A nurse is monitoring a client who is receiving 2 units of packed RBCs. Which of the following manifestations indicates a hemolytic transfusion reaction?
Bradycardia
Hypertension
Back pain
Chills
The Correct Answer is C
Choice A Reason:
Bradycardia - Bradycardia is not a typical symptom of a haemolytic transfusion reaction.
Choice B Reason;
Hypertension - Hypertension is not a common manifestation of a haemolytic transfusion reaction.
Choice C Reason:
Back pain A haemolytic transfusion reaction is a severe and potentially life-threatening complication that can occur when the immune system reacts against the transfused red blood cells. Back pain is a classic symptom of a haemolytic transfusion reaction. It is often accompanied by other symptoms such as fever, chills, chest pain, dyspnoea, nausea, vomiting, haematuria, and hemoglobinuria (presence of haemoglobin in the urine).
Choice D Reason:
Chills - Chills can occur in various types of transfusion reactions, including haemolytic reactions, but they are not as specific as back pain for indicating a haemolytic transfusion reaction.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Bradycardia is incorrect. Bradycardia refers to a slow heart rate, and while anaemia can lead to an increased heart rate (tachycardia) as the body tries to compensate for the decreased oxygen levels, it is not typically associated with bradycardia.
Choice B reason:
Headache Anaemia is a condition characterized by a decreased number of red blood cells or a decrease in the amount of haemoglobin in the blood, leading to reduced oxygen-carrying capacity. This can result in decreased oxygen delivery to various tissues and organs, including the brain. As a result, clients with anaemia often experience symptoms such as fatigue, weakness, and headaches.
Choice C reason:
Flushed skin colour - Anaemia is more likely to cause paleness of the skin (pallor) due to the decreased haemoglobin levels, rather than flushed skin colour.
Choice D reason:
Heat intolerance - Heat intolerance is not a typical symptom of anaemia. It might be seen in conditions affecting the thyroid or related to hormonal imbalances, but it is not directly related to anaemia.

Correct Answer is D
Explanation
Blurred vision is incorrectly. Blurred vision is not a common complication of immobility and is more likely related to other factors.
Choice B Reason:
Polyuria is incorrect. Increased urination (polyuria) is not directly related to immobility; it can be caused by various factors, such as fluid intake, medications, or underlying medical conditions.
Choice C Reason:
Diarrhea is incorrect. While immobility can contribute to constipation due to reduced activity and decreased bowel motility, it is not typically associated with diarrhea
Choice D Reason:
Confusion is correct. Confusion can be a potential complication of immobility in bedridden clients. Prolonged immobility can lead to reduced sensory stimulation, altered sleep patterns, and decreased cognitive engagement, which can contribute to confusion and cognitive decline.
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