A client with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The client develops low hemoglobin low white blood cell counts which is otherwise unexplained. What type of reaction is the client experiencing?
Hypersensitivity reaction
Paradoxical reaction
Idiosyncratic reaction
Anti-cholinergic reaction
The Correct Answer is C
A) Hypersensitivity reaction: A hypersensitivity reaction typically involves an immune response where the body reacts to a substance as if it were harmful, leading to symptoms like rashes, swelling, or difficulty breathing. However, low hemoglobin and low white blood cell counts are not typical signs of a hypersensitivity reaction. This would involve more common allergic symptoms like itching or swelling, rather than hematologic changes.
B) Paradoxical reaction: A paradoxical reaction refers to when a medication causes an effect opposite to the expected result. For example, a sedative causing agitation instead of sleepiness. While a paradoxical reaction can involve unexpected effects, the hematologic changes (low hemoglobin and white blood cell counts) in this scenario do not align with this type of response.
C) Idiosyncratic reaction: An idiosyncratic reaction is an unusual or unexpected response to
a medication that is not related to the drug's pharmacologic properties or the dose given. It may be related to genetic factors or other individual differences in how a person metabolizes or responds to the drug. The low hemoglobin and low white blood cell counts in this case are unusual effects of diphenhydramine and suggest an idiosyncratic response, where the client’s body is reacting in an unexpected way to the medication.
D) Anti-cholinergic reaction: Anti-cholinergic reactions are typically related to symptoms caused by the blocking of acetylcholine, such as dry mouth, blurred vision, urinary retention, or constipation. While diphenhydramine has anti-cholinergic properties, the symptoms described (low hemoglobin and white blood cell counts) are not typical of an anti-cholinergic reaction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) "I will avoid alcohol and cigarettes.": This is a correct and important statement for a client with GERD. Both alcohol and cigarettes can relax the lower esophageal sphincter, increasing the likelihood of acid reflux and exacerbating GERD symptoms. Avoiding these substances is a standard recommendation for managing GERD.
B) "I will have a small snack right before bedtime.": This statement indicates the need for additional education. Eating a meal or snack right before bedtime can exacerbate GERD symptoms because lying down after eating can increase the likelihood of acid reflux. It is generally recommended for clients with GERD to avoid eating at least 2-3 hours before going to bed to reduce the risk of reflux.
C) "I will wear loose fitting clothes.": Wearing loose-fitting clothes is an appropriate measure for managing GERD. Tight clothing around the abdomen can increase pressure on the stomach, promoting acid reflux. Loose clothing helps avoid this additional pressure, which can alleviate symptoms.
D) "I will take all NSAIDs and steroids with food.": This is generally good advice for reducing the risk of stomach irritation caused by NSAIDs and steroids, which can worsen GERD symptoms or cause gastric ulcers. Taking these medications with food can help buffer the stomach lining and reduce irritation.
Correct Answer is B
Explanation
A) Failed communication: While communication errors can lead to medication mistakes, in this specific scenario, there is no mention of poor communication. The prescription is clear, and the issue is more likely related to the accuracy of the prescribed dose or the nurse’s understanding of it, making "failed communication" a less likely source of error in this case.
B) Dose miscalculation: This is the most likely source of potential error. The medication is ordered as 0.9 mg of ondansetron IV, which is an unusual dosage because the typical dose of ondansetron IV for nausea is usually 4 mg or 8 mg. A dose of 0.9 mg is very specific and could easily be miscalculated, especially if the nurse is not familiar with this specific dosage form or if there’s any confusion regarding the intended dose. This could lead to an error either in preparation or administration of the medication.
C) Lack of client education: While client education is important for many aspects of treatment, it’s not directly related to the potential medication error in this scenario. The nurse’s concern should focus on the accuracy of administering the prescribed dose correctly, not the client’s understanding of the medication.
D) Poor distribution practices: Poor distribution practices may affect the availability or storage of medications, but this is not the likely source of error in this case. The concern here is more about the correct dosage and potential for miscalculation, rather than issues related to drug distribution or storage.
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