A nurse is caring for a client who is receiving a transfusion of packed red blood cells and develops itching and hives. What should be the nurse’s first response?

Choice A rationale:

Painful urination (dysuria) can be a sign of several conditions that could potentially affect the client's IVP or indicate a need for further assessment. These conditions include:

Urinary tract infection (UTI): UTIs are common in clients with recurrent kidney stones, and they can cause inflammation and pain in the urinary tract. If a client has a UTI, it's important to treat it before the IVP to reduce the risk of spreading the infection to the kidneys.

Kidney stone passage: The client's history of kidney stones makes it possible that the pain could be due to the passage of a stone. This would be important information for the healthcare team to know, as it could affect the interpretation of the IVP results.

Other urological conditions: There are other urological conditions, such as bladder or urethral strictures, that can also cause painful urination. These conditions might also need to be considered and assessed for.

It's important for the nurse to collect more data about the client's painful urination to determine the underlying cause and whether it could impact the IVP. This might include asking questions about:

The severity and duration of the pain

Any other associated symptoms, such as fever, urgency, or frequency The client's history of UTIs or kidney stones

Any recent changes in urinary habits

Based on this additional information, the nurse can then collaborate with the healthcare team to determine the best course of action, which might include:

Further assessment, such as a urinalysis or urine culture Treatment for a UTI, if present

Pain management

Rescheduling the IVP, if necessary

Choice B rationale:

Phlebitis is the inflammation of a vein, often caused by an IV catheter. It's characterized by redness, swelling, warmth, and pain along the vein.

Promptly discontinuing the IV infusion is crucial to prevent further irritation and potential complications such as: Thrombophlebitis (inflammation with clot formation)

Infection

Infiltration (leakage of fluids into surrounding tissues) Extravasation (leakage of vesicant or damaging medications)

Continuing the infusion could exacerbate the inflammation and increase the risk of these complications.

Choice A rationale:

Elevation of the extremity can help reduce swelling, but it does not address the underlying inflammation. It's often used as an adjunct measure after discontinuing the IV.

Choice C rationale:

Warm, moist compresses can provide some comfort and potentially promote blood flow, but they are not recommended as a first-line treatment for phlebitis. They may even worsen inflammation in some cases.

Choice D rationale:

Inserting an IV catheter in the opposite extremity is necessary if the patient still requires IV therapy, but it should not be done before addressing the phlebitis in the current site. This could lead to multiple sites of inflammation and increased risk of complications.