Year Woman With Question & Answer Guide (With Explanation)
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What This Question Is About
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How to Approach This Question
Focus on explaining concepts clearly and supporting them with examples.
Key Explanation
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Original Question
A 34-year-old woman with a history of bipolar disorder and an allergy to tree nuts. The client has experienced one hypersensitivity reaction as a child. However, as an adult she is careful to avoid ingestion of tree nuts and thought the sensitivity went away. She was unaware that the new dish at the restaurant had crushed cashews in the sauce. This evening patient was eating at a local restaurant. After eating several bites of a new dish, she began to experience itching and tightness in the back of her throat. Lips became red and edematous. The client described difficulty breathing and EMS notified. Emergency services arrived within 6 minutes. The client was hypoxic but awake on their arrival. The client received oxygen at 8 L per nasal cannula and 0.3 mg of epinephrine intramuscularly and a bolus of normal saline intravenously in route to the hospital. Current assessment reveals stridor with decreased breath sounds, laryngeal edema, facial swelling, and a decreased level of consciousness. Currently in sinus tachycardia with heart rate varied from 120 to 150 beats/min. Current blood pressure is 90/40 mm Hg after a normal saline fluid bolus in route to the hospital. The client’s spouse is present and reports occasional alcohol use and no illicit drug use. The client takes lithium 600 mg per day. She also takes cetirizine 10 mg daily. Temperature: 98.6°F (37°C) Blood pressure: 90/40 mm Hg Heart rate: 140 beats/min Oxygen saturation: 86% on 15 L per face mask Current height: 5 feet, 4 inches (162.6 cm) Current weight: 140 pounds (63.5 kg) Body mass index: 24 kg/m2 ORDERS 2000: continuous hemodynamic monitoring insert additional large-bore intravenous (IV) line administer IV normal saline 125 mL/h administer epinephrine 0.3 mg intramuscularly (IM) (second dose) laboratory tests: type and crossmatch, complete blood count (CBC), lithium level chest x-ray bedside glucose level electrocardiogram (ECG) arterial blood gas (ABG) The nurse reviews the client’s history and physical in the EHR to identify relevant cues related to her current presentation. Choose the most likely options for the information missing from the statements by selecting from the lists of options provided. Based on the client’s history of previous hypersensitivity reaction, the nurse identifies ____________and ________as priority assessment findings requiring immediate follow-up. Select response a history of bipolar disorder facial edema body mass index (BMI 24 kg/m²) sinus tachycardia select response heart rate 140 beats/min blood pressure 90/40 mm Hg decreased level of consciousness laryngeal edema
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