A nurse in an urgent care facility is collecting data from a client who was stung by a wasp. Which of the following findings indicates the client is experiencing anaphylaxis?

Bilateral tinnitus

Difficulty swallowing

Hypertension

Petechial rash on the abdomen

Answer and Explanation

The Correct Answer is B

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Correct Answer is A

Explanation

Ringing in ears. Furosemide is a loop diuretic, which can cause ototoxicity as an adverse effect, resulting in ringing in the ears, hearing loss, or vertigo. The nurse should instruct the client to monitor for these adverse effects and report them immediately if they occur.

An explanation for incorrect choices:

B. Metallic taste is a common adverse effect of metronidazole or clarithromycin, but not furosemide.

C. Rhinitis is associated with intranasal or occasionally oral corticosteroid use.

D. Agitation is a side effect for stimulants, sedatives, or antidepressants.

A. Apply a motion sensor mat to the client's bed. B. Move the overbed table away from the bed. C. Raise all four side rails while the client is in bed. D. Leave the television on in the client's room.

Correct Answer is A

Explanation

The correct answer is choice A, apply a motion sensor mat to the client's bed. This is an effective intervention to monitor the client's movements and prevent falls. The mat is placed under the bed sheet and will sound an alarm if the client tries to get out of bed.

Moving the overbed table away from the bed is not the correct answer because it does not prevent falls.
Raising all four side rails while the client is in bed is not the correct answer because it can cause the client to feel trapped and can lead to injuries if they try to climb over the rails.
Leaving the television on in the client's room is not the correct answer because it can be distracting and interfere with the client's sleep.

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A nurse in an urgent care facility is collecting data from a client who was stung by a wasp. Which of the following findings indicates the client is experiencing anaphylaxis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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