A nurse is collecting data from a client following the administration of a new medication. Which of the following findings should the nurse identify as a manifestation of an allergic reaction?
Jaundice
Urticaria
Bradycardia
Hypertension
The Correct Answer is B
A. Jaundice. Jaundice, or yellowing of the skin and eyes, is a sign of liver dysfunction and may indicate hepatotoxicity rather than an allergic reaction. Some medications can cause drug-induced liver injury (DILI), but jaundice is not a typical symptom of an immediate hypersensitivity reaction.
B. Urticaria. Urticaria (hives) is a classic allergic reaction that appears as raised, red, itchy welts on the skin. It occurs due to the release of histamine in response to an allergen, which increases capillary permeability and leads to swelling and itching. Urticaria may be accompanied by angioedema, respiratory distress, or anaphylaxis, requiring immediate intervention if severe.
C. Bradycardia. Bradycardia (slow heart rate) is not a typical manifestation of an allergic reaction. While anaphylaxis can cause hypotension and tachycardia due to systemic vasodilation, bradycardia is more commonly associated with beta-blockers, heart block, or vagal stimulation rather than an allergic response.
D. Hypertension. Allergic reactions, especially severe ones like anaphylaxis, typically cause vasodilation and hypotension, not hypertension. While stress or anxiety related to an allergic episode may lead to a temporary rise in blood pressure, persistent hypertension is not a direct sign of an allergic reaction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Tingling sensation. A mild tingling or paresthesia is a common side effect of sumatriptan due to its vasoconstrictive action. While it should be monitored, it is not typically harmful and does not require immediate medical intervention.
B. Hypertension. Sumatriptan works by constricting blood vessels to relieve migraine symptoms, but it can also cause a dangerous increase in blood pressure. Severe hypertension can lead to complications such as stroke or myocardial infarction. This is the priority finding that requires immediate reporting to prevent life-threatening cardiovascular events.
C. Dizziness. Dizziness can occur due to sumatriptan’s vasoconstrictive properties or from the migraine itself. While it can be uncomfortable, it is not an immediate threat to the client’s safety unless it is severe or associated with other neurological symptoms.
D. Flushing. Facial flushing is a known side effect of sumatriptan and is generally harmless. It occurs due to transient vasodilation in the skin and does not indicate a serious adverse reaction. Monitoring is appropriate, but it does not require urgent intervention.
Correct Answer is C
Explanation
A. Increased Hct. Propylthiouracil (PTU) is an antithyroid medication that reduces excessive thyroid hormone production in Graves' disease. It does not directly affect hematocrit (Hct) levels. While anemia can occur in some clients with untreated hyperthyroidism, PTU itself is not expected to raise Hct.
B. Decreased WBC count. A serious adverse effect of PTU is agranulocytosis, which results in a dangerously low white blood cell (WBC) count, increasing the risk of infection. However, this is a potential complication rather than an expected therapeutic outcome. Clients on PTU require regular monitoring of WBC levels to detect early signs of agranulocytosis.
C. Decreased heart rate. Graves’ disease causes hyperthyroidism, which increases metabolism and leads to symptoms such as tachycardia. PTU works by inhibiting thyroid hormone synthesis, leading to a gradual reduction in heart rate as thyroid function normalizes. This is a desired outcome of treatment, helping to reduce cardiovascular strain associated with hyperthyroidism.
D. Increased blood pressure. Hyperthyroidism can cause elevated blood pressure due to increased cardiac output. As PTU lowers thyroid hormone levels, blood pressure is expected to decrease or stabilize rather than increase. An increase in blood pressure would be unexpected and may indicate another underlying issue requiring evaluation.
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