A nurse is caring for a client who received epidural anesthesia during hip surgery. Which of the following manifestations should the nurse monitor as an adverse reaction?
Severe headache
Rapid rise in temperature
Hypertension
Tachycardia
The Correct Answer is A
A. Severe headache can result from epidural anesthesia due to post-dural puncture headache caused by leakage of cerebrospinal fluid.
B. Rapid rise in temperature may indicate infection but is not a common reaction to epidural anesthesia.
C. Hypertension is not a common adverse effect of epidural anesthesia; in fact, hypotension is more typical due to sympathetic blockade.
D. Tachycardia is not a typical adverse reaction, and the most likely response to epidural anesthesia is bradycardia due to autonomic blockade.
Nursing Test Bank
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Related Questions
Correct Answer is D
Explanation
A. Aspirating is not necessary for subcutaneous injections, as it is not a deep intramuscular injection.
B. Withholding heparin for an elevated platelet count is unnecessary unless there is a confirmed heparin-induced thrombocytopenia (HIT).
C. INR is not used to monitor heparin therapy. Heparin is monitored using aPTT (activated partial thromboplastin time) or anti-Xa levels.
D. It is standard practice to validate heparin dosage with a second nurse to ensure safety due to the high risk of bleeding associated with this medication.
Correct Answer is A
Explanation
A. Rhinitis (inflammation of the nasal passages) is a common side effect of intranasal calcitonin, and alternating nares can reduce this adverse effect.
B. Esophagitis is a potential side effect with oral calcitonin but not typically with the intranasal form.
C. Warmth of the face is not a common side effect related to calcitonin use.
D. Dyspnea on exertion is not a common side effect of intranasal calcitonin.
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