Difficulty: Medium
Average Score: 88%
Simulated
Passage / Scenario
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.)
Correct answer
A,C,E
Rationale
Stopping the transfusion, placing in high-Fowler's, and giving oxygen address circulatory overload symptoms.