The nurse knows the following are symptoms of anaphylaxis and they need to intervene quickly.
(Select All that Apply.)
Hypotension
Bradycardia
Hypertension
Tachycardia
Wheezing
Correct Answer : A,D,E
A. Hypotension: A rapid drop in blood pressure is a hallmark symptom of anaphylaxis.
B. Bradycardia: Bradycardia is not a common finding in anaphylaxis. Tachycardia (rapid heart rate) is more typical due to compensatory mechanisms.
C. Hypertension: Anaphylaxis usually causes hypotension due to vascular leakage and vasodilation.
D. Tachycardia: Tachycardia is commonly seen in anaphylaxis as the heart attempts to compensate for the drop in blood pressure.
E. Wheezing: Wheezing is a sign of bronchospasm and respiratory distress, which is a common feature of anaphylaxis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
"I need to carry the Epi-pen with me at all times": Individuals with severe allergies should always have an Epi-pen in case of exposure to allergens. No reinforcement needed.
"When my Epi-pen reaches its expiration date, I need to get a new one": Epi-pens have a limited shelf life, and using an expired pen may be ineffective. No reinforcement needed.
"Once I inject myself with my Epi-pen, I won't have to go to the hospital": Epinephrine provides temporary relief, but further medical evaluation is essential due to the risk of a biphasic reaction or persistent symptoms. Reinforcement needed.
"I need to avoid all foods that may have been exposed to peanuts": Strict avoidance of allergens is essential to prevent severe reactions. No reinforcement needed.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
Malnutrition: The client presents with weight loss, anorexia, and difficulty eating due to oral ulcers, all of which increase the risk of malnutrition.
Hemorrhage: There is no indication of active bleeding or conditions predisposing the client to hemorrhage.
Tuberculosis: Clients with HIV are at increased risk for opportunistic infections, including tuberculosis, especially with symptoms of cough and weight loss.
Sepsis: Although immunosuppressed clients are at risk for infections, there is no current evidence of systemic infection requiring immediate sepsis evaluation.
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