A nurse is assisting with the care of a client who is receiving a blood transfusion. The nurse should monitor for which of the following findings as an indication the client is having an acute hemolytic reaction?

Choice A reason: Emptying the drain device every shift is important to prevent infection and accumulation of fluid, which can impede healing.

Choice B reason: Minimizing use of the affected arm is not recommended; rather, gentle exercises to promote circulation and prevent lymphedema are usually encouraged.

Choice C reason: Measuring the circumference of both arms can be part of monitoring for lymphedema, but it is not the priority in immediate post-mastectomy care.

Choice D reason: Placing the affected arm below the level of the heart is not recommended as it can increase swelling; elevation is usually advised.

Choice A reason: LPNs are involved in developing the patient's plan of care by gathering data and collaborating with the RN to ensure the plan is tailored to the patient's needs.

Choice B reason: Providing informed consent is typically the responsibility of the physician or advanced practice nurses, not the LPN.

Choice C reason: LPNs provide emotional support to patients, helping to alleviate anxiety and offering comfort before the surgery.

Choice D reason: LPNs assist with data collection, such as gathering vital signs and medical history, which is crucial for the preoperative assessment.

Choice E reason: Including families in preoperative care is part of the holistic approach to nursing, where LPNs can provide information and support to the patient's family.

Choice F reason: LPNs reinforce patient teaching by reviewing instructions and care plans with the patient and their family to ensure understanding and compliance.