Nursing Elites

1. The nurse is assisting in the care of a client with a history of angina pectoris who is receiving nitroglycerin patches. Which instruction should the nurse reinforce with the client?

• A. Apply the patch to a different site each time.
• B. Remove the patch at night to prevent tolerance.
• C. Use more than one patch if chest pain occurs.
• D. Shower with caution while wearing the patch.

Correct answer: B

Rationale: Removing the nitroglycerin patch at night is crucial to prevent the development of tolerance. Tolerance can occur when the body becomes accustomed to a constant level of the medication, reducing its effectiveness. By removing the patch at night, the client experiences a drug-free period, which helps prevent tolerance and maintains the effectiveness of the nitroglycerin for angina relief. Choices A, C, and D are incorrect because applying the patch to a different site each time helps prevent skin irritation, using more than one patch is not recommended unless instructed by the healthcare provider, and showering with caution is important to prevent dislodging the patch, but it is not the most critical instruction to prevent tolerance development.

2. A client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned, knowing that this level could lead to which complication?

• A. Stroke
• B. Cardiac arrest
• C. High blood pressure
• D. Urinary stone formation

Correct answer: B

Rationale: A serum calcium level below normal (hypocalcemia) can lead to cardiac arrhythmias and potentially cardiac arrest. Calcium plays a crucial role in cardiac muscle contractility, and low levels can disrupt normal heart function, potentially leading to fatal arrhythmias and cardiac arrest. Choices A, C, and D are incorrect as hypocalcemia is not directly associated with stroke, high blood pressure, or urinary stone formation. The immediate concern with low serum calcium levels is the risk of cardiac complications.

3. The healthcare provider notes this rhythm on the client's cardiac monitor. The healthcare provider next reports that the client is experiencing which heart rhythm?

• A. Normal sinus
• B. Atrial fibrillation
• C. Sinus bradycardia
• D. Ventricular fibrillation

Correct answer: B

Rationale: The correct answer is B, Atrial fibrillation. Atrial fibrillation is characterized by an irregular and often rapid heart rate, which can lead to poor blood flow due to ineffective contractions of the atria. Sinus bradycardia (Choice C) is a regular but slow heart rhythm originating from the sinus node. Normal sinus rhythm (Choice A) refers to a regular heartbeat originating from the sinus node. Ventricular fibrillation (Choice D) is a life-threatening arrhythmia characterized by rapid, uncoordinated contractions of the ventricles.

4. 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.

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

• A. Monitor for a dry cough.
• B. Take the medication at bedtime.
• C. Avoid consuming grapefruit juice.
• D. Take the medication with food.

Correct answer: A

Rationale: The correct answer is A: Monitor for a dry cough. When a client is prescribed enalapril, it is important to monitor for a dry cough because it can be a side effect that indicates a potential issue like angioedema. This side effect needs close attention as it may require discontinuation of the medication to prevent further complications. Choices B, C, and D are incorrect because enalapril does not need to be taken at bedtime, does not interact with grapefruit juice, and can be taken without regard to meals.

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