A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast media. For which of the following client findings should the nurse intervene first?

Stridor

Hypotension

Urticaria

Vomiting

Answer and Explanation

The Correct Answer is A

A. Stridor is a high-pitched sound indicating upper airway obstruction and is a critical sign of anaphylaxis requiring immediate intervention to secure the airway.
B. Hypotension is a serious condition that occurs during anaphylaxis, but the priority is to address the airway obstruction first.
C. Urticaria (hives) is a common symptom of an allergic reaction but is not life-threatening and can be addressed after more severe symptoms.
D. Vomiting may occur during anaphylaxis but is not the most urgent finding when airway compromise is present.

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Correct Answer is D

Explanation

A. Furosemide is a diuretic and is not indicated in the acute management of anaphylaxis.
B. Methylprednisolone is a corticosteroid that may be used later to reduce inflammation but is not the first-line treatment in anaphylaxis.
C. Dobutamine is a medication used to treat heart failure and shock but does not address the acute allergic reaction.
D. Epinephrine is the first-line treatment for anaphylactic shock, as it acts quickly to reverse severe allergic reactions by causing vasoconstriction, bronchodilation, and inhibiting further release of mediators from mast cells.

A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis

Correct Answer is A

Explanation

A. Respiratory acidosis is characterized by a low pH (7.32) and an elevated PaCO2 (48 mm Hg), indicating that the body is unable to eliminate CO2 effectively, leading to acid retention. The HCO3 level is within normal limits, suggesting that there is not a metabolic compensation occurring yet.
B. Metabolic alkalosis would present with a high pH and elevated bicarbonate levels, which is not the case here.
C. Respiratory alkalosis typically shows a high pH and low PaCO2, indicating hyperventilation, which does not align with the current findings.
D. Metabolic acidosis would show a low pH with a low HCO3, which is not supported by the HCO3 level of 23 mEq/L in this case.

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A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast media. For which of the following client findings should the nurse intervene first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

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