A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin Gby intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

Call the client's provider.

Stop the infusion.

Auscultate the client's breath sounds.

Elevate the head of the bed.

Answer and Explanation

The Correct Answer is B

The client is exhibiting symptoms and signs of anaphylaxis. Anaphylaxis is a severe systemic allergic reaction that occurs due to allergens presenting with (itching) urticaria and sudden onset shortness of breath and/or shock. The first action should be to stop the infusion to prevent worsening the severity of the allergic reaction.

A. Important to allow for further prescription but not a priority

C. Auscultating the lungs allows the nurse to assess for the severity of the reaction but should come after stopping the infusion

D. Elevating the head can improve ventilation but is not a priority

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Correct Answer is B

Explanation

hydrochlorothiazide is a thiazide diuretic which lowers blood pressure through inhibition of water reabsorption in the renal tubules. Like all diuretics, it should be taken early in the morning to avoid sleep interruption due to frequent urination.

A. muscle pain is an adverse effect of hydrochlorothiazide that should be reported.

C. therapeutic effect is monitored using blood pressure measurements

D. hydrochlorothiazide can be taken with or without food

A. Monitor for increased muscle spasms. B. Discontinue medication if nausea occurs. C. Avoid driving until effects are known. D. Expect urine to turn orange.

Correct Answer is C

Explanation

Cyclobenzaprine is a muscle relaxant used to relieve muscle spasms in various musculoskeletal conditions. One of the common side effects of cyclobenzaprine is drowsiness and impaired cognitive function, which can affect the ability to operate machinery or drive safely.
A. Cyclobenzaprine is used to reduce muscle spasms, so monitoring for increased muscle spasms would not be appropriate.
B. Nausea can be a common side effect of cyclobenzaprine, but it does not typically require discontinuation of the medication unless it is severe or persistent and causing significant distress.
D. Cyclobenzaprine does not typically cause urine discoloration, so expecting urine to turn orange is not relevant to the medication.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide?

Correct Answer is B

Explanation

A nurse is teaching a client Who has a new prescription for cyclobenzaprine. Which of the following information should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is teaching a client who has iron deficiency anemia about ferrous sulfate. Which of the following instructions should the nurse include in the teaching?

A nurse is caring for a client who has developed gout. Which of the following medications should the nurse prepare to administer?

A nurse is planning to administer butorphanol to a client Who is in labor. Which of the following medications should the nurse plan to have available to reverse the action of this medication?

A nurse is teaching a client who has a new prescription for ibuprofen to treat hip pain. Which of the following instructions should the nurse include in the teaching?

A nurse is providing teaching to a client who has oral candidiasis and a new prescription for nystatin suspension. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is preparing to instill eardrops to a 5-year-old child. Which of the following techniques should the nurse use?

A nurse is caring for a client who is to start taking cyclosporine following a kidney transplant. The nurse should instruct the client that which of the following foods can have an adverse interaction with this medication?

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect?