A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin Gby intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

Call the client's provider.

Stop the infusion.

Auscultate the client's breath sounds.

Elevate the head of the bed.

Answer and Explanation

The Correct Answer is B

The client is exhibiting symptoms and signs of anaphylaxis. Anaphylaxis is a severe systemic allergic reaction that occurs due to allergens presenting with (itching) urticaria and sudden onset shortness of breath and/or shock. The first action should be to stop the infusion to prevent worsening the severity of the allergic reaction.

A. Important to allow for further prescription but not a priority

C. Auscultating the lungs allows the nurse to assess for the severity of the reaction but should come after stopping the infusion

D. Elevating the head can improve ventilation but is not a priority

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Correct Answer is B

Explanation

Theophylline has a narrow therapeutic window which increase the risk of overdose and toxicity. It is also given at very small doses which could be difficult for the nursing staff to accurately titrate the drops and hence requires an infusion pump
A. Infusion of theophylline loading dose should not exceed 25mg/min due to risk of seizures and cardiac arrhythmias
C. Use of a test dose is not necessary as the risk of hypersensitivity with theophylline is very low.
D. Covering the IV container with dark paper is not necessary for the administration of theophylline.

A. Hypoactive deep-tendon reflexes B. Drowsiness C. Insomnia D. Constipation

Correct Answer is C

Explanation

Rationale- Levothyroxine is a synthetic form of thyroxine. It is used to provide the body with thyroxine to sustain basal metabolism in cases of hypothyroidism. An overdose of the medication causes symptoms which include insomnia, hyperactive tendon reflexes, diarrhea and anxiety

A, B, D- features of hypothyroidism

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an emergency department is preparing to administer theophylline by continuous intravenous (IV) infusion to a client who is experiencing an asthma attack. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

Correct Answer is C

Explanation

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions?

A nurse is teaching a client Who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?

A nurse is providing teaching to a client who has peptic ulcer disease and a new prescription for sucralfate tablets. Which of the following information should the nurse provide?

A nurse is preparing to administer blood to a client. The unit of blood on hand is type B, and the client has type AB blood. Which of the following actions should the nurse take?

A nurse is reviewing the medical record of a client who is to receive the first dose of cefoxitin via intermittent IV bolus. Which of the following findings should the nurse identify as a contraindication for the client to receive cefoxitin and report to the provider?

A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which Of the following medications should the nurse plan to administer?