A nurse is caring for four clients.
Which one would the nurse see first?
A client who needs a beta blocker, and has a blood pressure of 98/58 mm Hg.
A client who had a first dose of captopril and needs to use the bathroom.
A hypertensive client with a blood pressure of 188/92 mm Hg.
A client who needs pain medication prior to a dressing change of a surgical wound.
The Correct Answer is A
Choice A rationale
A blood pressure of 98/58 mm Hg in a client who needs a beta blocker is a significant safety concern. Beta blockers work by blocking the effects of epinephrine, which can cause a decrease in heart rate and blood pressure. Administering a beta blocker to a client with a pre-existing low blood pressure (normotensive range is 120/80 mm Hg) could cause a profound and dangerous drop in blood pressure, leading to hypotension, syncope, and inadequate organ perfusion. This client needs immediate assessment before medication administration.
Choice B rationale
A client needing to use the bathroom after taking captopril is not an immediate priority. While captopril can cause hypotension, the primary concern is the potential for a first-dose hypotensive effect. However, a client's need to void is a common and expected request and does not indicate an acute, life-threatening crisis requiring immediate intervention before other clients.
Choice C rationale
A blood pressure of 188/92 mm Hg, while elevated, is not an immediate life-threatening emergency unless there are signs of end-organ damage (e.g., chest pain, neurological changes). This is considered a hypertensive urgency, which requires a prompt but not immediate intervention to lower the blood pressure gradually. This client is stable and can be assessed after the client in Choice A, who is at risk for a profound hypotensive event.
Choice D rationale
A client needing pain medication before a dressing change is not the highest priority. Pain management is an important aspect of care, but it is not an acute physiological emergency. Delaying pain medication for a short time to address a life-threatening physiological instability in another client is an appropriate triage decision. The client in Choice A is at higher risk for a critical physiological event. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
There is no known or documented significant drug-food interaction between griseofulvin and citrus fruits or juice. Griseofulvin absorption is actually enhanced by a high-fat meal. The biological mechanism of action for griseofulvin does not involve competition with compounds found in citrus.
Choice B rationale
Shellfish allergies are a common food allergy, but there is no specific interaction between griseofulvin, an antifungal, and shellfish consumption. Griseofulvin's mechanism of action involves disrupting fungal mitosis, which is not affected by dietary intake of shellfish.
Choice C rationale
Alcohol consumption while taking griseofulvin can lead to a disulfiram-like reaction, which is a severe adverse response. This reaction is characterized by flushing, headache, nausea, vomiting, and a rapid heartbeat. The exact mechanism is not fully understood, but it is a significant and dangerous interaction.
Choice D rationale
Griseofulvin is an antifungal medication, while corticosteroids are anti-inflammatory and immunosuppressive agents. There is no known direct pharmacological interaction between these two drug classes. Taking them concurrently is not contraindicated, although they treat different conditions.
Correct Answer is ["B","C"]
Explanation
Choice A rationale
Bathing a child with infantile eczema using products containing fragrance can be irritating to the already compromised skin barrier. Fragrances are common allergens and can trigger or worsen the inflammatory response in atopic dermatitis. It is essential to use fragrance-free, hypoallergenic products to minimize irritation and prevent exacerbations.
Choice B rationale
Using oatmeal and baking soda as bath additives can be soothing for the irritated skin of a child with infantile eczema. Colloidal oatmeal contains avenanthramides which have anti-inflammatory and antioxidant properties, while baking soda can help to relieve itching. These additives can help to calm the skin and reduce the urge to scratch.
Choice C rationale
Adding bath oil to bath water after the child has soaked for a period of time is a beneficial practice. Soaking in water allows the skin to rehydrate. Adding the oil at the end of the bath helps to seal in the moisture, forming a protective barrier and preventing transepidermal water loss, which is a key issue in eczema.
Choice D rationale
Lanolin is a fatty substance derived from sheep wool. While it can be a good moisturizer, it is also a common allergen. Applying lanolin-based lotions to a child with eczema can potentially trigger an allergic reaction or worsen the skin condition. It is safer to use hypoallergenic, non-irritating moisturizers.
Choice E rationale
Bathing a child several times a day can strip the skin of its natural oils, which can worsen the dryness and irritation associated with infantile eczema. The skin barrier is already compromised, and frequent bathing can exacerbate this problem. It is generally recommended to limit bathing to once a day or less to maintain skin integrity. .
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.