A nurse is caring for a client who has a peanut allergy. The client states. "I feel like my throat is closing "Which of the following actions should the nurse take?

Deliver 2 L of oxygen via partial nonrebreather mask.

Give epinephrine intramuscularly

Administer diazepam PO.

Notify the radiology department

Answer and Explanation

The Correct Answer is B

Rationale:

A. Deliver 2 L of oxygen via partial nonrebreather mask: While oxygen can support airway function, it does not address the underlying cause of anaphylaxis. Airway closure due to an allergic reaction requires immediate pharmacologic intervention, not just oxygen delivery.

B. Give epinephrine intramuscularly: Epinephrine is the first-line treatment for anaphylaxis. It counteracts bronchoconstriction, airway edema, and hypotension by stimulating alpha and beta receptors, and should be administered immediately when signs of airway compromise are present.

C. Administer diazepam PO: Diazepam is used for anxiety or seizures, not for acute allergic reactions. It has no effect on reversing airway swelling or bronchospasm and would delay the appropriate emergency treatment needed in this situation.

D. Notify the radiology department: Contacting the radiology department is not relevant or urgent in this scenario. The client is experiencing a life-threatening reaction that requires immediate medical intervention, not communication with non-emergency services.

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Correct Answer is B

Explanation

Rationale:

A. "You should eat three large meals and two snacks per day." Eating large meals increases gastric pressure and can worsen reflux symptoms by promoting the backflow of stomach acid into the esophagus. Clients with GERD are advised to consume smaller, more frequent meals to reduce gastric distention.

B. "You should elevate the head of the bed while sleeping." Elevating the head of the bed helps prevent nighttime reflux by using gravity to reduce the likelihood of stomach acid flowing back into the esophagus. This is a key non-pharmacologic strategy in managing GERD symptoms during sleep.

C. "You should only drink 2 cups of coffee per day." Coffee, regardless of the quantity, can relax the lower esophageal sphincter and stimulate acid production. Rather than limiting intake to two cups, clients with GERD are often advised to avoid coffee altogether or monitor symptoms closely.

D. "You should lay down for 1 hour following a meal." Lying down after eating increases the risk of acid reflux due to the horizontal position reducing the effect of gravity. Clients should remain upright for at least 2 to 3 hours after meals to minimize reflux episodes.

A. Preeclampsia B. An allergy to penicillin C. Gestational diabetes mellitus D. Cholelithiasis

Correct Answer is A

Explanation

Rationale:

A. Preeclampsia: Methylergonovine causes vasoconstriction and increases blood pressure, which can be dangerous in clients with preeclampsia. Administering this medication in such cases can elevate the risk of stroke or seizure due to worsening hypertension.

B. An allergy to penicillin: Methylergonovine is not a penicillin-based medication, so a penicillin allergy does not present a known contraindication or concern. Caution is unnecessary unless there is a known allergy to ergot alkaloids.

C. Gestational diabetes mellitus: Methylergonovine does not significantly impact blood glucose levels or insulin sensitivity. Therefore, it can be used safely in clients with gestational diabetes when indicated for hemorrhage control.

D. Cholelithiasis: There is no direct interaction or exacerbation of gallbladder disease with methylergonovine. The medication primarily acts on uterine smooth muscle and vascular tone, not on the biliary system.

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A nurse is caring for a client who has a peanut allergy. The client states. "I feel like my throat is closing "Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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