A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine?

The client tolerates a second dose of medication with no greater than 1 peripheral edema.

Respirations are unlabored.

Client reports decreased groin pain of 3 on a 1 to 10 scale.

The client's blood pressure when arising from resting position is at premedication levels.

Answer and Explanation

The Correct Answer is B

A) The client tolerates a second dose of medication with no greater than 1 peripheral edema:
This does not directly indicate a therapeutic response to epinephrine for angioedema. Angioedema primarily involves swelling of deeper layers of the skin, often around the eyes and lips, and sometimes the throat, which can cause breathing difficulties. Tolerating a second dose of medication with minimal peripheral edema does not specifically address the acute respiratory effects of angioedema.

B) Respirations are unlabored:
This is the correct answer. Angioedema can cause swelling in the airways, leading to difficulty breathing. Epinephrine is used to reduce this swelling and improve airway patency. Unlabored respirations indicate that the airway is not obstructed, which means the epinephrine has successfully alleviated the swelling causing the angioedema.

C) Client reports decreased groin pain of 3 on a 1 to 10 scale:
Decreased groin pain is not relevant to the treatment of angioedema with epinephrine. Pain relief in the groin area does not indicate a therapeutic response to epinephrine, which is primarily used to address airway and anaphylactic symptoms.

D) The client's blood pressure when arising from resting position is at premedication levels:
While epinephrine can affect blood pressure, the main concern with angioedema is airway obstruction rather than blood pressure control. Normalizing blood pressure does not specifically indicate that the epinephrine has successfully treated the angioedema and improved the client's respiratory status.

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Correct Answer is C

Explanation

A. Contact the provider for further orders:
Contacting the provider for further orders might delay the administration of blood, which is crucial in situations where there is an urgent need, such as severe bleeding or anemia. Given that the unit of blood available is type O negative, which is universally compatible with most recipients in emergency situations, waiting for further orders could jeopardize the client's health.
B. Complete an incident report:
There is no incident or error that occurred in this situation. Using type O negative blood for a recipient with type A positive blood is an accepted practice in emergencies, and therefore, does not warrant the completion of an incident report.
C. Administer the blood as ordered:
Type O negative blood can be safely administered to recipients with any blood type in emergency situations. Since the client requires blood, and the unit available is type O negative, which is universally compatible, administering the blood as ordered is the appropriate action to ensure timely treatment.
D. Notify the blood bank:
Notifying the blood bank is unnecessary in this situation. The nurse has a unit of type O negative blood on hand, which is appropriate for immediate administration to the client with type A positive blood. There's no need to inform the blood bank as the blood is compatible and can be safely administered.

A. Disenfranchised grief B. Anticipatory grief C. Prolonged grief D. Uncomplicated grief

Correct Answer is C

Explanation

A. Disenfranchised grief:
Disenfranchised grief occurs when the loss experienced by an individual is not openly acknowledged or socially supported. This type of grief may occur when the relationship with the deceased is not recognized or valued by others, such as in the case of a non-traditional relationship. In this scenario, the client's grief is acknowledged but persists beyond what is considered a typical mourning period, suggesting a different type of grief.

B. Anticipatory grief:
Anticipatory grief occurs when individuals experience feelings of loss before the actual loss or death occurs. This often happens in situations where death is expected due to a terminal illness. Since the client's partner has already died, anticipatory grief does not apply in this case.

C. Prolonged grief:
This is the correct answer. Prolonged grief, also known as complicated grief, occurs when the grieving process persists over an extended period, beyond what is considered typical or socially acceptable. Individuals experiencing prolonged grief may have difficulty accepting the reality of the loss and may continue to experience intense emotions related to the loss for an extended period, often interfering with their daily functioning.

D. Uncomplicated grief:
Uncomplicated grief refers to a normal and typical response to loss that typically resolves over time. While grief is a natural response to loss, uncomplicated grief does not persist for an extended period or significantly impair the individual's ability to function in their daily life. In this scenario, the client's continued inability to accept the loss suggests that the grief may be more complex than uncomplicated grief.

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A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine?

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