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    RN Hesi Exit Proctored ExamQuestion 62
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    RN Hesi Exit Proctored Exam

    A client develops urticaria on the trunk and neck shortly after a secondary infusion of piperacillin is initiated. In which, order should the nurse implement these interventions? (Arrange the actions in order of priority, with the highest priority first, and the least priority last or at the bottom.)

    Explanation & Rationale

    A) This is because the client is experiencing an allergic reaction to piperacillin, which can be life-threatening. The nurse should stop the infusion immediately to prevent further exposure to the drug and assess vital signs to monitor for signs of anaphylaxis, such as hypotension, tachycardia, wheezes, or stridor. B) Assessing vital signs is a priority to determine the severity of the reaction and the client's overall condition. C) The nurse should contact the healthcare provider to report the situation and obtain orders for treatment, such as antihistamines, corticosteroids, or epinephrine. D) The nurse should initiate an adverse event report to document the incident and follow the facility's protocol for reporting medication errors. E) The nurse should also document the reaction to the drug in the client's chart and notify the pharmacy to avoid future administration of piperacillin or related antibiotics.

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