A nurse is caring for a client with an allergic skin condition. The client develops wheezing, a swollen tongue, and hives. Which of the following is the nursing priority?
Assessing the client's neurologic status
Consulting an allergy specialist
Administering epinephrine
Determining the cause of the hives
The Correct Answer is C
Administering epinephrine is the immediate priority when managing anaphylaxis. Epinephrine is the first-line treatment for anaphylaxis as it helps to rapidly reverse severe allergic symptoms, such as airway constriction, swelling, and hypotension.
A. While assessing the client's neurologic status is important for monitoring their overall condition, it may not be the immediate priority when the client is experiencing symptoms of an allergic reaction, particularly anaphylaxis.
B. While consulting an allergy specialist may be necessary for further evaluation and management of the client's allergic condition, it is not the immediate priority.
D. While determining the cause of the hives is important for identifying the allergen and preventing future allergic reactions, it is not the immediate priority during an acute episode of anaphylaxis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
A. Sitting across the room from the client creates physical distance and may convey a lack of engagement or interest in the client's concerns.
B. Minimizing facial expressions can make it challenging for the client to interpret the student's emotions or gauge their level of attentiveness and empathy.
C. Standing while the client is seated can create a power imbalance and may be perceived as intimidating or disrespectful, particularly in cultures where hierarchical structures are emphasized or where sitting is a sign of respect.
D. Using a moderate amount of eye contact is generally considered positive in communication, as it can convey attentiveness, interest, and sincerity.
Correct Answer is A
Explanation
Gloves are typically the first piece of PPE to be removed after providing care. This helps prevent the spread of pathogens from contaminated gloves to other surfaces or body parts. Gloves should be removed carefully to avoid touching the outside surface, which may be contaminated. This should be followed by face shield, gown and mask in that order.
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