Nokea
A child at summer camp comes to see the camp nurse 10 minutes after being stung by a bee. The child complains of tingling around her mouth and tightness in her chest. The nurse's first action is summon help and to:
- A. Administer $\mathrm{O}_2$ at $4 \mathrm{~L} / \mathrm{min}$ by nasal cannula.
- B. Apply a tourniquet proximal to the bee sting and give epinephrine subcutaneously.
- C. Administer $\mathrm{O}_2$ at $6 \mathrm{~L} / \mathrm{min}$ and give Benadryl (Diphenhydramine) $25 \mathrm{mg}$ PO.
- D. Reassure the child that she is only excited due to the sting.
Correct Answer: B
Rationale: Tingling and chest tightness suggest anaphylaxis; epinephrine is the first-line treatment, and a tourniquet may slow venom spread.
You may also like to solve these questions
A client with considerable pain asks, 'What is your opinion regarding acupuncture as a drug-free method for alleviating pain?' The nurse responds, 'I'd forget about it as those weird non-Western treatments can be scary.' The nurse's response is an example of
- A. prejudice
- B. discrimination
- C. ethnocentrism
- D. cultural insensitivity
Correct Answer: C
Rationale: Ethnocentrism, the universal tendency of human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways, can be a major barrier to providing culturally conscious care.
A client is going to have an endoscopy performed. Which of the following is not a probable reason for an endoscopy procedure?
- A. Aspiration noted on honey thick diet.
- B. Pain with a bowel movement
- C. Pain felt in the left upper quadrant
- D. Right shoulder pain
Correct Answer: B
Rationale: Bowel movement pain should be examined with a colonoscopy not an endoscopy.
A client has fludrocortisone acetate (Florinef) prescribed. What blood tests should the nurse monitor when administering this drug?
- A. Liver function tests
- B. Renal function tests
- C. Serum electrolytes
- D. Complete blood count
Correct Answer: C
Rationale: Fludrocortisone, a mineralocorticoid, affects sodium and potassium balance, requiring monitoring of serum electrolytes to detect imbalances like hypernatremia or hypokalemia.
A nurse who travels with an agency is uncertain about what tasks can be performed when working in a different state. It would be best for the nurse to check which resource?
- A. The state nurse practice act in which the assignment is made
- B. With a nurse colleague who has worked in that state 2 years ago
- C. The policies and procedures of the assigned agency in the state
- D. The Nursing Social Policy Statement within the United States
Correct Answer: A
Rationale: The state nurse practice act is the governing document of the scope of practice in the given state.
The nurse is preparing a client environment that will reduce the chance of falls. Which action is appropriate?
- A. Keep the half side rails down on the side the client uses to get out of bed.
- B. Keep the lights down since glare bothers some clients.
- C. Call housekeeping to clean up the spilled water.
- D. Make sure that a path is cleared to assist the client when walking.
Correct Answer: D
Rationale: Clearing a path reduces tripping hazards, a key environmental modification to prevent falls.