# After a packed red blood cell transfusion, a client develops dyspnea, bilateral crackles, jugular venous distention, and blood pressure 178/96 mm Hg without fever. Which complication best explains these findings?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568883&lang=en  
> language: en  
> subject: Postsurgical Complications  
> category: ROR

## Question

After a packed red blood cell transfusion, a client develops dyspnea, bilateral crackles, jugular venous distention, and blood pressure 178/96 mm Hg without fever. Which complication best explains these findings?

## Option

1. Transfusion-related acute lung injury causing noncardiogenic pulmonary edema
2. Transfusion-associated circulatory overload causing hydrostatic pulmonary edema **✔ Correct answer**
3. Acute hemolytic transfusion reaction causing intravascular red-cell destruction
4. Severe allergic transfusion reaction causing bronchospasm and upper-airway edema

**Correct answer: 2**

## Explanation

Dyspnea and crackles after transfusion occur with several reactions, but hypertension and jugular venous distention indicate circulatory overload. TACO produces hydrostatic pulmonary edema from excess volume. TRALI is noncardiogenic and lacks the same volume-overload pattern.

## In-depth explanation

Quick answer
The hypertension, jugular venous distention, and pulmonary edema pattern indicates transfusion-associated circulatory overload.

Why this is correct
The transfused volume has exceeded the client's circulatory capacity, raising filling pressures and pushing fluid into the lungs. The cardiovascular overload cues distinguish TACO from respiratory reactions without volume excess.

Easy analogy or mental picture
TACO is like adding fluid to a closed system faster than the system can handle it, causing pressure to back up into the lungs. The analogy explains hydrostatic overload but does not replace a full transfusion-reaction evaluation.

Memory hook
TACO backs up volume: hypertension, neck-vein distention, pulmonary edema.

NCLEX decision rule
After transfusion, combine respiratory findings with hemodynamics: hypertension, positive volume cues, and jugular venous distention favor TACO over TRALI.

Why the other choices are wrong
TRALI causes noncardiogenic lung injury without the same overload pattern. Hemolysis more often produces fever, pain, hypotension, or hemoglobinuria, while severe allergy features urticaria, bronchospasm, or airway edema.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]NHSN Hemovigilance Module Adverse Reaction ProtocolCenters for Disease Control and Prevention

## Clinical scenario

Clinical Practice Guide
For Postoperative hemorrhage cues, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Hemorrhage** — Excessive bleeding that can reduce circulating volume.
- **Shock** — Inadequate tissue perfusion that can lead to organ dysfunction.
- **Postoperative Drainage** — Fluid from a surgical site that may signal expected healing or complications.

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