Exhibits
The nurse would determine what actions to implement in an emergent situation. Drag from Word Choices to complete the sentence.
The client is at immediate risk for developing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B","dropdown-group-3":"B"}
A. anaphylaxis
The correct answer is A. Anaphylaxis is a severe, life-threatening allergic reaction that can occur in response to medication administration. The client's symptoms of dizziness, headache, burning feeling on extremities, and redness on face and extremities, along with the sudden onset of symptoms after starting vancomycin infusion, are indicative of a possible anaphylactic reaction.
B. arrhythmias
The correct answer is B. Arrhythmias refer to abnormal heart rhythms, which can be
triggered by various factors including medication reactions. Given the client's history of symptomatic bradycardia and the sudden onset of symptoms after starting vancomycin infusion, arrhythmias such as bradycardia or other rhythm disturbances are a concern.
C. Cardiac arrest
The correct answer is C. Cardiac arrest is the cessation of normal heart function, which can be precipitated by severe arrhythmias or anaphylaxis. The client's symptoms, along with the drop in blood pressure, indicate a potential risk of progressing to cardiac arrest if not promptly treated.
D. Necrosis
Necrosis, or tissue death, is not typically associated with the symptoms described in the scenario. While vancomycin infusion can potentially cause tissue irritation or damage at the
injection site, the symptoms described suggest a systemic reaction rather than localized tissue necrosis.
E. Renal failure
Renal failure is not directly indicated by the symptoms described in the scenario. While vancomycin can be nephrotoxic in some cases, the symptoms of dizziness, headache, and redness are more suggestive of an allergic or cardiovascular reaction.
F. Peripheral edema
Peripheral edema, or swelling in the extremities, is not indicated by the symptoms described in the scenario. The client's symptoms, such as dizziness, headache, and redness, are more
indicative of a systemic reaction rather than localized swelling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Respiratory acidosis. Respiratory acidosis occurs when there is hypoventilation, leading to an accumulation of carbon dioxide and increased acidity in the blood. Hyperventilation, as described in the scenario, would not lead to respiratory acidosis.
B. Respiratory alkalosis. Hyperventilation leads to respiratory alkalosis by blowing off excessive carbon dioxide, resulting in decreased levels of carbonic acid and increased blood pH.
C. Metabolic acidosis. Metabolic acidosis results from an accumulation of acids or loss of bicarbonate ions. The scenario does not indicate factors leading to metabolic acidosis.
D. Metabolic alkalosis. Metabolic alkalosis occurs due to excessive loss of acids or increased bicarbonate levels, neither of which is suggested in the scenario.
Correct Answer is {"A":{"answers":"A,B,C"},"B":{"answers":"A,B"},"C":{"answers":"B"},"D":{"answers":"B,C"},"E":{"answers":"A,B,C"}}
Explanation
- Decreased hemoglobin and hematocrit levels: Consistent with iron deficiency anemia, vitamin B12 deficient anemia, and folic acid deficient anemia. Iron deficiency anemia results from
inadequate iron stores, while vitamin B12 deficient anemia and folic acid deficient anemia are characterized by inadequate levels of these respective vitamins, all of which contribute to decreased hemoglobin and hematocrit levels.
- Uptake often impeded by medications: Consistent with iron deficiency anemia and vitamin B12 deficient anemia. Iron absorption can be affected by certain medications, such as proton pump
inhibitors or antacids, which can hinder iron uptake. Vitamin B12 deficiency can result from medications that interfere with its absorption, such as proton pump inhibitors or metformin.
- Often associated with chronic alcoholism: Consistent with vitamin B12 deficient anemia. Chronic alcoholism can lead to vitamin B12 deficiency due to poor dietary intake,
malabsorption, or liver dysfunction associated with excessive alcohol consumption.
- Can be caused by malabsorption syndrome: Consistent with vitamin B12 deficient anemia and folic acid deficient anemia. Malabsorption syndromes, such as celiac disease or Crohn's disease, can impair the absorption of both vitamin B12 and folic acid from the gastrointestinal tract,
leading to deficiencies.
- Result of dietary deficiency: Consistent with iron deficiency anemia, vitamin B12 deficient anemia, and folic acid deficient anemia. Iron deficiency anemia results from inadequate dietary intake of iron-rich foods, while vitamin B12 deficient anemia and folic acid deficient anemia stem from insufficient dietary intake of foods rich in these respective vitamins.
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