A nurse is reinforcing teaching about receiving epinephrine as an emergency intervention for anaphylaxis. Which of the following information should the nurse reinforce with the client?
Epinephrine relaxes the bronchioles and counteracts the effect of histamine
Epinephrine should be given along with a beta blocker.
Epinephrine should be administered intranasally
Epinephrine causes a decrease in blood pressure
The Correct Answer is A
A. Epinephrine relaxes the bronchioles and counteracts the effect of histamine: Epinephrine is the first-line treatment for anaphylaxis because it rapidly relaxes bronchial smooth muscles, reducing airway constriction, and counteracts histamine's effects, which include vasodilation, edema, and hypotension. This helps restore breathing and circulation.
B. Epinephrine should be given along with a beta blocker: Administering epinephrine with a beta blocker is dangerous because beta blockers can reduce the effectiveness of epinephrine and may worsen bronchospasm. Beta blockers are not recommended during acute management of anaphylaxis.
C. Epinephrine should be administered intranasally: Epinephrine is typically administered intramuscularly (IM), usually into the thigh, during anaphylactic emergencies for rapid absorption. Intranasal administration is not effective for treating life-threatening systemic allergic reactions.
D. Epinephrine causes a decrease in blood pressure: Epinephrine actually increases blood pressure by causing vasoconstriction. This counters the dangerous hypotension that occurs during anaphylaxis, helping to stabilize cardiovascular function quickly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Temperature of 37.2° C (99.0° F): A temperature of 37.2° C is within the normal range and does not necessarily indicate infection. Mild temperature elevations are common in the immediate postoperative period due to inflammatory responses rather than infection, which typically presents with more significant fever.
B. Elevated WBC count: An elevated white blood cell (WBC) count is a classic and early indicator of infection. It reflects the body's immune response to a bacterial or viral invasion, and postoperative infections often present with leukocytosis, making it a key finding to monitor closely.
C. Pain rating of 4 on a scale of 0 to 10: Moderate pain is expected after surgery and does not, by itself, suggest infection. Postoperative pain should be assessed in context with other symptoms like redness, swelling, or drainage; pain alone, especially if stable, is not definitive for infection.
D. Increased urinary output: Increased urinary output is generally a positive sign of good kidney perfusion and hydration status. A decrease, not an increase, in urinary output would be more concerning postoperatively and could suggest complications, but not necessarily infection.
Correct Answer is D
Explanation
A. The client recently received a pay raise at work: Receiving a pay raise is generally considered a positive life event that can improve self-esteem and financial security. Positive achievements like this are not associated with increased suicide risk and may actually serve as protective factors against depressive symptoms.
B. The client is married and has children: Being married and having children are typically viewed as protective factors against suicide. Strong familial bonds and social connections provide emotional support, a sense of responsibility, and a buffer against feelings of isolation or hopelessness that often contribute to suicidal ideation.
C. The client has a strong religious affiliation: Strong religious beliefs can serve as a significant protective factor against suicide by providing hope, purpose, community support, and moral objections to self-harm. Clients with strong spiritual ties often demonstrate greater resilience during periods of emotional distress.
D. The client has a history of chronic back pain: Chronic pain is a known risk factor for suicide because it can lead to feelings of hopelessness, helplessness, and a diminished quality of life. Clients with long-term physical pain often experience comorbid depression and are at higher risk for suicidal thoughts and behaviors.
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