A nurse is caring for a group of patients on an adult medical-surgical unit.
Which patient should the nurse identify as having the highest risk for aspiration?

Choice A rationale:

Painful urination (dysuria) can be a sign of several conditions that could potentially affect the client's IVP or indicate a need for further assessment. These conditions include:

Urinary tract infection (UTI): UTIs are common in clients with recurrent kidney stones, and they can cause inflammation and pain in the urinary tract. If a client has a UTI, it's important to treat it before the IVP to reduce the risk of spreading the infection to the kidneys.

Kidney stone passage: The client's history of kidney stones makes it possible that the pain could be due to the passage of a stone. This would be important information for the healthcare team to know, as it could affect the interpretation of the IVP results.

Other urological conditions: There are other urological conditions, such as bladder or urethral strictures, that can also cause painful urination. These conditions might also need to be considered and assessed for.

It's important for the nurse to collect more data about the client's painful urination to determine the underlying cause and whether it could impact the IVP. This might include asking questions about:

The severity and duration of the pain

Any other associated symptoms, such as fever, urgency, or frequency The client's history of UTIs or kidney stones

Any recent changes in urinary habits

Based on this additional information, the nurse can then collaborate with the healthcare team to determine the best course of action, which might include:

Further assessment, such as a urinalysis or urine culture Treatment for a UTI, if present

Pain management

Rescheduling the IVP, if necessary

Choice A rationale:

Intravenous theophylline (aminophylline) is a bronchodilator that can be life-saving in cases of anaphylactic shock with bronchospasm. It works by relaxing the smooth muscles in the airways, allowing for increased airflow.

Anaphylactic shock can cause severe bronchospasm, which can lead to respiratory failure and death. Theophylline can help to reverse bronchospasm and improve oxygenation.

The dosage of theophylline should be individualized based on the patient's weight and severity of bronchospasm. It is important to monitor the patient's heart rate and blood pressure while administering theophylline, as it can cause tachycardia and arrhythmias.

Choice B rationale:

Culturing the site of the bee sting and administering antibiotics is not appropriate in the acute management of anaphylactic shock. Anaphylaxis is an allergic reaction, not an infection. Antibiotics will not address the underlying cause of the reaction.

Antibiotics may be necessary if the patient develops a secondary infection at the site of the bee sting. However, this is not a priority in the acute setting.

Choice C rationale:

Providing sips of water to moisten the mouth and throat is not a priority in the acute management of anaphylactic shock. The patient's primary concern is likely to be difficulty breathing.

If the patient is able to drink, it is important to ensure that they are able to do so safely without compromising their airway. However, this is not a life-saving intervention.

Choice D rationale:

Diphenhydramine (Benadryl) is an antihistamine that can help to block the effects of histamine, one of the chemicals released during an allergic reaction. This can help to reduce symptoms such as swelling, itching, and hives.

Diphenhydramine can also help to prevent further release of histamine, which can help to stop the progression of the allergic reaction.

Diphenhydramine is available over-the-counter, but it is important to consult a healthcare professional before administering it to a patient in anaphylactic shock.

Choice E rationale:

Surgical management of the airway may be necessary if the patient's airway becomes compromised due to swelling. This could include intubation or a tracheostomy.

It is important to be prepared for surgical airway management in case it is needed. Early preparation can help to prevent delays in treatment and improve the patient's chances of survival.