acute hemolytic reaction, but it may indicate ototoxicity, which is a possible adverse effect of some medications, such as aminoglycosides, loop diuretics, or salicylates. Ototoxicity may damage the inner ear or the auditory nerve and cause hearing loss, tinnitus, or vertigo. The nurse should assess the client's medication history and monitor the client's hearing function.

Choice A reason: Giving the medication in the morning daily is a correct instruction, as it helps to prevent asthma attacks throughout the day and night. Montelukast is a leukotriene receptor antagonist that blocks the inflammatory response and bronchoconstriction caused by leukotrienes. Montelukast has a long duration of action and can be given once a day, preferably in the evening or at bedtime. However, for children who have exercise-induced asthma, the medication can be given in the morning to prevent exercise-induced bronchospasm.

Choice B reason: Administering the granules mixed with 20 oz of water is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Montelukast granules should be administered within 15 minutes of opening the packet and can be mixed with a small amount of soft food, such as applesauce, mashed carrots, or ice cream. The granules should not be mixed with liquids, such as water, juice, or milk, as they may dissolve and lose their potency.

Choice C reason: Giving the medication at the onset of wheezing is not a correct instruction, as it may not provide immediate relief of the symptoms and may delay the use of a rescue inhaler. Montelukast is not a bronchodilator and does not work quickly to open the airways. Montelukast is a preventive medication that should be taken regularly to reduce the frequency and severity of asthma attacks. The child should use a short-acting beta-agonist, such as albuterol, for the quick relief of wheezing.

Choice D reason: Administering the medication 2 hr before exercise is not a correct instruction, as it may not prevent exercise-induced bronchospasm and may interfere with the daily dosing schedule. Montelukast should be taken once a day, preferably in the evening or at bedtime, to provide consistent protection against asthma triggers. However, for children who have exercise-induced asthma, the medication can be given in the morning to prevent exercise-induced bronchospasm. The child should also use a short-acting beta-agonist before exercise, as needed.