Nursing Elites

1. A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. What is the next appropriate nursing action?

• A. Administer another dose of nitroglycerin.
• B. Notify the healthcare provider immediately.
• C. Have the client lie down and stay calm.
• D. Give the client aspirin 325 mg to chew.

Correct answer: A

Rationale: If chest pain persists after the first dose of nitroglycerin, it is appropriate to administer a second dose while continuing to monitor the client's response. Nitroglycerin is a vasodilator commonly used to relieve angina symptoms by dilating blood vessels and increasing blood flow to the heart. Reassessing the client's response and providing a second dose may be necessary to achieve adequate pain relief and improve blood flow to the heart. Administering another dose of nitroglycerin is the next appropriate step in managing angina symptoms. Notifying the healthcare provider immediately (Choice B) may be necessary if the client's condition worsens or if there are other concerning symptoms. Having the client lie down and stay calm (Choice C) is generally recommended but addressing the ongoing chest pain takes precedence. Giving the client aspirin 325 mg to chew (Choice D) is beneficial for suspected myocardial infarction but is not the immediate action indicated for persistent angina symptoms.

2. The LPN/LVN is assisting with the care of a client who has been diagnosed with a myocardial infarction (MI). Which laboratory test result would the nurse expect to see elevated within the first 24 hours of the client's admission?

• A. Serum troponin
• B. Serum creatinine
• C. Serum sodium
• D. Serum albumin

Correct answer: A

Rationale: Elevated serum troponin levels are indicative of myocardial damage and are commonly used as a diagnostic marker for myocardial infarction. Troponin levels typically rise within a few hours of an MI and remain elevated for several days, making it a crucial test for early detection and monitoring of cardiac injury. Serum creatinine is not typically elevated in the acute phase of a myocardial infarction. Serum sodium and serum albumin levels are not directly associated with myocardial infarction and are unlikely to be elevated in the first 24 hours following an MI.

3. Before administering a calcium channel blocker to a client with hypertension, what parameter should the nurse check?

• A. Serum calcium level
• B. Apical pulse
• C. Blood pressure
• D. Respiratory rate

Correct answer: C

Rationale: Before administering a calcium channel blocker to a client with hypertension, the nurse should check the client's blood pressure. Calcium channel blockers are prescribed to lower blood pressure, so it is essential to assess the current blood pressure to ensure safe administration and monitor the medication's effectiveness. Checking the serum calcium level (Choice A) is not necessary before administering a calcium channel blocker, as it does not directly impact the drug's action. Monitoring the apical pulse (Choice B) is important for other types of medications like beta-blockers, not specifically for calcium channel blockers. Assessing the respiratory rate (Choice D) is not directly related to administering calcium channel blockers for hypertension.

4. A client with a history of coronary artery disease (CAD) is prescribed atorvastatin (Lipitor). The nurse should teach the client about which common side effect of this medication?

• A. Dry mouth
• B. Muscle pain
• C. Drowsiness
• D. Diarrhea

Correct answer: B

Rationale: Muscle pain is a common side effect of statins like atorvastatin. It is important for the nurse to educate the client about this potential side effect, as it can indicate a serious condition called rhabdomyolysis, which requires immediate medical attention. Dry mouth, drowsiness, and diarrhea are not typically associated with atorvastatin use.

5. A healthcare provider is providing discharge instructions to a client who has a new prescription for digoxin. Which of the following instructions should the healthcare provider include?

• A. Take the medication at bedtime.
• B. Avoid taking antacids with this medication.
• C. Monitor your pulse rate daily.
• D. Increase your intake of potassium-rich foods.

Correct answer: C

Rationale: The correct answer is C: 'Monitor your pulse rate daily.' Monitoring the pulse rate daily is crucial when taking digoxin as it helps in early detection of digoxin toxicity. Digoxin can cause toxicity, which may manifest as changes in the heart rate, making monitoring the pulse rate an essential part of managing the medication. It is important for the client to be aware of their normal pulse rate and report any significant changes to their healthcare provider promptly. Choices A, B, and D are incorrect. Taking digoxin at bedtime is not a specific instruction related to monitoring its effects. Avoiding antacids is relevant for some medications, but not a key concern with digoxin. Increasing potassium-rich foods may interact with digoxin due to its effect on potassium levels, but monitoring the pulse rate is a more direct and immediate need for safety.

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