Question

While eating a peanut butter sandwich as a bedtime snack, the nurse observes a client begin to wheeze and complain of dizziness. What should the nurse do first?

1) Lower the head of the bed.
2) Prepare to administer epinephrine.
3) Provide an antihistamine.
4) Notify anesthesia for intubation.

Answer 1

The nurse should first prepare to administer epinephrine when observing signs of anaphylaxis, such as wheezing and dizziness, after a client eats a peanut butter sandwich.

Step-by-step explanation:

When a nurse observes a client beginning to wheeze and complain of dizziness after eating a peanut butter sandwich, it is important to recognize these as potential signs of anaphylaxis, a severe allergic reaction. The nurse should initially prepare to administer epinephrine, as this is the first-line treatment for anaphylaxis. Epinephrine works by raising blood pressure and relaxing bronchial smooth muscles, which can counteract the effects of anaphylactic shock, potentially saving the client's life. Other actions like providing antihistamines, lowering the head of the bed, or notifying anesthesia for intubation, while important, are secondary to the immediate administration of epinephrine. Therefore, the nurse's first action should be to prepare to administer epinephrine (Option 2).