A patient with a history of chronic asthma arrives for their scheduled omalizumab injection. The nurse reviews the patient's medical history and notices that they have a reported allergy to peanuts.
What is the most appropriate nursing action?
Administer the omalizumab injection as scheduled.
Withhold the injection and notify the healthcare provider about the allergy.
Ask the patient if they experienced any symptoms of anaphylaxis recently.
Ensure the patient has an EpiPen available before administering the injection.
The Correct Answer is B
Choice A rationale
Administering omalizumab despite a reported allergy to peanuts is potentially unsafe because omalizumab has a black box warning for anaphylaxis, which can be life-threatening. While the peanut allergy may not directly contraindicate omalizumab, it suggests a heightened risk for severe allergic reactions due to atopy. Prudence dictates consulting the provider for risk assessment, skin testing, or alternative treatments, prioritizing patient safety before injection.
Choice B rationale
Omalizumab carries a risk of anaphylaxis, which can occur after any dose, including the first. A documented allergy, particularly to a common and potent allergen like peanuts, indicates a predisposition to hypersensitivity reactions (atopy). The most appropriate and safest nursing action is to withhold the injection and notify the healthcare provider to evaluate the risk and determine if the medication is still indicated or if precautions, such as desensitization or alternative therapy, are required.
Choice C rationale
Asking about recent anaphylaxis symptoms does not mitigate the potential risk of a future, severe reaction to omalizumab, which has a boxed warning for anaphylaxis. While a history of severe allergies is pertinent, the immediate safety concern is the risk of a severe hypersensitivity reaction to the drug itself. The nurse must address the reported allergy and the drug's known risks before proceeding with administration.
Choice D rationale
While ensuring an EpiPen is available is a precautionary measure for any patient receiving omalizumab due to the risk of anaphylaxis, it does not address the underlying concern of the documented peanut allergy, which might increase the patient's overall allergic predisposition. The nurse's first action must be to ensure the drug is safe to administer, which means consulting the provider about the allergy before administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
The kinin system, primarily involving bradykinin, is responsible for mediating inflammation by promoting vasodilation, increased capillary permeability, and pain. It does not function directly to tag pathogens for destruction; its role is more focused on the vascular changes and sensory signals of the inflammatory process.
Choice B rationale
The fibrin system is not a formally recognized component of the plasma protein systems involved in immunity or inflammation. Fibrin is the final product of the clotting cascade, forming the insoluble meshwork necessary for blood clot formation, which traps platelets and blood cells at a site of injury.
Choice C rationale
The complement cascade is a critical part of the innate immune system, consisting of multiple plasma proteins. A key function is opsonization, where complement proteins (specifically C3b) coat the surface of pathogenic microorganisms. This coating acts as a molecular tag, enhancing their recognition and subsequent engulfment and destruction by phagocytes like macrophages.
Choice D rationale
The clotting cascade (also called the coagulation cascade) is a series of enzymatic reactions leading to the formation of a fibrin clot, which prevents blood loss and localizes the inflammatory process. While intertwined with inflammation, its primary role is hemostasis, not the specific tagging of pathogens via opsonization.
Correct Answer is B
Explanation
Choice A rationale
Pseudoephedrine is a sympathomimetic drug that acts primarily as an alpha and beta agonist, stimulating the central nervous system (CNS). This stimulation usually leads to wakefulness, nervousness, and insomnia, rather than excessive sleepiness, which is a CNS depressant effect. Drowsiness can occur but is less common than CNS stimulation effects, as the drug promotes adrenergic activity.
Choice B rationale
Pseudoephedrine stimulates beta-1 adrenergic receptors in the heart, leading to an increase in heart rate (tachycardia) and force of contraction. This enhanced cardiac activity can be perceived by the patient as palpitations (irregular or rapid heartbeat). The normal adult heart rate is 60 to 100 beats per minute, and this drug can push it toward the upper limit or beyond.
Choice C rationale
Pseudoephedrine acts as a vasoconstrictor by stimulating alpha-1 adrenergic receptors on blood vessels, leading to an increase in systemic vascular resistance. This increase in resistance and cardiac stimulation typically results in a rise in blood pressure (hypertension), not hypotension. The normal adult blood pressure is less than 120/80 mm Hg.
Choice D rationale
Pseudoephedrine is generally a bronchodilator due to its beta-2 adrenergic receptor stimulation, which relaxes bronchial smooth muscles and improves (not worsens) respiration. Shallow respirations are a sign of respiratory depression or distress, which is not a common adverse effect of this sympathomimetic, which tends to increase the respiratory drive.
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