A client is receiving an initial dose of penicillin IV. During the infusion, the client becomes short of breath. What is the first thing the nurse should do?
Increase the head of the bed.
Place the patient in a recovery position.
Stop the infusion of the medication.
Slow down the infusion of the medication.
The Correct Answer is C
A. Increasing the head of the bed may help ease breathing but does not address the potential cause of the problem.
B. The recovery position is used for unconscious patients to maintain an open airway—not appropriate here.
C. Stopping the infusion of the medication is the first and most critical action. The client is likely experiencing an allergic reaction or anaphylaxis to penicillin, and continuing the drug could worsen symptoms.
D. Slowing the infusion does not prevent further reaction and delays stopping the exposure to the allergen.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Platelets are administered to treat or prevent bleeding due to thrombocytopenia or platelet dysfunction, not primarily for volume loss.
B. Albumin is a plasma volume expander and may be used in hypovolemia, but it does not replace oxygen-carrying capacity like RBCs do.
C. Cryoprecipitates are rich in clotting factors (e.g., fibrinogen, factor VIII) and are used for coagulopathies, not as a primary treatment for hypovolemic shock.
D. Packed RBCs are the appropriate choice in hypovolemic shock, especially when blood loss has occurred, as they restore oxygen-carrying capacity and circulating blood volume.
Correct Answer is C
Explanation
A. In the refractory stage, cardiac output is decreased and tissue perfusion is severely impaired, not improved.
B. Fluid balance is not restored during the refractory stage; instead, hypovolemia worsens.
C. The refractory stage is characterized by irreversible damage with worsening organ dysfunction and failure despite interventions.
D. Heart rate usually increases initially, and blood pressure typically decreases; decreased heart rate and improved blood pressure are not features of this stage.
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