A nurse in an emergency department is caring for a client who is suspected to have anaphylaxis following a bee sting.
Which of the following actions should the nurse take first?

Auscultate for wheezing.

Assess the client’s level of consciousness.

Administer epinephrine.

Monitor for hypotension.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Auscultating for wheezing is important but not the first action. The priority is to administer epinephrine to counteract the severe allergic reaction.

Choice B rationale

Assessing the client’s level of consciousness is important but not the first action. Administering epinephrine takes precedence to stabilize the client’s condition.

Choice C rationale

Administering epinephrine is the first action. It is crucial to counteract the severe allergic reaction and prevent further complications.

Choice D rationale

Monitoring for hypotension is important but not the first action. Administering epinephrine is the priority to stabilize the client’s condition.

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Correct Answer is ["5"]

Explanation

Step 1 is: Calculate the amount of diphenhydramine elixir needed per dose. 25 mg ÷ (12.5 mg ÷ 5 mL) = 10 mL The nurse should administer 10 mL per dose.

A. Visual Analog Scale. B. FLACC. C. Oucher. D. Faces.

Correct Answer is B

Explanation

Choice B rationale

The FLACC scale (Face, Legs, Activity, Cry, Consolability) is specifically designed for assessing pain in infants and young children who are unable to communicate their pain verbally.

Choice A rationale

The Visual Analog Scale is used for older children and adults who can understand and communicate their pain level.

Choice C rationale

The Oucher scale is used for children aged 3 to 12 years and involves matching facial expressions to a pain level.

Choice D rationale

The Faces scale is used for children aged 3 years and older who can point to a face that best represents their pain level.

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A nurse in an emergency department is caring for a client who is suspected to have anaphylaxis following a bee sting. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to the parent of a child who is prescribed diphenhydramine 25 mg elixir every 6 hours as needed. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth.)

Correct Answer is ["5"]

Explanation

A nurse is caring for a 6-month-old infant who is postoperative following a myringotomy. Which of the following pain scales should the nurse use to determine the infant’s pain level?

Correct Answer is B

Explanation

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A nurse in an emergency department is caring for a client who is suspected to have anaphylaxis following a bee sting.
Which of the following actions should the nurse take first?