A client with streptococcal pneumonia is receiving penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports itching at the IV site, dizziness, and shortness of breath. What should the nurse do first?

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Question 1 of 5

A client with streptococcal pneumonia is receiving penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports itching at the IV site, dizziness, and shortness of breath. What should the nurse do first?

Correct Answer: A

Rationale: In this scenario, the client is exhibiting signs of anaphylaxis, a severe allergic reaction. The priority action for the nurse is to stop the infusion immediately to prevent further administration of the allergen and worsening symptoms. Once the infusion is stopped, the nurse can then proceed with additional interventions, such as calling the provider, assessing the client's respiratory status, and providing appropriate care as needed.

Question 2 of 5

A healthcare professional is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion. Which of the following results indicates that the heparin infusion should be increased?

Correct Answer: A

Rationale: An aPTT of 90 seconds is above the therapeutic range for heparin, which typically falls between 60-80 seconds. This indicates that the current heparin dose is too high, and the infusion rate should be decreased to avoid excessive anticoagulation and the risk of bleeding. Monitoring aPTT is crucial in adjusting heparin therapy to maintain it within the therapeutic range.

Question 3 of 5

A nurse is providing teaching to a client who has asthma and is beginning to take montelukast. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer: B

Rationale: Montelukast is typically taken once daily in the evening for long-term control of asthma symptoms. It helps prevent asthma attacks by reducing inflammation in the airways. While montelukast can also be used for exercise-induced bronchospasm in some cases, it is generally not a rescue medication and should be taken regularly, not on an as-needed basis.

Question 4 of 5

A client in a critical care unit is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should the client be placed?

Correct Answer: D

Rationale: After a pneumonectomy, positioning the client in a semi-Fowler's position is crucial for optimal ventilation. This position helps improve lung expansion on the remaining side, facilitating better oxygenation and preventing complications like atelectasis. Placing the client prone, on the nonoperative side, or in Sims' position would not provide the same respiratory benefits post-pneumonectomy.

Question 5 of 5

A client with peptic ulcer disease is prescribed sucralfate. Which of the following instructions should the nurse include?

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

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