A nurse is monitoring a client who is taking captopril and has developed swelling of the lips and tongue. Which of the following actions should the nurse plan to take to manage this adverse medication reaction?
Administer a dose of subcutaneous epinephrine.
Advise the client not to consume grapefruit products.
Place warm compresses on both sides of the client's face.
Swab the client's oral mucosa with nystatin suspension.
The Correct Answer is A
A. Administer a dose of subcutaneous epinephrine.: The swelling of the lips and tongue is indicative of angioedema, a serious adverse reaction to captopril. Epinephrine is the first-line treatment for severe allergic reactions or angioedema to quickly counteract the swelling and prevent airway obstruction.
B. Advise the client not to consume grapefruit products.: Grapefruit can interact with some medications, but it is not related to the management of angioedema. This action would be more relevant for drugs metabolized by CYP3A4, not specifically for angioedema.
C. Place warm compresses on both sides of the client's face.: Warm compresses are not appropriate for angioedema and may not address the underlying issue. This action does not manage the immediate, potentially life-threatening reaction caused by captopril.
D. Swab the client's oral mucosa with nystatin suspension.: Nystatin is used for fungal infections of the oral mucosa, not for angioedema. This action does not address the adverse reaction related to captopril.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) HDL 65 mg/dL: High-density lipoprotein (HDL) levels of 65 mg/dL are considered protective against heart disease. Higher HDL levels are generally associated with a lower risk of cardiovascular disease, so this result is not a concern.
B) LDL 120 mg/dL: Low-density lipoprotein (LDL) levels of 120 mg/dL are elevated for individuals at increased risk of cardiovascular disease, especially with a family history of hyperlipidemia and cardiac disease. An LDL level above 100 mg/dL is a risk factor for heart disease, making this result important to report to the provider for potential intervention.
C) Cholesterol 195 mg/dL: A total cholesterol level of 195 mg/dL is slightly above the recommended level of less than 200 mg/dL but may not be immediately alarming unless the client has other risk factors. However, this value alone is not as critical as LDL levels in assessing risk.
D) Triglycerides 175 mg/dL: Triglyceride levels of 175 mg/dL are slightly elevated, as normal levels are typically less than 150 mg/dL. While elevated triglycerides are a risk factor for cardiovascular disease, this level is less critical compared to elevated LDL levels in the context of the client’s family history.
Correct Answer is D
Explanation
A) Drink 8 oz of milk when hypoglycemia develops:
While consuming a fast-acting carbohydrate is important during hypoglycemia, 8 oz of milk may not be the most effective choice. Typically, glucose tablets or juice are recommended as they provide a quicker absorption of sugar into the bloodstream.
B) Initiate a 1,400-calorie diet daily:
Caloric needs should be individualized based on the adolescent’s age, weight, activity level, and overall health. A fixed 1,400-calorie diet might not be appropriate for every adolescent and could lead to insufficient energy intake or excessive restriction.
C) Rotate the insulin injection site to a different area of the body with every other injection:
While rotating injection sites is important to prevent lipodystrophy, it is generally recommended to use different sites within the same area (such as different spots on the abdomen) rather than entirely different areas of the body with each injection. This ensures consistent absorption of insulin.
D) Keep unopened insulin refrigerated at 4.44° C (40° F):
Unopened insulin should be stored in the refrigerator to maintain its potency until it is ready to be used. This temperature range ensures the insulin remains stable and effective for use.
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