Exhibits
The nurse would determine what actions to implement in an emergent situation. Drag from Word Choices to complete the sentence.
The client is at immediate risk for developing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B","dropdown-group-3":"B"}
A. anaphylaxis
The correct answer is A. Anaphylaxis is a severe, life-threatening allergic reaction that can occur in response to medication administration. The client's symptoms of dizziness, headache, burning feeling on extremities, and redness on face and extremities, along with the sudden onset of symptoms after starting vancomycin infusion, are indicative of a possible anaphylactic reaction.
B. arrhythmias
The correct answer is B. Arrhythmias refer to abnormal heart rhythms, which can be
triggered by various factors including medication reactions. Given the client's history of symptomatic bradycardia and the sudden onset of symptoms after starting vancomycin infusion, arrhythmias such as bradycardia or other rhythm disturbances are a concern.
C. Cardiac arrest
The correct answer is C. Cardiac arrest is the cessation of normal heart function, which can be precipitated by severe arrhythmias or anaphylaxis. The client's symptoms, along with the drop in blood pressure, indicate a potential risk of progressing to cardiac arrest if not promptly treated.
D. Necrosis
Necrosis, or tissue death, is not typically associated with the symptoms described in the scenario. While vancomycin infusion can potentially cause tissue irritation or damage at the
injection site, the symptoms described suggest a systemic reaction rather than localized tissue necrosis.
E. Renal failure
Renal failure is not directly indicated by the symptoms described in the scenario. While vancomycin can be nephrotoxic in some cases, the symptoms of dizziness, headache, and redness are more suggestive of an allergic or cardiovascular reaction.
F. Peripheral edema
Peripheral edema, or swelling in the extremities, is not indicated by the symptoms described in the scenario. The client's symptoms, such as dizziness, headache, and redness, are more
indicative of a systemic reaction rather than localized swelling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Bruising of the skin is not typically associated with acute gastritis caused by contaminated water. While bruising may be a sign of other medical conditions or complications, it is not directly related to gastritis.
B. Low-grade fever can be a symptom of gastritis, especially if it is caused by an infectious agent. However, it is not typically a severe or emergent symptom that requires immediate reporting unless it is accompanied by other concerning symptoms.
C. Abdominal cramping is a common symptom of gastritis and may occur due to inflammation of the stomach lining. While it should be monitored, it is not as concerning as the potential complication indicated by option D.
D. Bloody emesis (vomiting blood) is a serious symptom that can indicate severe gastritis or complications such as gastrointestinal bleeding. It is essential to report this symptom promptly as it may require immediate medical attention and intervention.
Correct Answer is C
Explanation
A. This instruction is incorrect because it suggests collecting catheterized specimens, which is not necessary for a creatinine clearance test. Catheterization may increase the risk of contamination and is not typically performed for this test.
B. This instruction is incorrect because it does not involve the collection of a complete 24-hour urine specimen. Collecting specimens every 6 hours would not provide an accurate measurement of creatinine clearance over a 24-hour period.
C. This instruction is correct. For a 24-hour urine collection, the client should urinate at a specified time to start the collection period, discard this urine, and then collect all subsequent urine produced over the next 24 hours. This ensures that the entire 24-hour period is captured for analysis.
D. This instruction is incorrect because it does not involve the collection of all urine produced over a 24-hour period. Additionally, discarding the first portion of voiding is not necessary for a creatinine clearance test and may lead to inaccurate results.
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