A nurse is monitoring a client who is receiving 2 units of packed RBCs. Which of the following manifestations indicates a hemolytic transfusion reaction?

A. Inability to exhale retained carbon dioxide: During an acute asthma attack, airway obstruction due to bronchospasm, inflammation, and increased mucus production leads to air trapping. This makes it difficult for the client to fully exhale, resulting in the retention of carbon dioxide. Hyperinflation of the lungs and respiratory acidosis can occur as a result, contributing to the client's manifestations.

B. Acute loss of alveolar elasticity: A loss of alveolar elasticity is associated with conditions like emphysema, not asthma. Asthma primarily affects the airways rather than the alveoli, and elasticity is not typically impacted during an acute asthma attack.

C. Decreased responsiveness of airways to allergens: Asthma is characterized by increased responsiveness of the airways to triggers such as allergens, not decreased responsiveness. This hyperresponsiveness is a hallmark of the condition and contributes to airway narrowing during an attack.

D. Suppressed bronchiolar inflammatory response: Asthma attacks involve heightened inflammation of the bronchioles, not a suppressed inflammatory response. The inflammation contributes to airway swelling, increased mucus production, and bronchospasm.

Choice A reason:

Initiating a continuous IV insulin infusion is the first priority. The priority intervention for a client in diabetic ketoacidosis (DKA) is to normalize blood glucose levels and reverse the ketoacidosis. Initiating a continuous IV insulin infusion is essential to rapidly lower the elevated blood glucose levels and counteract the metabolic acidosis associated with DKA.

Choice B reason:

Beginning a bicarbonate continuous IV infusion is generally not the priority in DKA management. While metabolic acidosis is a concern in DKA, insulin therapy and fluid resuscitation are typically the initial focus of treatment.

Choice C reason:

Checking potassium levels is important since potassium imbalances are common in DKA. However, while this is important, it is not the first priority. It's important to ensure that insulin therapy has been initiated before addressing potassium levels.

Choice D reason:

Administering 0.9% sodium chloride (normal saline) is a crucial part of DKA treatment but it is not the first priority as it helps correct dehydration and electrolyte imbalances. However, starting insulin therapy to address the underlying metabolic issue takes precedence.