A client taking antibiotics for three days to treat a Streptococcal throat infection returns to the clinic reporting a feel itchy rash across the chest and arms. The nurse auscultates pulmonary wheezing and an elevated heart rate. Which action should the nurse implement?
Swab the throat for a rapid strep test.
Provide a mask for the client to wear.
Instruct client to stop taking the antibiotics.
Apply a hypoallergenic cream to the rash.
The Correct Answer is C
Choice A reason: Swabbing the throat for a rapid strep test is not a priority action that the nurse should implement, because it is not relevant to the client's current condition. A rapid strep test is a diagnostic tool that can detect the presence of Streptococcus bacteria in the throat, which can cause strep throat, a common bacterial infection. However, the client has already been diagnosed with strep throat and has been taking antibiotics for three days, so the test result may not be accurate or useful.
Choice B reason: Providing a mask for the client to wear is not a necessary action that the nurse should implement, because it is not related to the client's problem. A mask is a protective device that can prevent the transmission of respiratory infections, such as COVID-19, influenza, or tuberculosis, by blocking the droplets or aerosols that contain the pathogens. However, the client's symptoms are not caused by a respiratory infection, but by an allergic reaction to the antibiotics, which is not contagious.
Choice C reason: Instructing the client to stop taking the antibiotics is the most important action that the nurse should implement, because it can prevent further exposure to the allergen and reduce the severity of the reaction. The client's symptoms, such as rash, wheezing, and tachycardia, indicate that the client is having an allergic reaction to the antibiotics, which can be a serious and potentially life-threatening condition, especially if it progresses to anaphylaxis, a severe systemic reaction that can cause shock, airway obstruction, and organ failure. The nurse should instruct the client to stop taking the antibiotics immediately and notify the doctor.
Choice D reason: Applying a hypoallergenic cream to the rash is not a sufficient action that the nurse should implement, because it can only provide temporary relief and not address the underlying cause of the rash. A hypoallergenic cream is a topical product that can moisturize, soothe, and protect the skin, and it does not contain any ingredients that can cause allergic reactions. However, the rash is not caused by a skin irritant, but by a systemic reaction to the antibiotics, which requires more than a cream to treat.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Isolating the client from other clients, family, and healthcare workers not wearing proper PPE is the most important action that the nurse should take, because it can prevent the transmission of COVID-19, which is a highly contagious respiratory disease caused by a novel coronavirus. The client has symptoms that are consistent with COVID-19, such as conjunctivitis, loss of taste and smell, and recent travel history, and the nasal swab test can confirm the diagnosis. The nurse should follow the infection control precautions, such as wearing a mask, gloves, gown, and eye protection, and place the client in a private room with negative pressure ventilation, if available.
Choice B reason: Reporting the COVID-19 result to the local health department according to CDC guidelines is an important action that the nurse should take, but it is not the most important one. Reporting the COVID-19 result can help the public health authorities to monitor the epidemiology, track the contacts, and implement the interventions to control the outbreak. However, reporting the result can only be done after the test is completed and confirmed, which may take some time. The nurse should prioritize the immediate isolation of the client to prevent the spread of the virus.
Choice C reason: Teaching the client to wear a mask, hand wash, and social distance to prevent spreading the virus is an important action that the nurse should take, but it is not the most important one. Teaching the client to wear a mask, hand wash, and social distance can help the client to protect themselves and others from COVID-19, which can be transmitted through respiratory droplets, contact, and aerosols. However, teaching the client these measures can only be effective if the client follows them and adheres to the isolation guidelines. The nurse should first isolate the client and then provide the education.
Choice D reason: Explaining to the client to inform others that they may have been potentially exposed in the last 14 days is an important action that the nurse should take, but it is not the most important one. Explaining to the client to inform others that they may have been potentially exposed in the last 14 days can help the client to notify their close contacts, such as family, friends, co-workers, and travel companions, who may have been at risk of COVID-19 infection. However, explaining to the client this information can only be useful if the client cooperates and remembers their contacts. The nurse should first isolate the client and then assist the client with the contact tracing.
Correct Answer is A
Explanation
Choice A reason: Whole milk and ice cream are high in fat, which can trigger the inflammation of the gallbladder (cholecystitis) and the formation of gallstones. The client should avoid foods that are high in fat, such as fried foods, cheese, butter, cream, and fatty meats.
Choice B reason: Citrus fruit and melon with a salt substitute are not a problem for a client with cholecystitis, unless they have other conditions that require dietary modifications, such as diabetes or kidney disease. The client should eat a balanced diet that includes fruits, vegetables, grains, and lean proteins.
Choice C reason: Pasta with herbal butter and no meat sauce is also acceptable for a client with cholecystitis, as long as the butter is used sparingly and the pasta is not cooked with oil or cheese. The client should limit the intake of refined carbohydrates, such as white bread, rice, and sugar, and choose whole grains instead.
Choice D reason: Canned vegetables with additional table salt are not recommended for a client with cholecystitis, because they are high in sodium, which can increase the risk of fluid retention and hypertension. The client should reduce the intake of salt and processed foods, such as canned soups, sauces, and snacks, and use herbs and spices to flavor the food.
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