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What is the nurse's priority action when a patient shows signs of an allergic reaction?
Asked on Feb 17, 2026
Answer
When a patient shows signs of an allergic reaction, the nurse's priority action is to ensure the patient's airway is open and assess for any signs of respiratory distress or anaphylaxis. This involves using the ABCs (Airway, Breathing, Circulation) framework to guide immediate interventions.
Example Nursing Steps:
- Step 1 – Assess the patient's airway for patency and check for signs of respiratory distress or swelling.
- Step 2 – Administer oxygen if needed and prepare to give epinephrine if anaphylaxis is suspected.
- Step 3 – Monitor vital signs, document the reaction, and notify the healthcare provider immediately.
Additional Comment:
- Always prioritize airway management in suspected allergic reactions.
- Look for signs such as hives, difficulty breathing, or swelling of the face and throat.
- Be prepared to initiate emergency protocols if the patient shows signs of anaphylaxis.
- Document all findings and interventions accurately in the patient's chart.
- Use the ABCs framework to guide your assessment and interventions.
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