Nursing Elites

1. A client with angina pectoris has been prescribed nitroglycerin tablets prn for chest pain. Which statement by the client causes the practical nurse (PN) to clarify instructions for this client?

• A. I will take one tablet every 5 minutes, up to three tablets.
• B. I should take one tablet at the onset of angina and stop activity.
• C. I need to replace nitroglycerin tablets every 3 to 6 months to maintain freshness.
• D. I should ensure that I chew the pill completely before swallowing it.

Correct answer: D

Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet should be placed under the tongue (sublingually), not chewed or swallowed. One tablet can be taken every 5 minutes, up to three doses. If pain relief not achieved after taking three pills, seek medical attention immediately. Nitroglycerin should be replaced every 3 to 6 months. Nitroglycerin pain relief should occur in 5 minutes and duration should last 30 minutes.

2. A client with a diagnosis of generalized anxiety disorder is prescribed escitalopram. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Nausea
• D. Headache

Correct answer: A

Rationale: The correct potential side effect of escitalopram is drowsiness. Escitalopram is known to cause sedation, so clients should be advised to avoid activities that require mental alertness, such as driving, until they know how the medication affects them. Dry mouth, nausea, and headache are also common side effects of various medications but are not specifically associated with escitalopram.

3. A client with a diagnosis of bipolar disorder is prescribed valproate. The nurse should monitor for which potential adverse effect?

• A. Weight gain
• B. Hair loss
• C. Hyperglycemia
• D. Hypoglycemia

Correct answer: A

Rationale: The correct answer is A: Weight gain. Valproate is known to cause weight gain as a common adverse effect. It is important for the nurse to monitor the client's weight regularly while on this medication to detect and address any changes that may occur.

4. A client who is obtunded arrives in the emergency center with a suspected drug overdose. Intravenous naloxone is given, but within a short period, the client's level of consciousness deteriorates. What action should the nurse take first?

• A. Initiate a second intravenous access site
• B. Prepare to initiate cardiopulmonary resuscitation
• C. Determine the results of the drug toxicity screen
• D. Administer an additional dose of naloxone

Correct answer: D

Rationale: Administering an additional dose of naloxone should be the first action taken by the nurse in this scenario. Naloxone is an opioid antagonist used to reverse the effects of opioid overdose. If the client's level of consciousness deteriorates after the initial dose, administering another dose can help further reverse the overdose effects and improve the client's condition. Once the additional naloxone dose is given, the nurse can then proceed to assess the client's response and consider other interventions as needed.

5. A practical nurse (PN) is reviewing teaching with the client and/or significant others about the concurrent use of benztropine and olanzapine to manage psychotic behavior. What information should the PN reinforce?

• A. Benztropine will reduce olanzapine's side effect of urinary retention.
• B. Benztropine potentiates the effect of olanzapine.
• C. Benztropine is used to control the side effects of olanzapine.
• D. The combined effect of these drugs will modify psychotic behavior.

Correct answer: C

Rationale: The correct answer is C because benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with olanzapine use. Choice A is incorrect because benztropine does not directly reduce olanzapine's side effect of urinary retention. Choice B is incorrect as benztropine does not potentiate the effect of olanzapine; its main role is to counteract extrapyramidal symptoms. Choice D is incorrect because the primary purpose of using benztropine alongside olanzapine is to manage side effects, not specifically to modify psychotic behavior.

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