Final answer:
During the first 15 minutes of the blood transfusion, the nurse should assess for an acute hemolytic reaction to ensure the patient's safety and properly manage any adverse events.
Step-by-step explanation:
The nurse should plan to assess for an acute hemolytic reaction during the first 15 min of the transfusion of packed RBCs to a client who has a Hgb of 8 g/dL. This monitoring is critical to quickly identify and respond to any adverse reactions such as fever, chills, pruritus (itching), urticaria (hives), dyspnea (difficulty breathing), hemoglobinuria (hemoglobin in the urine), and hypotension (low blood pressure) which could indicate an incompatibility or acute transfusion reaction. Consent for the transfusion should already have been obtained beforehand, and while an explanation of the procedure is essential, it should not be the primary focus during the initial stage of the transfusion. Blood cultures are not routinely obtained unless there is a suspicion of infection.
Cross matching and blood type verification using commercially prepared anti-A, anti-B, and anti-Rh antibodies must have occurred prior to the transfusion to ensure compatibility between donor and recipient and to prevent hemolytic reactions.
The nurse should plan to assess for an acute hemolytic reaction during the first 15 minutes of the transfusion. This is because an acute hemolytic reaction can occur if the client receives packed RBCs with an incompatible ABO blood type, which can lead to a potentially lethal hypersensitivity reaction. Symptoms of an acute hemolytic reaction include fever, chills, pruritus, urticaria, dyspnea, hemoglobinuria, and hypotension.
The correct answer is A. Obtain consent from the client for the transfusion.