ATI RN Pharmacology Proctored Exam 2023
Select All That Apply
A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)
Explanation & Rationale
A. Stop the transfusion. The first action is to stop the transfusion to prevent further fluid overload. B. Place the client in high-Fowler's position. This position reduces venous return to the heart and improves breathing and oxygenation. C. Obtain a prescription for a diuretic. Diuretics (e.g., furosemide) help remove excess fluid, relieving pulmonary congestion and reducing strain on the heart. D. Administer oxygen to the client. Oxygen helps relieve hypoxia caused by fluid buildup in the lungs. E. Administer epinephrine to the client. Epinephrine is used for anaphylactic reactions, not circulatory overload. There is no indication of an allergic reaction in this scenario.
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