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?

Stridor

Hypotension

Urticaria

Vomiting

Answer and Explanation

The Correct Answer is A

A. Stridor is a high-pitched sound indicating upper airway obstruction and is a critical sign of anaphylaxis requiring immediate intervention to secure the airway.
B. Hypotension is a serious condition that occurs during anaphylaxis, but the priority is to address the airway obstruction first.
C. Urticaria (hives) is a common symptom of an allergic reaction but is not life-threatening and can be addressed after more severe symptoms.
D. Vomiting may occur during anaphylaxis but is not the most urgent finding when airway compromise is present.

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Correct Answer is ["A","C"]

Explanation

A. Orthostatic hypotension is a common sign of hypovolemia, as the lack of fluid volume can lead to a drop in blood pressure when changing positions.
B. Bradycardia is not typically associated with fluid volume deficit; tachycardia is more common as the body tries to compensate for low blood volume.
C. Decreased skin turgor is a classic sign of dehydration and fluid volume deficit, indicating reduced skin elasticity.
D. Weight gain is associated with fluid volume overload, not deficit.
E. Pulmonary edema is related to fluid volume overload or congestive heart failure, not hypovolemia.

A. Hepatitis B. Tuberculosis C. Gonorrhea D. Chlamydia

Correct Answer is B

Explanation

A. Hepatitis is a concern for individuals with HIV, but it is not specifically indicated by a low CD4-T-cell count.
B. A CD4-T-cell count of 150/mm³ indicates severe immunosuppression, making the client highly susceptible to opportunistic infections like tuberculosis, which is common in individuals with HIV.
C. While gonorrhea is a risk for sexually active individuals, it is not specifically related to the low CD4-T-cell count.
D. Chlamydia is also a sexually transmitted infection, but similar to gonorrhea, it is not directly linked to the immunocompromised state indicated by the CD4-T-cell count.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following signs are commonly associated with fluid volume deficit (hypovolemia)? (Select All that Apply.)

Correct Answer is ["A","C"]

Explanation

A nurse is caring for a client who has HIV and a CD4-T-cell count of 150/mm³. Which of the following conditions should the nurse monitor the client for?

Correct Answer is B

Explanation

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