After administering an antibiotic to the patient, the patient complains of feeling very ill. The nurse notes that the patient is scratching and has hives. The patient soon starts having difficulty breathing and his blood pressure drops
What is the nurse's assessment of the situation?
a.
The patient is having a mild allergic reaction and an antihistamine will make the patient feel better.
b.
The patient is having an anaphylactic reaction and epinephrine should be administered right away.
c.
The patient's infection is worsening and progressing to septic shock so blood cultures should be drawn.
d.
The patient has developed toxic shock syndrome and the antibiotic orders must be changed right away.
ANS: B
The patient's symptoms are indicative of anaphylaxis: a severe, life-threatening allergic reaction. the airways close up, the throat swells closed, and the blood pressure drops dangerously low. The patient may go into shock and die. Patients may have very mild allergic reactions to medications and experience a rash or itching.
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