Difficulty: Medium
Average Score: 72%
Simulated
A nurse is administering platelets to a client who reports having lower back pain and feeling chilled and itchy. Which of the following actions should the nurse take first?
Correct answer
D
Rationale
The correct answer is D: Stop the infusion. Lower back pain, feeling chilled, and itching are symptoms of a transfusion reaction. Stopping the infusion is the priority to prevent further complications. Collecting a urine sample (A) is not relevant to the client's immediate symptoms. Returning the platelet bag (B) can be done after stopping the infusion. Notifying the provider (C) can be done after ensuring the client's safety.