A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

Document that the client experienced an anaphylactic reaction to the medication.

Decrease the infusion rate on the IV.

Apply cold compresses to the neck area.

Change the IV infusion site.

Answer and Explanation

The Correct Answer is B

A. The symptoms described (flushing and tachycardia) are not indicative of an anaphylactic reaction, which typically includes symptoms like difficulty breathing, hives, or swelling. Documenting it as an anaphylactic reaction would be misleading and could lead to inappropriate management.
B.   Slowing the infusion rate can help mitigate the symptoms of Red Man Syndrome, which is often related to the rate of vancomycin administration. The recommended infusion rate for vancomycin is generally over at least 60 minutes, and reducing the rate can help alleviate symptoms.
C.   Applying cold compresses should help with pain but as important like documentation.
D.   The infusion should be continued and not used again for the client.

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Correct Answer is B

Explanation

Beclomethasone is an inhaled corticosteroid used as controller therapy is asthma to prevent bronchial hyperresponsiveness and airway remodeling. Rinsing the mouth prevents oral thrush and throat irritation that may occur due to continuous deposition of the steroid in the mouth.
A. Beclomethasone has no significant interaction with caffeine
C. Beclomethasone does not cause changes in pulse
D. Being an inhaled medication, it has no relation with meals

A. Increase caffeine intake. B. Reduce calorie intake. C. Take this medication before bedtime. D. Avoid activities that require alertness such as driving.

Correct Answer is D

Explanation

Methylphenidate is a CNS agent used in the management of ADHD. It has the potential to cause dizziness or drowsiness and clients should be advised to avoid driving or operation of any machinery as it may lead to accidents.

A- Methylphenidate is a CNS agent used in the management of ADHD. It has nopotential interaction with caffeine.

B- Methylphenidate caused significant decrease in appetite with subsequent weight loss. The parents should be advised to increase the client’s caloric intake to promote healthy weight gain.

C- Methylphenidate causes insomnia and taking the medication right before bedtime leads to poor sleep pattern.

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A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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