what is the correct intervention for a patient experiencing anaphylaxis

ATI LPN

ATI NCLEX PN Predictor Test

1. What is the correct intervention for a patient experiencing anaphylaxis?

A. Administer epinephrine
B. Provide oxygen
C. Monitor airway
D. All of the above

Correct answer: D

Rationale: In cases of anaphylaxis, all of the listed interventions are crucial for effective management. Administering epinephrine is the primary treatment to reverse the allergic reaction rapidly. Providing oxygen ensures adequate oxygenation to vital organs, and monitoring the airway is essential to prevent obstruction and maintain a clear air passage. Therefore, all three interventions are necessary in managing anaphylaxis. Choices A, B, and C are not individually sufficient to address all aspects of anaphylaxis, making the comprehensive approach of 'All of the above' the correct answer.

2. What are the key components of a respiratory assessment?

A. Inspection, Palpation, Percussion, Auscultation
B. Inspection, Observation, Auscultation, Percussion
C. Auscultation, Palpation, Observation, Percussion
D. Observation, Palpation, Percussion, Auscultation

Correct answer: A

Rationale: The correct answer is A: Inspection, Palpation, Percussion, Auscultation. A focused respiratory assessment involves inspecting the chest for symmetry and signs of distress, palpating for tenderness or abnormal masses, performing percussion to assess underlying tissues, and auscultating lung sounds. Choice B is incorrect as observation is a broad term that can encompass both inspection and palpation. Choice C is incorrect as auscultation is usually performed after inspection and palpation. Choice D is incorrect as observation should be more specific, and auscultation is a key component that is typically done last in a respiratory assessment.

3. What is the best strategy for managing fatigue in a client who has had an acute myocardial infarction and is concerned about self-care?

A. Instruct the client to rest completely and avoid all self-care tasks
B. Encourage the client to gradually resume self-care tasks with frequent rest periods
C. Assign assistive personnel to complete all self-care tasks
D. Ask the client's family to assist with self-care tasks

Correct answer: B

Rationale: The best strategy for managing fatigue in a client who has had an acute myocardial infarction and is concerned about self-care is to encourage the client to gradually resume self-care tasks with frequent rest periods. This approach helps the client regain independence while managing fatigue effectively. Choice A is incorrect because complete rest without any self-care tasks may hinder recovery and independence. Choice C is not the best option as it does not promote the client's independence. Choice D, while involving family support, does not empower the client to regain self-care abilities.

4. A healthcare provider is reviewing the medical record of a client who is scheduled for surgery. Which of the following findings should the provider report?

A. White blood cell count of 8,000/mm³
B. Potassium level of 4.0 mEq/L
C. Creatinine level of 1.0 mg/dL
D. Hemoglobin level of 12 g/dL

Correct answer: C

Rationale: An elevated creatinine level indicates impaired kidney function, which may affect the client's ability to undergo surgery. The other laboratory values (white blood cell count, potassium level, and hemoglobin level) are within normal ranges and do not directly impact the client's readiness for surgery.

5. Which of the following situations can be identified as an ethical dilemma?

A. A nurse demonstrates signs of chemical impairment
B. A family has conflicting feelings about tube feeding for their terminally ill father
C. A nurse overhears a colleague threatening to restrain a patient if they do not stay in bed
D. A client with terminal cancer hesitates to name their spouse as power of attorney

Correct answer: B

Rationale: The correct answer is B. Ethical dilemmas involve conflicting values or feelings. In this situation, the family is conflicted about tube feeding for their terminally ill father, which presents a moral and ethical challenge. Choices A, C, and D do not represent ethical dilemmas. Choice A involves a nurse's impairment, which is a different issue. Choice C involves a nurse's observation of a colleague's threat, which is a patient safety concern. Choice D involves a client's hesitation in naming a spouse as power of attorney, which is a legal and decision-making issue, not necessarily an ethical dilemma.