A nurse is providing care to a client who is experiencing wheezing after receiving an antibiotic 20 min ago. Which of the following findings is the priority of the nurse to monitor for?

Decreased blood pressure

Stomach pain

Urticaria

Lightheadedness

Answer and Explanation

The Correct Answer is A

Choice A Reason:

Decreased blood pressure is correct. Decreased blood pressure (hypotension) is the priority finding to monitor for because it is indicative of a severe allergic reaction known as anaphylaxis. Anaphylaxis is a potentially life-threatening condition that can lead to shock, organ failure, and death if not promptly treated. Hypotension in the context of an allergic reaction suggests widespread vasodilation and increased vascular permeability, resulting in a decrease in blood pressure.

Choice B Reason:

Stomach pain is incorrect. Stomach pain may indicate gastrointestinal distress or adverse effects of the antibiotic, but it is not typically as immediately life-threatening as decreased blood pressure in the context of anaphylaxis. While abdominal pain should not be ignored, it is not the priority finding when assessing for signs of anaphylaxis.

Choice C Reason:

Urticaria is incorrect. Urticaria, also known as hives, is a common allergic reaction characterized by raised, itchy welts on the skin. While urticaria can be uncomfortable and distressing, it is not immediately life-threatening. However, urticaria may be a precursor to more severe allergic reactions, such as anaphylaxis, so it is still important to monitor closely.

Choice D Reason:

Lightheadedness is incorrect. Lightheadedness may occur as a result of hypotension in the context of anaphylaxis, but it is not as critical as directly monitoring blood pressure. Lightheadedness may also be caused by other factors, such as anxiety or dehydration, and may not always indicate a severe allergic reaction. While it is important to assess for lightheadedness and monitor the client's overall condition, it is not the priority finding compared to decreased blood pressure.

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Correct Answer is ["A","B","C","D","E"]

Explanation

Choice A Reason:

Weight control if the client's BMI is greater than 35 is correct. Obesity is a risk factor for cardiovascular disease and can exacerbate symptoms of heart failure. Weight control, particularly if the client's BMI is greater than 35, is important for managing cardiac conditions such as heart failure and reducing the risk of pulmonary edema.

Choice B Reason:

Healthy lifestyle is correct. Adopting a healthy lifestyle, including regular exercise, balanced diet, adequate hydration, and stress management, is essential for managing cardiac conditions and reducing the risk of complications such as pulmonary edema.

Choice C Reason:

Smoking cessation is correct. Smoking is a major risk factor for cardiovascular disease and can worsen heart failure symptoms. Smoking cessation is crucial for managing cardiac conditions and reducing the risk of pulmonary edema and other complications.

Choice D Reason:

Heart disease prevention is correct. Providing information about heart disease prevention strategies, such as maintaining a healthy diet, managing blood pressure and cholesterol levels, regular exercise, and regular medical check-ups, can help reduce the risk of exacerbations and complications in clients with pre-existing cardiac conditions.

Choice E Reason:

Glycemic control if the client is diabetic is correct. Diabetes is a risk factor for cardiovascular disease and can contribute to the development and progression of heart failure. Glycemic control, along with lifestyle modifications and medication management, is important for managing diabetes and reducing the risk of complications such as pulmonary edema.

A. Dyspnea is not commonly seen in other chronic conditions of the aging older adult. B. Aging is associated with decreased sensitivity to medications. C. Adverse reactions to medications in the aging older adult are lower. D. Physiological changes in the respiratory system can mimic the presence of airway obstruction.

Correct Answer is D

Explanation

Choice A Reason:

Dyspnea is not commonly seen in other chronic conditions of the aging older adult: This statement is incorrect. Dyspnea, or difficulty breathing, can occur in various chronic conditions commonly seen in aging adults, such as chronic obstructive pulmonary disease (COPD), heart failure, and pulmonary fibrosis, among others. Dyspnea can be a symptom of respiratory or cardiovascular issues and is not exclusive to asthma.

Choice B Reason:

Aging is associated with decreased sensitivity to medications: This statement is generally incorrect. Aging can affect drug metabolism and clearance, leading to changes in medication sensitivity. Older adults may have altered pharmacokinetics and pharmacodynamics, which can increase their sensitivity to certain medications, particularly those with sedative or CNS depressant effects. This increased sensitivity can potentially increase the risk of adverse drug reactions.

Choice C Reason:

Adverse reactions to medications in the aging older adult are lower: This statement is incorrect. While some physiological changes associated with aging may decrease the risk of adverse drug reactions, such as decreased renal function and altered drug metabolism, older adults are still at risk for adverse drug reactions due to factors such as polypharmacy, drug interactions, and increased sensitivity to medications.

Choice D Reason:

Physiological changes in the respiratory system can mimic the presence of airway obstruction: This statement is true. Physiological changes in the aging respiratory system, such as decreased lung elasticity, increased chest wall stiffness, and reduced respiratory muscle strength, can mimic the symptoms of airway obstruction seen in conditions like asthma or COPD. These changes can lead to decreased lung function, reduced exercise tolerance, and increased susceptibility to respiratory infections.

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A nurse is providing care to a client who is experiencing wheezing after receiving an antibiotic 20 min ago. Which of the following findings is the priority of the nurse to monitor for?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following information should the nurse include when educating a client who has pulmonary edema as a result of a pre-existing cardiac condition? (Select All that Apply.)

Correct Answer is ["A","B","C","D","E"]

Explanation

A nurse is caring for a client with asthma. Which of the following statements are true regarding physiological changes of the respiratory system in the aging adult client?

Correct Answer is D

Explanation

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