the nurse is giving nitroglycerin sublingually for chest pain what is the most important instruction to give to the client
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Nursing Elites

ATI RN

Cardiovascular System Practice Exam

1. The nurse is giving nitroglycerin sublingually for chest pain. What is the most important instruction to give to the client?

Correct answer: A

Rationale: The correct answer is A. The tablet should be placed under the tongue and allowed to dissolve completely to ensure rapid absorption. This route of administration allows the medication to be quickly absorbed into the bloodstream. Choice B is incorrect because nitroglycerin is meant to be absorbed sublingually, not swallowed. Choice C is incorrect as chewing the tablet can cause the medication to be rapidly absorbed, leading to adverse effects like a drop in blood pressure. Choice D is incorrect because the client should take only one tablet every 5 minutes up to a maximum of three tablets for chest pain relief.

2. What is a condition where the blood pressure in the arteries is consistently too high, increasing the risk of heart disease and stroke?

Correct answer: A

Rationale: Hypertension, also known as high blood pressure, is a condition where the force of the blood against the artery walls is consistently too high. This increased pressure can lead to serious health issues such as heart disease and stroke. Hypotension (choice B) refers to low blood pressure, which is not the correct term in this context. Diabetes (choice C) and hyperlipidemia (choice D) are also serious conditions but are not specifically characterized by consistently high blood pressure.

3. Which term refers to a condition where the blood supply to part of the heart muscle is blocked, often referred to as a heart attack?

Correct answer: A

Rationale: The correct answer is A, myocardial infarction. A myocardial infarction, commonly known as a heart attack, occurs when the blood supply to part of the heart muscle is blocked, often by a blood clot. Choices B, C, and D are incorrect because arrhythmia refers to an irregular heartbeat, stroke involves the interruption of blood flow to the brain, and an aneurysm is a bulge in a blood vessel.

4. Which structure serves as the normal pacemaker of the heart?

Correct answer: A

Rationale: The correct answer is the SA node. The sinoatrial (SA) node is known as the natural pacemaker of the heart as it generates electrical impulses initiating each heartbeat. The SA node is located in the right atrium and sets the rhythm and rate of the heartbeat. The AV node (choice B) is responsible for delaying the electrical impulse to allow the atria to contract before the ventricles. Purkinje fibers (choice C) are specialized cardiac fibers responsible for the rapid conduction of impulses to the myocardial cells, and the atria (choice D) are the upper chambers of the heart involved in receiving blood from the veins.

5. What is the condition where the lung collapses due to air leaking into the space between the lung and chest wall?

Correct answer: A

Rationale: Pneumothorax is the correct answer. It is the collapse of a lung due to air leaking into the space between the lung and chest wall. This condition often requires emergency treatment. Choice B, Pleural effusion, is the buildup of excess fluid between the layers of the pleura outside the lung, not air. Choice C, Pulmonary fibrosis, is a lung disease characterized by scarring and thickening of lung tissue, not related to lung collapse. Choice D, Lung cancer, is the uncontrolled growth of abnormal cells in the lung, not directly causing lung collapse.

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