Nursing Elites

1. A client with Angina Pectoris asks the nurse about the next step if one tablet does not relieve Anginal pain after waiting 5 minutes. Which of the following responses should the nurse make?

• A. Take two more sublingual tablets simultaneously.
• B. Call emergency services.
• C. Take a sustained-release nitroglycerin capsule.
• D. Wait another 5 minutes before taking a second sublingual tablet.

Correct answer: B

Rationale: In a situation where Anginal pain persists after taking one sublingual tablet and waiting 5 minutes, it is crucial to call emergency services (911) immediately. This could indicate a myocardial infarction (heart attack) rather than a typical Anginal attack. The client should not take two more sublingual tablets simultaneously without seeking immediate medical help as this could delay appropriate intervention if the pain is due to a heart attack. Taking a sustained-release nitroglycerin capsule is not recommended for immediate relief of acute Anginal pain as it works too slowly. Waiting another 5 minutes before taking a second sublingual tablet is not appropriate if the pain persists, as prompt action is essential in suspected heart-related issues.

2. A client has been prescribed an ACE Inhibitor for hypertension. Which of the following instructions should be included by the healthcare provider?

• A. Avoid salt substitutes.
• B. Take this medication at bedtime.
• C. Avoid foods high in potassium.
• D. Limit your fluid intake.

Correct answer: A

Rationale: The correct answer is to 'Avoid salt substitutes.' ACE Inhibitors can increase potassium levels, so clients should avoid salt substitutes that contain potassium to prevent hyperkalemia, which is a potential side effect of ACE Inhibitors. Choice B 'Take this medication at bedtime' is incorrect as ACE Inhibitors are usually taken in the morning to avoid nocturnal diuresis. Choice C 'Avoid foods high in potassium' is incorrect because although ACE Inhibitors can increase potassium levels, clients are generally encouraged to consume potassium-rich foods in moderation unless contraindicated. Choice D 'Limit your fluid intake' is also incorrect as ACE Inhibitors do not typically require fluid restrictions unless specified by a healthcare provider for other reasons.

3. A client has a new prescription for Metformin. Which of the following adverse effects of Metformin should the nurse instruct the client to report to the provider?

• A. Somnolence
• B. Constipation
• C. Fluid retention
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A: Somnolence. Somnolence can indicate lactic acidosis, a rare but serious adverse effect of Metformin. Lactic acidosis is manifested by extreme drowsiness, hyperventilation, and muscle pain. Clients should be instructed to report these symptoms to their healthcare provider promptly to prevent further complications.

4. When teaching a client with a new prescription for Lisinopril, which instruction should the nurse include?

• A. Take the medication with food.
• B. Expect a persistent, dry cough.
• C. Increase your intake of potassium-rich foods.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct answer is B: 'Expect a persistent, dry cough.' Lisinopril, an ACE inhibitor, commonly causes a persistent, dry cough as a side effect. This should be reported to the healthcare provider if it becomes bothersome. It is essential for the nurse to educate the client about this potential side effect so the client is aware and can seek appropriate guidance if needed. Choices A, C, and D are incorrect. Taking Lisinopril with food is not required. Increasing potassium-rich foods is not a specific instruction for Lisinopril, and taking the medication at bedtime is not a typical recommendation associated with this medication.

5. A client has a new prescription for Digoxin. Which of the following instructions should the nurse provide?

• A. Monitor your heart rate before taking the medication.
• B. Increase your intake of high-potassium foods.
• C. Take the medication with a full glass of milk.
• D. Expect your stools to be black and tarry.

Correct answer: A

Rationale: Clients prescribed Digoxin should monitor their heart rate before each dose. This is essential to identify any potential bradycardia, defined as a heart rate below 60 bpm, which can be a side effect of Digoxin. Any significant changes in heart rate should be reported promptly to the healthcare provider for further evaluation and management. Choice B is incorrect because increasing intake of high-potassium foods can lead to hyperkalemia, a condition that can be exacerbated by Digoxin. Choice C is incorrect as taking Digoxin with a full glass of milk is not necessary. Choice D is incorrect as black, tarry stools are not an expected side effect of Digoxin.

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