A postoperative patient is undergoing antibiotic therapy. She has never had any problems taking medications in the past. When the nurse hung the second dose of IV antibiotics, the patient suddenly developed hives and itching. The nurse recognized this was most likely a(n):

allergic reaction.

side effect.

toxic effect.

idiosyncratic reaction.

Answer and Explanation

The Correct Answer is A

A. An allergic reaction is an immune response to a medication, even if the patient has taken the medication before without issues. Symptoms like hives and itching are classic signs of an allergic reaction.
B. A side effect is an expected, often mild and predictable reaction to a medication, not typically involving an immune response and severe symptoms like hives.
C. A toxic effect refers to harmful effects from a medication overdose or accumulation in the body, not sudden onset after an appropriate dose.
D. An idiosyncratic reaction is an uncommon response not related to allergies or toxic effects, usually not presenting with hives and itching.

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Correct Answer is D

Explanation

A. This statement is an objective finding, describing an action taken (administration of nitroglycerin).
B. This statement describes objective observations of the client's physical appearance.
C. This statement provides objective data about the client's blood pressure.
D. This statement reflects the client's report of symptoms, making it part of the subjective component of SOAP documentation.

A. Ask a family member to verify the client's identity. B. Check the client's name on the medication administration record (MAR) C. Verify the client's room number D. Ask the client's full name and date of birth.

Correct Answer is D

Explanation

A. Family members are not reliable sources for verifying patient identity.
B. Checking the client's name on the MAR is a part of the process but alone is not sufficient for identification.
C. Room numbers can change or be occupied by different patients; they do not verify patient identity.
D. Asking the client's full name and date of birth ensures direct confirmation from the patient, which is the most reliable method of identification.

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A postoperative patient is undergoing antibiotic therapy. She has never had any problems taking medications in the past. When the nurse hung the second dose of IV antibiotics, the patient suddenly developed hives and itching. The nurse recognized this was most likely a(n):

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is documenting in a client's health record using the subjective, objective, assessment, and plan (SOAP) charting model. Which of the following information should be included in the subjective component?

Correct Answer is D

Explanation

Before administering client medications, the nurse must identify the client. Which of the following methods of identification should the nurse use?

Correct Answer is D

Explanation

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