A nurse is caring for a client who experienced a hemorrhage and received a blood transfusion. Which clinical manifestation should the nurse monitor to determine the effectiveness of the transfusion?

A) Incorrect. Applying a warm compress may promote vasodilation and increase bleeding in the joint. It is not recommended for managing joint bleeding in a client with hemophilia.

B) Correct. The priority intervention for managing joint bleeding in a client with hemophilia is to administer prescribed clotting factor replacement therapy to promote clot formation and stop the bleeding.

C) Incorrect. Elevating the affected joint can help reduce swelling, but it is not the priority intervention when the client is experiencing an acute joint bleed.

D) Incorrect. Encouraging active range of motion exercises can worsen joint bleeding and is contraindicated in a client with acute joint bleeding due to hemophilia.

Questions

A) Correct. Dizziness and lightheadedness are common signs of decreased blood flow, indicating a potential worsening of internal bleeding. Immediate intervention is required to prevent further complications.

B) Incorrect. While a slightly decreased blood pressure could be a concern, it may not be an immediate priority. The nurse should closely monitor the blood pressure and respond promptly if it drops significantly or trends downward.

C) Incorrect. Pale and cool skin may indicate poor perfusion, but it doesn't necessarily require immediate intervention unless it worsens or is accompanied by other alarming signs.

D) Incorrect. Although heart rate can be affected by hemorrhage, being within the normal range doesn't necessarily warrant immediate intervention. Other signs and symptoms should be considered as well.