A nurse is assessing a client who is receiving a unit of packed red blood cells. Which of the following findings is a manifestation of acute hemolytic reaction?

Choice A reason: Bleeding gums is a possible adverse effect of taking gingko biloba, as it may increase the risk of bleeding by inhibiting platelet aggregation and interfering with clotting factors. Gingko biloba may also interact with other medications that affect bleeding, such as anticoagulants, antiplatelets, or NSAIDs. The nurse should advise the client to monitor for signs of bleeding, such as bruising, nosebleeds, or hematuria, and report them to the provider.

Choice B reason: Decreased alertness is not a likely adverse effect of taking gingko biloba, as it may have the opposite effect of enhancing cognitive function and memory. Gingko biloba may improve blood flow to the brain and protect against oxidative stress and neuronal damage. The nurse should inform the client that gingko biloba may take several weeks to show its benefits and that the evidence for its effectiveness is inconclusive.

Choice C reason: Breast enlargement is not a known adverse effect of taking gingko biloba, as it does not affect the hormonal levels or the breast tissue. Gingko biloba may have some estrogenic activity, but it is not significant enough to cause gynecomastia or breast tenderness. The nurse should assess the client for other possible causes of breast enlargement, such as medications, liver disease, or tumors.

Choice D reason: Bad breath is not a common adverse effect of taking gingko biloba, as it does not affect the oral hygiene or the digestive system. Gingko biloba may have a mild odor, but it is not unpleasant or persistent. The nurse should advise the client to maintain good oral care and to check for other possible causes of bad breath, such as infections, dental problems, or dietary factors.

Choice A reason: Hematocrit 45% is not the correct data. Hematocrit is the percentage of red blood cells in the blood. The normal range for hematocrit is 37% to 47% for women and 42% to 52% for men. Hematocrit 45% is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or destruction of red blood cells.

Choice B reason: Platelets 74,000/mm3 is the correct data. Platelets are the blood cells that are responsible for clotting and preventing bleeding. The normal range for platelets is 150,000 to 400,000/mm3. Platelets 74,000/mm3 is below the normal range and indicates thrombocytopenia, which is a low platelet count. Thrombocytopenia is a serious complication of heparin therapy that can cause bleeding, bruising, and petechiae. The nurse should report this finding to the provider immediately and stop the heparin infusion.

Choice C reason: Partial thromboplastin time (PTT) 65 seconds is not the correct data. PTT is a blood test that measures the time it takes for the blood to clot. The normal range for PTT is 25 to 35 seconds. PTT 65 seconds is above the normal range and indicates that the blood is taking longer to clot. This is an expected effect of heparin therapy, as heparin is an anticoagulant that inhibits the formation of blood clots. The nurse should monitor the PTT and adjust the heparin dose according to the provider's orders and the protocol.

Choice D reason: White blood cell count 8,000/mm3 is not the correct data. White blood cells are the blood cells that are involved in the immune system and fight infections. The normal range for white blood cells is 4,500 to 11,000/mm3. White blood cell count 8,000/mm3 is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or function of white blood cells.