# Clinical context Twelve minutes after a red-blood-cell transfusion begins, a client develops sudden chills, severe low-back pain, chest tightness, hypotension, tachycardia, and dark-red urine, requiring an immediate response for a serious transfusion reaction with hemolysis and shock risk. Highlight the findings that support an acute serious transfusion reaction with hemolysis and shock risk. Do not select intact equipment or stable findings.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522656&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
Twelve minutes after a red-blood-cell transfusion begins, a client develops sudden chills, severe low-back pain, chest tightness, hypotension, tachycardia, and dark-red urine, requiring an immediate response for a serious transfusion reaction with hemolysis and shock risk.

Highlight the findings that support an acute serious transfusion reaction with hemolysis and shock risk. Do not select intact equipment or stable findings.

Transfusion Record\nThe client was comfortable before the transfusion. Twelve minutes after red blood cells were started, the client reports sudden chills, severe low-back pain, and chest tightness. Findings include blood pressure 82/48 mm Hg, heart rate 128/min, and new dark-red urine in the catheter. The IV site is dry without swelling, the unit is infusing through a filter, and the lung sounds remain clear bilaterally.

## Explanation

Chills, severe low-back pain, chest tightness, hypotension, tachycardia, and dark urine are acute transfusion-reaction cues. The transfusion must be stopped while the client is assessed and the reaction is investigated.

## In-depth explanation

Quick answer
Recognize systemic symptoms, pain, hemodynamic change, and hemoglobinuria during transfusion.

Why this is correct
Acute hemolysis can begin within minutes of incompatible red-cell exposure. Fever or rigors also require investigation for bacterial contamination rather than an assumption that the reaction is benign.

Easy analogy or mental picture
Treat every infusion as a controlled clinical system: verify the product and access, recognize a changing cue, stop preventable exposure, stabilize the client, and confirm the response.

Memory hook
Product, access, compatibility, infusion cue, protective action, and reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate infusion-related harm while preserving vascular access and the ordered diagnostic evidence.

Why the other choices are wrong
Options that restart a suspect product, bypass a safety device, force an occluded tube, or delay reassessment can convert a reversible warning into serious harm.References
1CDC NHSN Hemovigilance Module Surveillance Protocol, January 2026Definitions and clinical patterns for acute hemolytic reaction, TACO, TRALI, and transfusion-transmitted infection
2CDC Clinical Guidance for Bacterial Contamination and Blood SafetyStop a suspected contaminated transfusion, preserve the unit, culture the patient, and investigate the residual component
3FDA-recognized Circular of Information for Blood and Blood ComponentsTransfusion reaction recognition, immediate discontinuation, product investigation, and supportive care

## Clinical scenario

Clinical context
Twelve minutes after a red-blood-cell transfusion begins, a client develops sudden chills, severe low-back pain, chest tightness, hypotension, tachycardia, and dark-red urine, requiring an immediate response for a serious transfusion reaction with hemolysis and shock risk.

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