Before administering botulinum antitoxin to a patient in the ...

[james9437]

Before administering botulinum antitoxin to a patient in the emergency department, it is most important for the nurse to
 
  a. obtain the patient's temperature.
  b. administer an intradermal test dose.
  c. document the neurologic symptoms.
  d. ask the patient about an allergy to eggs.

Question 2

A patient who had a C7 spinal cord injury a week ago has a weak cough effort and audible rhonchi. The initial intervention by the nurse should be to
 
  a. administer humidified oxygen by mask.
  b. suction the patient's mouth and nasopharynx.
  c. push upward on the epigastric area as the patient coughs.
  d. encourage incentive spirometry every 2 hours during the day.

[Tonny]

Answer to Question 1

ANS: B
To assess for possible allergic reactions, an intradermal test dose of the antitoxin should be administered. Although temperature, allergy history, and symptom assessment and documentation are appropriate, these assessments will not affect the decision to administer the antitoxin.

Answer to Question 2

ANS: C
Because the cough effort is poor, the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.

[james9437]

TYSM

[mammy1697]

Excellent