A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast media. For which of the following client findings should the nurse intervene first?
Vomiting
Stridor
Hypertension
Urticaria
The Correct Answer is B
A. Vomiting: While vomiting can occur during anaphylaxis, it is not the most immediately life-threatening symptom.
B. Stridor: Stridor indicates upper airway obstruction, which is a critical and life-threatening sign of anaphylaxis. This finding requires immediate intervention, such as administering epinephrine and ensuring airway patency.
C. Hypertension: Hypertension is not typically associated with anaphylaxis; instead, hypotension is more common due to vascular collapse.
D. Urticaria: Urticaria (hives) can occur in anaphylaxis, but it is not as urgent as stridor, which indicates a compromised airway.
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is ["C","D","E"]
Explanation
A. Stimulate production of androgens: The kidneys do not stimulate androgen production. Androgens are produced primarily by the adrenal glands and gonads.
B. Stimulate production of white blood cells: The kidneys do not stimulate white blood cell production. This is mainly a function of the bone marrow.
C. Excrete various drugs and drug metabolites: The kidneys play a key role in filtering and excreting drugs and drug metabolites, helping to remove them from the body.
D. Produce urine: The primary function of the kidneys is to filter blood and produce urine, which is then excreted to remove waste products and maintain fluid balance.
E. Regulate acid/base balance: The kidneys are essential in maintaining acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate, which helps regulate the pH level in the body.
Correct Answer is D
Explanation
A. "Gradually decrease the dose once tolerance to the effect is reached." Tolerance can develop over time, but this approach is not the most effective or safest way to manage sedation.
B. "Take the medication with meals." Taking diphenhydramine with food may help with gastrointestinal side effects but does not reduce sedation.
C. "Distribute the doses evenly throughout the day." Distributing doses evenly may not effectively reduce sedation, as diphenhydramine has sedative effects regardless of timing.
D. "Take the daily dose at bedtime.” Taking diphenhydramine at bedtime can minimize daytime sedation, as the sedative effects will occur during sleep.