Which assessment finding will the nurse expect for a patient with the following laboratory values: sodium 145 mEq/L, potassium 45 mq, calcium 45 mg/dL?

A. Hyponatremia: Hyponatremia is characterized by low sodium levels in the blood and can lead to symptoms such as weakness, confusion, and seizures. While hyponatremia can contribute to fluid imbalance, the client's presentation with shortness of breath, lower extremity swelling, crackles in the lungs, and elevated blood pressure is more indicative of fluid volume excess rather than hyponatremia.

B. Hypervolemia: Hypervolemia, or fluid volume excess, occurs when there is an abnormal increase in the extracellular fluid volume. This can lead to symptoms such as shortness of breath, crackles in the lungs (indicative of pulmonary edema), peripheral edema, and elevated blood pressure. Given the client's reported symptoms and assessment findings, hypervolemia is the most likely diagnosis.

C. Hypovolemia: Hypovolemia, or fluid volume deficit, occurs when there is a decrease in the extracellular fluid volume. This condition is characterized by symptoms such as thirst, dry mucous membranes, decreased urine output, and hypotension. The client in this scenario presents with signs and symptoms consistent with fluid volume excess rather than hypovolemia.

D. Hyperkalemia: Hyperkalemia is characterized by elevated potassium levels in the blood and can lead to symptoms such as muscle weakness, cardiac dysrhythmias, and nausea. While hyperkalemia can occur in clients with end-stage kidney disease, the client's reported symptoms and assessment findings are more suggestive of fluid volume excess rather than hyperkalemia.

A. Collect a urine sample from the client: While collecting a urine sample may be necessary for further assessment, it is not the priority in this situation. The client's symptoms of lower back pain, feeling chilled, and itching suggest a potential transfusion reaction, which requires immediate attention to ensure the client's safety. Therefore, collecting a urine sample is not the most appropriate initial action.

B. Return the platelet bag and tubing to the blood bank: Returning the platelet bag and tubing to the blood bank may be necessary after stopping the infusion, but it is not the first action the nurse should take. Stopping the infusion and assessing the client's condition are the immediate priorities to address the potential transfusion reaction.

C. Notify the provider: While it is important to notify the provider about the client's symptoms and the suspected transfusion reaction, this action should follow after stopping the infusion and assessing the client's condition. Immediate intervention to ensure the client's safety takes precedence over contacting the provider.

D. Stop the infusion: This is the correct action. The client's symptoms of lower back pain, feeling chilled, and itching are indicative of a potential transfusion reaction, such as febrile non-hemolytic transfusion reaction or allergic reaction. The immediate priority is to stop the infusion to prevent further administration of platelets and assess the client's condition. This action takes precedence over other interventions as addressing the client's safety and well-being is paramount in the event of a transfusion reaction.