The healthcare provider has ordered 1000 mL of 0.9% sodium chloride to be administered intravenously over 5 hours. The drop factor on the tubing is 15 drops/mL. How many milliliters per hour will you administer and how many drops per minute?

A) Low-back pain:
Low-back pain is not a common manifestation of an allergic reaction to a blood transfusion. It may be associated with other conditions, such as musculoskeletal issues or renal complications, but it is not typically addressed by diphenhydramine administration during transfusion.

B) Fever:
While fever can occur as a manifestation of an adverse reaction to a blood transfusion, it is more commonly associated with non-allergic transfusion reactions such as transfusion-related acute lung injury (TRALI) or bacterial contamination of the blood product. Diphenhydramine is not specifically indicated for the prevention of fever during transfusion.

C) Dyspnea:
Dyspnea, or difficulty breathing, can occur as a manifestation of a severe allergic reaction or anaphylaxis during a blood transfusion. However, diphenhydramine alone may not be sufficient to prevent or treat severe respiratory symptoms associated with anaphylaxis. In such cases, prompt medical intervention and administration of epinephrine may be necessary. Diphenhydramine primarily targets histamine-mediated symptoms such as urticaria and itching.

D) Urticaria.
Urticaria, commonly known as hives, is a skin reaction characterized by raised, itchy welts that can occur as a result of an allergic or hypersensitivity reaction. During a blood transfusion, if the recipient's immune system reacts to foreign proteins in the transfused blood, it can lead to an allergic reaction characterized by symptoms such as urticaria, itching, flushing, and sometimes more severe reactions like anaphylaxis.
Diphenhydramine is an antihistamine medication that works by blocking the effects of histamine, a chemical released by the body during allergic reactions. By administering diphenhydramine before the blood transfusion, the nurse aims to prevent or minimize the occurrence of urticaria and other allergic symptoms.

A. Hypotension: Norepinephrine is administered to treat hypotension, so monitoring for hypotension is not typically a concern while the patient is receiving this medication. In fact, hypotension is often the reason for administering norepinephrine in the first place.

B. Liver failure: Monitoring for signs of liver failure may be important in patients receiving certain medications, but it is not a specific consideration when administering norepinephrine. Norepinephrine primarily affects blood pressure regulation and does not typically have direct effects on liver function.

C. Bradycardia: While norepinephrine can increase blood pressure by constricting blood vessels, it may also cause reflex bradycardia (a decrease in heart rate) as a compensatory response. However, the primary concern with norepinephrine administration is hypertension, not bradycardia.

D. Hypertension
Norepinephrine (Levophed) is a vasopressor medication commonly used to treat hypotension and shock. It works by constricting blood vessels, which increases blood pressure. Therefore, when administering norepinephrine, the nurse should monitor the patient for hypertension, as the medication's intended effect is to raise blood pressure.