Nursing Elites

1. A client with a history of myocardial infarction (MI) is prescribed nitroglycerin (Nitrostat) for chest pain. Which instruction should the nurse provide?

• A. Take the medication with food.
• B. Swallow the tablet whole.
• C. Take the medication at bedtime.
• D. Place the tablet under your tongue.

Correct answer: D

Rationale: The correct instruction for a client prescribed nitroglycerin (Nitrostat) for chest pain is to place the tablet under the tongue. This route allows for rapid absorption of the medication, providing quick relief for chest pain associated with myocardial infarction.

2. A client with hypertension is receiving dietary education from a nurse. Which recommendation should the nurse include?

• A. Increase your intake of saturated fats.
• B. Limit your sodium intake to less than 2 grams per day.
• C. Avoid foods high in potassium.
• D. Consume at least three alcoholic beverages daily.

Correct answer: B

Rationale: The correct recommendation for a client with hypertension is to limit sodium intake to less than 2 grams per day. High sodium intake can worsen hypertension by increasing blood pressure. Choices A, C, and D are incorrect. Increasing saturated fats (Choice A) can be detrimental to heart health and exacerbate hypertension. Avoiding foods high in potassium (Choice C) is not recommended as potassium-rich foods can actually be beneficial for managing blood pressure. Consuming three alcoholic beverages daily (Choice D) can also have a negative impact on blood pressure and overall health.

3. A client with a cold is taking the antitussive benzonatate (Tessalon). Which assessment data indicates to the nurse that the medication is effective?

• A. Reports reduced nasal discharge.
• B. Denies having coughing spells.
• C. Able to sleep through the night.
• D. Expectorating bronchial secretions.

Correct answer: B

Rationale: The correct answer is B. Denying having coughing spells indicates the effectiveness of benzonatate, an antitussive that suppresses coughing. The goal of antitussive medications like benzonatate is to reduce or eliminate coughing, so the absence of coughing spells signifies the drug's efficacy. The other options do not directly reflect the medication's intended effect and are not specific indicators of benzonatate's effectiveness.

4. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

5. A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?

• A. Upper endoscopy
• B. Chest/abdominal CT scan
• C. Barium swallow
• D. Esophageal manometry

Correct answer: C

Rationale: For a patient presenting with intermittent dysphagia, especially with solids like meat, a barium swallow is the most appropriate initial test. In this case, the classic presentation suggests a Schatzki’s ring, which is best visualized through a barium study. Upper endoscopy may not always visualize Schatzki’s rings effectively. Chest/abdominal CT scan and esophageal manometry are not the preferred tests for diagnosing Schatzki’s rings. Treatment for Schatzki’s rings often involves bougie dilatation, and no further therapy may be necessary.

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