A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing a hemolytic reaction?

Choice A reason: Using IV tubing specific for heparin sodium when administering the infusion is not the correct action. Heparin sodium can be administered using any standard IV tubing, as long as it is primed with heparin solution to prevent clotting in the tubing.

Choice B reason: Administering 50,000 units of heparin by IV bolus every 12 hours is not the correct action. This is a very high dose of heparin that can cause bleeding complications. The usual dose of heparin for continuous IV infusion is 15 to 25 units/kg/hour, adjusted according to the aPTT results.

Choice C reason: Having vitamin K available on the nursing unit is not the correct action. Vitamin K is the antidote for warfarin, not heparin. Vitamin K reverses the effects of warfarin by increasing the synthesis of clotting factors in the liver.

Choice D reason: Checking the activated partial thromboplastin time (aPTT) every 4 hours is the correct action. The aPTT is a blood test that measures the time it takes for the blood to clot. It is used to monitor the effectiveness and safety of heparin therapy. The therapeutic range of aPTT for heparin is 1.5 to 2.5 times the normal value, or 60 to 80 seconds. The nurse should check the aPTT every 4 hours until it is within the therapeutic range, and then every 6 to 8 hours thereafter. The nurse should adjust the heparin infusion rate according to the aPTT results and the prescriber's orders.

Choice A reason: Lidocaine is an antiarrhythmic medication that stabilizes the cardiac membrane and suppresses abnormal electrical impulses in the heart. It is used to treat ventricular dysrhythmias, such as ventricular tachycardia and ventricular fibrillation, which can occur after a cardiac arrest.

Choice B reason: Lidocaine is not primarily used to relieve pain, although it has local anesthetic properties. It is not effective for chest pain caused by myocardial ischemia or infarction.

Choice C reason: Lidocaine does not dissolve blood clots, nor does it prevent their formation. It has no anticoagulant or thrombolytic effects.

Choice D reason: Lidocaine does not slow intestinal motility, nor does it affect the gastrointestinal system. It has no antispasmodic or antidiarrheal effects.