Nursing Elites

1. A client has a new prescription for nitroglycerin. Which of the following instructions should the nurse include?

• A. Store the medication in a cool, dry place.
• B. Take the medication as directed by the healthcare provider.
• C. Take the medication 30 minutes before meals.
• D. Take the medication at the first sign of chest pain.

Correct answer: D

Rationale: Instructing the client to take nitroglycerin at the first sign of chest pain is crucial for immediate relief of angina symptoms. Nitroglycerin is a fast-acting medication that helps dilate blood vessels, improving blood flow to the heart muscle. Therefore, prompt administration at the onset of chest pain is essential to alleviate anginal episodes effectively. Choices A, B, and C are incorrect because storing the medication properly, taking it as directed, or before meals are not specific instructions for managing acute anginal episodes, which require immediate action for symptom relief.

2. A client being seen in the emergency department for complaints of chest pain confides in the nurse about regular use of cocaine as a recreational drug. The nurse takes which important action in delivering holistic nursing care to this client?

• A. Reports the client to the police for illegal drug use
• B. Explains to the client the damage that cocaine does to the heart
• C. Tells the client it is imperative to stop before myocardial infarction occurs
• D. Teaches about the effects of cocaine on the heart and offers a referral for further help

Correct answer: D

Rationale: In this scenario, the nurse should prioritize educating the client about the effects of cocaine on the heart and provide a referral for further help. This approach is crucial in addressing the root cause of the client's health issues and supporting them in making informed decisions about their health. Reporting the client to the police is not appropriate in this situation as the focus should be on the client's health and well-being. Simply explaining the damage without offering solutions may not effectively address the client's needs or promote holistic care. Telling the client to stop without providing support or education may not be as effective as teaching about the effects of cocaine and offering help for cessation. Therefore, educating about the effects and providing a referral for further assistance is the best course of action for holistic nursing care.

3. The client with deep vein thrombosis (DVT) is receiving anticoagulant therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the therapy?

• A. Complete blood count (CBC)
• B. Activated partial thromboplastin time (aPTT)
• C. Serum electrolytes
• D. Liver function tests

Correct answer: B

Rationale: Activated partial thromboplastin time (aPTT) is the correct laboratory test to monitor the effectiveness of anticoagulant therapy, especially with heparin. A prolonged aPTT indicates effective anticoagulation, reducing the risk of further clot formation in the client with deep vein thrombosis (DVT). The other options, such as complete blood count (CBC), serum electrolytes, and liver function tests, do not directly assess the therapeutic effectiveness of anticoagulant therapy. Therefore, the correct answer is B.

4. A client with peripheral arterial disease complains of leg pain while walking. The nurse should reinforce which teaching point with the client?

• A. Wear compression stockings daily.
• B. Increase daily walking distance gradually.
• C. Elevate legs above heart level when resting.
• D. Use a heating pad to soothe leg muscles.

Correct answer: B

Rationale: For clients with peripheral arterial disease experiencing leg pain while walking, the priority teaching point is to gradually increase daily walking distance. This approach helps improve circulation, build tolerance, and reduce symptoms over time. While compression stockings can be beneficial for circulation, they are not the priority teaching point in this scenario. Elevating legs above heart level when resting is more appropriate for clients with venous insufficiency, not peripheral arterial disease. Using a heating pad is not recommended as it can potentially cause burns or skin damage in clients with compromised circulation.

5. A client has a new prescription for heparin. Which of the following laboratory results should be monitored to evaluate the effectiveness of the medication?

• A. Prothrombin time (PT)
• B. International normalized ratio (INR)
• C. Activated partial thromboplastin time (aPTT)
• D. Platelet count

Correct answer: C

Rationale: Activated partial thromboplastin time (aPTT) is the laboratory result that should be monitored to evaluate the effectiveness of heparin. Heparin works by prolonging the aPTT, and monitoring this parameter helps ensure the medication's effectiveness and safety in preventing clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor the effectiveness of warfarin, another anticoagulant. Platelet count is essential to assess platelet function and clotting disorders, but it is not specifically used to monitor heparin therapy.

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