The nurse cares for a patient with osteoarthritis and obesity.The patient has been taking ibuprofen for the past five years.
The nurse should educate the patient about the risk for developing which of these conditions?

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.

Choice A rationale

Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, characterized by severe central nervous system depression, particularly respiratory depression (e.g., respirations <10 breaths/min). The patient's vital signs are stable and within normal range (Respirations 18/min, HR 71 bpm, BP 110/70 mm Hg), and itching alone does not indicate an overdose requiring reversal.

Choice B rationale

The patient's vital signs (Respirations 18/min, HR 71 bpm, BP 110/70 mm Hg) and clinical presentation (clear breath sounds, no rash) are stable. Itching (pruritus) is a common, non-life-threatening side effect of morphine sulfate due to histamine release, not a sign of impending respiratory or cardiovascular collapse. Therefore, preparing resuscitation equipment is an unnecessary, excessive intervention.

Choice C rationale

Anaphylactic reactions are a true drug allergy and are characterized by life-threatening systemic symptoms like urticaria, angioedema, wheezing, bronchospasm, and hypotension. The patient only reports isolated itching (pruritus) with stable vital signs and clear breath sounds, indicating a common, benign, histamine-release reaction, not an IgE-mediated anaphylactic emergency requiring epinephrine.

Choice D rationale

Pruritus (itching) is a very common side effect of opioid administration, including morphine, resulting from a generalized histamine release from mast cells that is unrelated to a true allergic reaction. Since the patient exhibits stable vital signs and no other signs of anaphylaxis (e.g., rash, wheezing), the appropriate action is to reassure the patient and perhaps offer a non-pharmacological comfort measure or an antihistamine, if ordered.