A nurse is assisting with the care of a client who is receiving penicillin via intermittent IV bolus. Which of the following should the nurse recognize as a clinical manifestation of anaphylaxis?
Pallor
Peripheral edema
Hypertension
Pruritus
The Correct Answer is D
Choice A: This is incorrect because pallor is not a sign of anaphylaxis. Pallor can indicate shock, anemia, or hypoxia.
Choice B: This is incorrect because peripheral edema is not a sign of anaphylaxis. Peripheral edema can indicate heart failure, kidney disease, or venous insufficiency.
Choice C: This is incorrect because hypertension is not a sign of anaphylaxis. Hypertension can indicate stress, pain, or renal disease.
Choice D: This is correct because pruritus is a sign of anaphylaxis. Pruritus is a severe itching sensation that can accompany hives, rash, or angioedema.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Using NSAIDs for pain relief is not a risk factor for osteoporosis. NSAIDs are nonsteroidal anti-inflammatory drugs that are used to treat pain and inflammation. They do not affect bone density or calcium metabolism.
Choice B reason: Age 45 years is not a risk factor for osteoporosis. Osteoporosis is more common in older adults, especially postmenopausal women, but it can affect anyone at any age. The risk of osteoporosis increases with age, but it is not determined by a specific age.
Choice C reason: Smoking cigarettes is a risk factor for osteoporosis. Smoking can reduce bone mass and increase bone loss by interfering with the production and activity of estrogen, which is a hormone that protects bone health. Smoking can also impair blood circulation and oxygen delivery to the bones, which can affect their growth and repair.
Choice D reason: Regular aerobic exercise is not a risk factor for osteoporosis. Aerobic exercise is a type of physical activity that increases the heart rate and improves cardiovascular fitness. Aerobic exercise can also benefit bone health by stimulating bone formation and increasing bone density. Aerobic exercise can also prevent falls and fractures by improving balance and coordination.
Correct Answer is D
Explanation
Choice A: This is incorrect because stool being a dark green color is not a finding that the nurse should report to the provider. Stool from an ileostomy can be dark green, brown, or yellow depending on the diet and fluid intake of the client.
Choice B: This is incorrect because stoma being a cherry red color is not a finding that the nurse should report to the provider. Stoma from an ileostomy should be moist and pink or red, indicating adequate blood supply and healing.
Choice C: This is incorrect because stool containing scant red blood is not a finding that the nurse should report to the provider. Stool from an ileostomy can contain small amounts of blood due to irritation or inflammation of the bowel mucosa.
Choice D: This is correct because stoma retracting into the abdominal wall is a finding that the nurse should report to the provider. Stoma from an ileostomy should protrude slightly above the skin level, allowing for proper drainage and appliance fitting. Stoma retraction can indicate ischemia, obstruction, or peritonitis.
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