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 D
Explanation
A. Removing dentures or other oral appliances is not directly related to managing obstructive sleep apnea. While it may be necessary for certain procedures or assessments, it does not address the client's OSA during narcotic administration.
B. Elevating the head of the bed to a 45-degree angle is a standard practice to prevent aspiration during narcotic administration, but it does not specifically address the client's obstructive sleep apnea.
C. Lifting and locking the side rails in place is important for client safety but does not directly address the client's obstructive sleep apnea.
D. Applying the client's positive airway pressure (PAP) device is crucial for managing obstructive sleep apnea, especially when administering a narcotic analgesic, which can further depress respiratory function. The PAP device helps maintain airway patency and prevent apneic episodes, reducing the risk of respiratory complications in clients with OSA.
Correct Answer is C
Explanation
A. Phobia.
A phobia is an irrational fear of a specific object, situation, or activity that leads to a desire to avoid it. The client's behavior is more characteristic of a compulsion rather than a phobia.
B. Obsession.
An obsession is an intrusive, unwanted thought, image, or urge that causes significant anxiety.
While the client's fear of contamination could be an obsession, the handwashing itself is a compulsion.
C. Compulsion.
This is the correct answer because a compulsion is a repetitive behavior or mental act that a person feels driven to perform in response to an obsession. The client's excessive handwashing ritual is a classic example of a compulsion.
D. Addiction.
Addiction involves a compulsive need for and use of a habit-forming substance or behavior, typically involving a sense of euphoria or pleasure, which is not applicable to the client's behavior.
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