The nurse is administering the second unit of whole blood to an older adult client who was admitted yesterday with gastrointestinal (GI) bleeding. Which parameters should the nurse monitor that indicate fluid overload?

A. Thready pulse, hypotension, and chest or back pain: These findings are more consistent with a transfusion reaction such as hemolysis or hypovolemic shock, not fluid overload. Fluid overload produces signs of increased vascular volume, not low BP or weak pulses. B. Urticaria, itching, and wheezing: These symptoms suggest an allergic transfusion reaction. They result from hypersensitivity to donor plasma proteins, but they are unrelated to circulatory overload. C. Chills, fever, and tachycardia: These findings are typical of a febrile non-hemolytic transfusion reaction. While concerning, they do not represent the hemodynamic changes expected with volume overload. D. Bounding pulse, hypertension, and distended neck veins: These are hallmark signs of fluid overload, particularly in older adults receiving transfusions. Increased intravascular volume causes elevated blood pressure, stronger peripheral pulses, jugular venous distention, and risk of pulmonary edema.