The nurse is caring for a patient with wheezes, shortness of breath, urticaria and itching after receiving a new antibiotic The nurse understands that the epinephrine in this situation would be administered intramuscularly (IM), rather than intravenously (IV) because:

IM epinephrine is the fastest route of administration

IV epinephrine is only administered during cardiac arrest

Epinephrine would not be administered in this situation

IM epinephrine is less concentrated than IV.

Answer and Explanation

The Correct Answer is B

A) IM epinephrine is the fastest route of administration:
While epinephrine is often administered intramuscularly in cases of anaphylaxis and allergic reactions, the speed of action is not the primary reason for choosing this route over intravenous (IV) administration in this situation. Intramuscular administration of epinephrine allows for a rapid onset of action, but it is not necessarily the fastest route compared to IV. IV administration would act more quickly in an emergency setting where immediate blood circulation is critical, but IM is preferred in allergic reactions to prevent excessive systemic effects and to avoid rapid peaks in plasma levels.

B) IV epinephrine is only administered during cardiac arrest:
Epinephrine is generally administered intravenously during life-threatening situations such as cardiac arrest or severe shock, where immediate circulatory effects are needed. In cases of anaphylaxis, however, intramuscular (IM) administration of epinephrine is the preferred route because it allows for a more controlled absorption rate and reduces the risk of excessive blood pressure and other adverse cardiovascular effects. This is the correct rationale for why epinephrine is administered IM in the context of an allergic reaction.

C) Epinephrine would not be administered in this situation:
Epinephrine is the first-line treatment for severe allergic reactions and anaphylaxis, especially in cases where symptoms like wheezing, shortness of breath, urticaria, and itching are present. Therefore, withholding epinephrine is not an appropriate response in this situation. Immediate intervention with epinephrine is critical to reverse the symptoms of anaphylaxis and prevent further respiratory distress or cardiovascular collapse.

D) IM epinephrine is less concentrated than IV:
The concentration of epinephrine used for IM and IV administration is the same. The primary reason for choosing the IM route over the IV route is the slower absorption and the fact that it minimizes the risk of a rapid increase in systemic blood pressure and other adverse reactions. While IM epinephrine may be absorbed more slowly than IV, its concentration is appropriate for treating anaphylaxis effectively. The choice of IM is based on safety and controlled response, not on the concentration of the drug.

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Correct Answer is A

Explanation

A) Unstable:
Unstable angina is the type of angina most closely related to an impending myocardial infarction (MI). It is characterized by unpredictable chest pain that occurs at rest or with minimal exertion, or that increases in severity or frequency. Unstable angina represents a medical emergency and can progress to an MI if not promptly treated. It occurs when there is increased myocardial oxygen demand and a partially occluded coronary artery, often due to a ruptured atherosclerotic plaque.

B) Variant (Prinzmetal's) angina:
Variant angina, also known as Prinzmetal's angina, is caused by a spasm of the coronary artery, which temporarily narrows or obstructs blood flow. Although it can be severe and may occur at rest, it is typically transient and is not directly related to the development of an MI. Variant angina usually responds to medications such as nitrates or calcium channel blockers, and while it can be dangerous, it is not the most likely type of angina associated with a myocardial infarction.

C) Chronic stable angina:
Chronic stable angina occurs with predictable patterns, typically with exertion or stress, and resolves with rest or nitroglycerin. It does not usually indicate an impending MI, as it is a chronic condition caused by atherosclerosis that limits the heart's blood supply under stress. While chronic stable angina increases the risk of MI over time, it is not directly associated with an imminent heart attack.

D) Nocturnal angina:
Nocturnal angina refers to chest pain that occurs during the night or early morning hours, often during sleep. It may be associated with sleep apnea, GERD, or increased sympathetic tone during sleep. This type of angina is less commonly linked to an impending MI compared to unstable angina, although it should still be evaluated for any underlying cardiovascular issues.

A. Assess lung sounds and respiratory rate at least every 2 hours B. Assess and document pain level once every shift C. Maintain sequential compression device (SCD's) while in bed D. Elevate the head of the bed ten degrees

Correct Answer is A

Explanation

A) Assess lung sounds and respiratory rate at least every 2 hours:
In a patient with Myasthenia Gravis (MG) who has undergone thymectomy, monitoring respiratory status is critical. MG is a neuromuscular disorder that can lead to respiratory muscle weakness, which may be exacerbated post-operatively. Assessing lung sounds and respiratory rate at least every 2 hours is crucial to detect early signs of respiratory compromise, including hypoventilation or atelectasis.

B) Assess and document pain level once every shift:
While pain assessment is important, especially after a thymectomy, this action alone does not directly address the immediate issue of ineffective breathing patterns. In patients with MG, respiratory complications are a priority concern. Pain management should be part of the overall plan of care, but it is secondary to monitoring respiratory function in the acute post-operative period. Pain can affect respiratory effort, but it should be managed in the context of more pressing issues like airway and breathing assessment.

C) Maintain sequential compression device (SCD's) while in bed:
While SCDs are important in preventing deep vein thrombosis (DVT) in patients who are immobile, they are not the most appropriate intervention for a client with ineffective breathing patterns. The primary concern in a post-thymectomy patient with MG is respiratory function.

D) Elevate the head of the bed ten degrees:
While elevating the head of the bed can help with comfort and potentially improve ventilation in some patients, it is not the most specific or effective intervention for managing ineffective breathing patterns in a patient with MG. For optimal respiratory function, it is typically more beneficial to elevate the head of the bed to a higher degree (e.g., 30-45 degrees) to enhance lung expansion, rather than just 10 degrees.

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The nurse is caring for a patient with wheezes, shortness of breath, urticaria and itching after receiving a new antibiotic The nurse understands that the epinephrine in this situation would be administered intramuscularly (IM), rather than intravenously (IV) because:

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Naxlex Comprehensive Predictor Exams

The nurse knows which of the following types of angina is most closely related with an impending myocardial infarction (MI)?

Correct Answer is A

Explanation

The nurse is caring for a client diagnosed with Myasthenia Gravis (MG) who is post op thymectomy. The client problem is Ineffective Breathing Pattern, Which action would the nurse include in the plan of care?

Correct Answer is A

Explanation

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