# Clinical context Fifteen minutes after an evolocumab injection, a 63-year-old develops generalized hives, lip and tongue swelling, hoarseness, and increasing work of breathing while still in the clinic. A client develops lip swelling, generalized hives, and hoarseness shortly after evolocumab. Which actions are appropriate? Select exactly 4 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=602998&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
Fifteen minutes after an evolocumab injection, a 63-year-old develops generalized hives, lip and tongue swelling, hoarseness, and increasing work of breathing while still in the clinic.

A client develops lip swelling, generalized hives, and hoarseness shortly after evolocumab. Which actions are appropriate? Select exactly 4 responses.

Select exactly 4 responses.

1

Observe for 30 minutes, then send the client home if swelling decreases without documenting the reaction.

2

Activate emergency assessment and support the airway.

3

Stop further evolocumab exposure.

4

After symptoms resolve, give the next scheduled dose with antihistamine premedication without prescriber review.

5

Document the serious reaction and ensure evolocumab is reviewed as a contraindicated future exposure.

6

Provide standard hypersensitivity treatment and monitor until symptoms resolve.

## Explanation

Lip swelling, hives, and hoarseness indicate serious hypersensitivity with airway risk. Evolocumab should be discontinued, treated according to standard care, and avoided after a serious hypersensitivity reaction.

## In-depth explanation

Quick answer
Respond to evolocumab-associated angioedema as an airway emergency.

Why this is correct
Observation alone or rechallenge can allow rapid progression. Documentation and medication reconciliation prevent inadvertent re-exposure.

Easy analogy or mental picture
Use a closed medication-safety loop: identify the immune or cytotoxic exposure, connect the new findings, interrupt further harm, stabilize the client, and verify the response over time.

Memory hook
Exposure, immune effect, organ toxicity, infection risk, immediate action, and serial reassessment.

NCLEX decision rule
Choose the action that reduces the most immediate medication-related risk while preserving diagnostic evaluation and authorized treatment.

Why the other choices are wrong
Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic or infectious process active.References
1DailyMed: REPATHA (evolocumab)Subcutaneous administration, serious hypersensitivity including angioedema, discontinuation, and follow-up

## Clinical scenario

Clinical context
Fifteen minutes after an evolocumab injection, a 63-year-old develops generalized hives, lip and tongue swelling, hoarseness, and increasing work of breathing while still in the clinic.

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