A nurse is teaching a client about reducing the risk for osteoporosis. Which of the following statements by the client indicates an understanding of possible anaphylaxis?
A feeling of swelling in the feet
Pain at the injection site
A sudden decrease in heart rate
A sharp decrease in blood pressure
The Correct Answer is D
A. A feeling of swelling in the feet: Swelling in the feet can be caused by various factors such as fluid retention, circulatory issues, or certain medical conditions like venous insufficiency. It is not a typical symptom of anaphylaxis, which usually involves more generalized symptoms such as hives, itching, swelling of the face or throat, difficulty breathing, and a drop in blood pressure.
B. Pain at the injection site: Pain at the injection site is a common side effect of receiving an injection or medication. It occurs due to tissue irritation or trauma from the needle. While allergic reactions can cause localized redness, swelling, or itching at the injection site, severe pain alone is not a hallmark symptom of anaphylaxis.
C. A sudden decrease in heart rate: Anaphylaxis typically leads to an increase in heart rate (tachycardia) rather than a decrease. This increase in heart rate is a response to the body's attempt to compensate for the drop in blood pressure caused by anaphylaxis. Bradycardia (a decrease in heart rate) is not a typical feature of anaphylaxis unless it occurs very late in a severe reaction due to profound circulatory collapse.
D. A sharp decrease in blood pressure: This choice is indicative of an understanding of possible anaphylaxis. Anaphylaxis can cause a rapid and severe drop in blood pressure, known as hypotension. This drop in blood pressure is often a key feature of anaphylaxis and can lead to symptoms such as dizziness, fainting, confusion, and shock.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A nurse administers a medication without first identifying the client.
Negligence refers to the failure to provide care that a reasonable and prudent person would normally perform in a similar situation, resulting in harm to the client. In this scenario, administering medication without first identifying the client constitutes negligence because it violates the standard of care expected of a nurse. Proper identification of the client is essential to ensure that the correct medication is administered to the right individual, preventing medication errors and potential harm.
B. A nurse begins a blood transfusion without obtaining consent from a client:
This situation involves a failure to obtain informed consent, which is a violation of the client's rights but does not necessarily constitute negligence. Negligence typically involves a failure to provide proper care rather than a failure to obtain consent.
C. An assistive personnel prevents a client from leaving the facility:
While preventing a client from leaving the facility without appropriate authorization may be inappropriate or a breach of the client's rights, it does not necessarily constitute negligence. Negligence involves a failure to provide care that meets the standard of care expected in a given situation.
D. An assistive personnel discusses client care in the facility cafeteria with visitors present:
This situation may involve a breach of confidentiality or privacy but does not constitute negligence unless the discussion leads to harm or adverse consequences for the client. Negligence typically involves a failure to provide care that results in harm or injury to the client.
Correct Answer is A
Explanation
A. Honey: In Traditional Chinese Medicine (TCM), yin and yang are concepts used to describe the balance between opposing forces in the body. Yin represents coolness, darkness, and calmness, while yang represents warmth, brightness, and activity. In TCM, headaches may be viewed as an imbalance between yin and yang energies.
Given this perspective, honey is considered a yin-nourishing food in TCM. It is believed to have cooling properties that can help balance excess yang energy in the body. Therefore, the client who believes in the concept of yin and yang may choose honey to treat their headache, aiming to restore balance by reducing yang energy.
B. Fresh vegetables: While fresh vegetables are generally considered healthy and nutritious, they do not have specific associations with yin or yang energies in TCM. Therefore, the client may not necessarily choose fresh vegetables to address a headache based on the yin-yang concept.
C. Chicken: Chicken is a neutral food in TCM and is not specifically associated with either yin or yang energies. Therefore, the client may not necessarily choose chicken to address a headache based on the yin-yang concept.
D. Chili peppers: Chili peppers are considered yang-warming foods in TCM due to their spicy nature. They are believed to increase yang energy in the body. Therefore, the client who believes in the concept of yin and yang may not choose chili peppers to treat their headache, as it may exacerbate yang energy rather than balance it.
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