Difficulty: Medium
Average Score: 67%
Simulated
A nurse is assessing a client who received an IM antibiotic injection 15 min ago. Which of the following findings should the nurse identify as an indication of a possible anaphylactic reaction to the medication?
Correct answer
B
Rationale
The correct answer is B: A sharp decrease in blood pressure. An anaphylactic reaction is a severe allergic reaction that can lead to a sudden drop in blood pressure, known as anaphylactic shock. This is a life-threatening emergency that requires immediate intervention. A sudden decrease in heart rate (A) is not typically associated with an anaphylactic reaction. A feeling of swelling in the feet (C) could indicate a localized reaction but is not specific to anaphylaxis. Pain at the injection site (D) is a common side effect of IM injections but not a sign of anaphylactic reaction.