A nurse working on a medical unit is completing the admission of a client who reports a severe allergy to penicillin. Which of the following actions should the nurse take?

Remove all objects that contain latex from the client’s room.

Verify the client’s medication prescriptions do not include cephalosporin.

Notify dietary services to adjust the client’s diet.

Have the client purchase a medication alert bracelet to wear in the hospital.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Removing all objects that contain latex from the client’s room is important for clients with a latex allergy, not a penicillin allergy. Latex allergies can cause severe reactions, including anaphylaxis, but this action is not relevant to a penicillin allergy.

Choice B reason:

Verifying that the client’s medication prescriptions do not include cephalosporin is crucial because cephalosporins can have cross-reactivity with penicillin. Clients with a penicillin allergy may also react to cephalosporins, so it is essential to avoid prescribing these antibiotics.

Choice C reason:

Notifying dietary services to adjust the client’s diet is not directly related to managing a penicillin allergy. Dietary adjustments are more relevant for clients with food allergies or specific dietary restrictions.

Choice D reason:

Having the client purchase a medication alert bracelet to wear in the hospital is a good practice for general safety, but it is not an immediate action the nurse should take during the admission process. The primary focus should be on ensuring that the client’s medications do not include penicillin or related antibiotics.

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Correct Answer is D

Explanation

Choice A reason:

Stop taking the pills and switch to a different contraceptive method: This is not necessary for a single missed dose. Stopping the pills entirely and switching methods would be an overreaction and could lead to unnecessary complications. The standard recommendation for a missed dose is to take it as soon as remembered and continue with the regular schedule.

Choice B reason:

Take a home pregnancy test: Taking a home pregnancy test is not required immediately after missing a single dose of oral contraceptives, especially if it is the first week of the cycle. Pregnancy tests are typically recommended if there is a significant delay in the menstrual cycle or if multiple doses are missed.

Choice C reason:

Do not have vaginal intercourse until after your next period: This advice is overly cautious for a single missed dose. While it is important to use backup contraception if multiple doses are missed, abstaining from intercourse until the next period is not necessary for just one missed pill.

Choice D reason:

Take the missed dose now, then continue the medication as ordered: This is the correct course of action. According to guidelines, if a single hormonal pill is missed, it should be taken as soon as possible, and the next pill should be taken at the usual time. This may mean taking two pills in one day, but it ensures continuous contraceptive protection.

A. Purple striations B. Hirsutism C. Hyperpigmentation D. Intention tremors

Correct Answer is C

Explanation

Choice A reason:

Purple striations: Purple striations, or stretch marks, are more commonly associated with Cushing’s syndrome, which involves excess cortisol production. Addison’s disease, on the other hand, is characterized by insufficient cortisol and aldosterone production.

Choice B reason:

Hirsutism: Hirsutism refers to excessive hair growth in women in areas where hair is normally minimal or absent. It is not typically associated with Addison’s disease. Hirsutism is more commonly linked to conditions involving excess androgens, such as polycystic ovary syndrome (PCOS).

Choice C reason:

Hyperpigmentation: Hyperpigmentation, or darkening of the skin, is a hallmark symptom of Addison’s disease. This occurs due to increased production of melanocyte-stimulating hormone (MSH) as a byproduct of elevated adrenocorticotropic hormone (ACTH) levels. The skin changes are often most noticeable in areas exposed to friction, such as the elbows, knees, and knuckles.

Choice D reason:

Intention tremors: Intention tremors, which occur during purposeful movement, are not typically associated with Addison’s disease. These tremors are more commonly seen in neurological conditions such as multiple sclerosis or cerebellar disorders.

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A nurse working on a medical unit is completing the admission of a client who reports a severe allergy to penicillin. Which of the following actions should the nurse take?

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