A nurse is assessing a client who is receiving a dose of IV amphotericin B. Which of the following findings should indicate to the nurse that the client is experiencing an acute infusion reaction?
Pedal edema
Dry cough
Fever
Hyperglycemia
The Correct Answer is C
A. Pedal edema is not typically associated with an acute infusion reaction to amphotericin B.
B. A dry cough is not typically associated with an acute infusion reaction to amphotericin B.
C. Fever is a common manifestation of an acute infusion reaction to amphotericin B, indicating a systemic inflammatory response.
D. Hyperglycemia is not typically associated with an acute infusion reaction to amphotericin B.
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Related Questions
Correct Answer is C
Explanation
A. "You will be weighed twice a week while receiving TPN": While weight monitoring may be part of the client's overall care plan, it is not specifically related to TPN administration.
Therefore, this statement is not a priority for inclusion in the teaching.
B. "Your blood sugar will be checked once a day": Blood sugar monitoring may be necessary for clients receiving TPN, especially if they have diabetes or are at risk of hyperglycemia. However, the frequency of monitoring may vary depending on individual factors and is not universally applicable. Therefore, this statement may or may not be accurate for this client and should not be included in the teaching.
C. "You will have a central line placed to receive TPN": TPN solutions are administered through a central venous catheter to ensure adequate and safe delivery of nutrients directly into the bloodstream. Therefore, informing the client about the need for a central line is essential for TPN administration and should be included in the teaching.
D. "Your intake and output will be measured every 2 days": While monitoring intake and output is important for assessing fluid balance and renal function, the frequency of measurement may vary depending on the client's condition and institutional protocols. Therefore, this statement
may or may not be accurate for this client and should not be a priority for inclusion in the teaching.
Correct Answer is A
Explanation
A. Asking the adolescent to describe the quality of their pain can provide valuable information about the characteristics of the pain, such as sharp, dull, throbbing, or burning.
B. Asking the adolescent to point to the area of most severe pain assesses location, not quality.
C. Asking about pain level assesses intensity, not quality.
D. Asking about the timing of pain increasing assesses onset, not quality.
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