A nurse is monitoring a client who is receiving a blood transfusion. Which of the following findings indicates an allergic transfusion reaction?

Choice A rationale A blood pressure of 184/92 mm Hg, while elevated, is more indicative of a hypertensive reaction or fluid overload rather than a primary allergic transfusion reaction. Allergic reactions typically manifest with widespread vasodilation and histamine release, often leading to hypotension or fluctuating blood pressure rather than isolated hypertension. Choice B rationale Bilateral flank pain is a classic symptom of an acute hemolytic transfusion reaction, which is caused by the immune-mediated destruction of red blood cells. This pain typically arises from renal ischemia and hemoglobinuria as the kidneys attempt to filter the cellular debris. It is not a primary sign of an allergic reaction. Choice C rationale Distended jugular veins suggest fluid overload or cardiac dysfunction, such as congestive heart failure, which can be a complication of rapid transfusion but is not a direct sign of an allergic reaction. Allergic reactions are characterized by hypersensitivity responses, not primarily by volume expansion leading to venous distention. Choice D rationale Generalized urticaria, or hives, is a common manifestation of an allergic transfusion reaction. It results from histamine release from mast cells and basophils, causing increased capillary permeability and localized vasodilation, leading to itchy, raised wheals on the skin. This is a direct immunological response to an allergen in the blood product.