A nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. The nurse should understand that this client is at increased risk for which of the following conditions?

Choice A reason: The nurse collects a urine specimen is an appropriate action, as it can help detect the presence of hemoglobinuria, which is a sign of hemolysis. Hemoglobinuria is the excretion of hemoglobin in the urine, which can cause the urine to appear red or brown.

Choice B reason: The nurse sends a blood specimen to the laboratory is an appropriate action, as it can help confirm the diagnosis of a hemolytic reaction and identify the cause. The laboratory can perform tests such as blood typing, cross-matching, direct antiglobulin test (DAT), and serum bilirubin.

Choice C reason: The nurse initiates an infusion of 0.9% sodium chloride is an appropriate action, as it can help maintain the client's fluid and electrolyte balance and prevent hypovolemic shock. 0.9% sodium chloride is the preferred solution for blood transfusion reactions, as it is isotonic and compatible with blood products.

Choice D reason: The nurse starts the transfusion of another unit of blood product is an inappropriate action, as it can worsen the client's condition and increase the risk of complications. The nurse should not resume the transfusion until the cause of the reaction is determined and the provider orders a new unit of blood product. The nurse should also return the unused blood product and tubing to the blood bank for analysis.

Choice A reason: Applying a new transdermal patch when chest pain is experienced is not a correct instruction, as it may delay the relief of the pain and increase the risk of adverse effects. Transdermal nitroglycerin is a long-acting form of nitrate that is used for the prevention of angina attacks, not for the treatment of acute episodes. The client should use a short-acting form of nitrate, such as sublingual or spray, for the immediate relief of chest pain.

Choice B reason: Applying the transdermal patch in the morning is a correct instruction, as it helps to maintain a steady level of nitrate in the blood throughout the day and prevent angina attacks. Transdermal nitroglycerin has a duration of action of about 12 to 24 hours, depending on the dose and the individual response. The client should apply the patch in the morning and remove it at night, to allow a nitrate-free interval of at least 8 hours and prevent the development of tolerance.

Choice C reason: Applying the transdermal patch in the same location as the previous patch is not a correct instruction, as it may cause skin irritation and reduce the absorption of the medication. Transdermal nitroglycerin should be applied to a clean, dry, and hairless area of the skin, preferably on the chest, upper arm, or back. The client should rotate the application sites and avoid areas that are exposed to heat, moisture, or friction.

Choice D reason: Applying a new transdermal patch once a week is not a correct instruction, as it may not provide adequate protection against angina attacks and increase the risk of rebound angina. Transdermal nitroglycerin should be applied daily, with a nitrate-free interval of at least 8 hours, to maintain a therapeutic level of nitrate in the blood and prevent the loss of efficacy. The client should follow the prescribed dosing schedule and consult the provider before making any changes.