A client taking antibiotics for three days to treat a Streptococcal throat infection returns to the clinic reporting a feel itchy rash across the chest and arms. The nurse auscultates pulmonary wheezing and an elevated heart rate. Which action should the nurse implement?
Swab the throat for a rapid strep test.
Provide a mask for the client to wear.
Instruct client to stop taking the antibiotics.
Apply a hypoallergenic cream to the rash.
The Correct Answer is C
Choice A reason: Swabbing the throat for a rapid strep test is not a priority action that the nurse should implement, because it is not relevant to the client's current condition. A rapid strep test is a diagnostic tool that can detect the presence of Streptococcus bacteria in the throat, which can cause strep throat, a common bacterial infection. However, the client has already been diagnosed with strep throat and has been taking antibiotics for three days, so the test result may not be accurate or useful.
Choice B reason: Providing a mask for the client to wear is not a necessary action that the nurse should implement, because it is not related to the client's problem. A mask is a protective device that can prevent the transmission of respiratory infections, such as COVID-19, influenza, or tuberculosis, by blocking the droplets or aerosols that contain the pathogens. However, the client's symptoms are not caused by a respiratory infection, but by an allergic reaction to the antibiotics, which is not contagious.
Choice C reason: Instructing the client to stop taking the antibiotics is the most important action that the nurse should implement, because it can prevent further exposure to the allergen and reduce the severity of the reaction. The client's symptoms, such as rash, wheezing, and tachycardia, indicate that the client is having an allergic reaction to the antibiotics, which can be a serious and potentially life-threatening condition, especially if it progresses to anaphylaxis, a severe systemic reaction that can cause shock, airway obstruction, and organ failure. The nurse should instruct the client to stop taking the antibiotics immediately and notify the doctor.
Choice D reason: Applying a hypoallergenic cream to the rash is not a sufficient action that the nurse should implement, because it can only provide temporary relief and not address the underlying cause of the rash. A hypoallergenic cream is a topical product that can moisturize, soothe, and protect the skin, and it does not contain any ingredients that can cause allergic reactions. However, the rash is not caused by a skin irritant, but by a systemic reaction to the antibiotics, which requires more than a cream to treat.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Exposure to persons with pneumonia or chickenpox is not a good idea for anyone, but it is not the main factor that can worsen COPD. COPD is a chronic inflammatory condition that affects the airways and the lungs, and it is mainly caused by smoking or other environmental irritants. Pneumonia and chickenpox are acute infections that can affect the respiratory system, but they are not the primary cause of COPD exacerbation.
Choice B reason: Excessive physical exertion and respiratory tract infections are the most common triggers that can lead to COPD exacerbation, which is a sudden worsening of symptoms, such as shortness of breath, cough, and mucus production. Physical exertion can increase the oxygen demand and the work of breathing, while respiratory infections can cause inflammation and mucus obstruction in the airways. Therefore, the nurse should advise the client to avoid these factors and to seek medical attention if they occur.
Choice C reason: Overdose of albuterol and alcohol consumption are not recommended for anyone, but they are not the main factors that can aggravate COPD. Albuterol is a bronchodilator that can help relax the muscles around the airways and improve breathing, but it can also cause side effects, such as palpitations, tremors, and anxiety, if taken in excess. Alcohol consumption can impair the immune system and the liver function, but it does not directly affect the lungs or the airways.
Choice D reason: Excessive bedrest and lack of exercise are not beneficial for anyone, but they are not the main factors that can exacerbate COPD. Bedrest can lead to muscle weakness and deconditioning, while lack of exercise can reduce the cardiovascular and respiratory fitness. However, these factors do not cause inflammation or obstruction in the airways, which are the main features of COPD. The nurse should encourage the client to maintain a moderate level of physical activity and to follow a pulmonary rehabilitation program if available.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A reason: Teaching the client breathing exercises can help improve lung function, reduce mucus accumulation, and prevent atelectasis and pneumonia. Breathing exercises can include pursed-lip breathing, diaphragmatic breathing, and coughing techniques.
Choice B reason: Establishing a regular bladder routine is not directly related to pulmonary complications. However, it can help prevent urinary tract infections, bladder distension, and incontinence, which are common problems for clients with ALS.
Choice C reason: Performing chest physiotherapy can help mobilize secretions, improve ventilation, and prevent respiratory infections. Chest physiotherapy can include percussion, vibration, and postural drainage.
Choice D reason: Encouraging use of incentive spirometer can help increase lung expansion, improve oxygenation, and prevent alveolar collapse. Incentive spirometer is a device that measures the amount of air the client can inhale and exhale.
Choice E reason: Initiating passive range of motion exercises can help maintain joint mobility, prevent contractures, and improve circulation. Passive range of motion exercises are performed by the nurse or a caregiver who moves the client's limbs through their full range of motion.
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