Nursing Elites

1. A client with chronic stable angina is prescribed nitroglycerin (Nitrostat) for chest pain. The nurse should include which instruction when teaching the client about this medication?

• A. Take nitroglycerin at the first sign of chest pain.
• B. Swallow the tablet whole with water.
• C. Take nitroglycerin with meals to prevent stomach upset.
• D. Store nitroglycerin in a cool, dry place.

Correct answer: A

Rationale: The correct instruction when teaching a client about nitroglycerin (Nitrostat) is to take it at the first sign of chest pain. Nitroglycerin works rapidly to dilate blood vessels, improving blood flow to the heart muscle. Taking it promptly can help alleviate symptoms quickly and prevent the condition from worsening. Choice B is incorrect because nitroglycerin is usually taken sublingually (under the tongue) and not swallowed. Choice C is incorrect because nitroglycerin is not typically taken with meals. Choice D is incorrect because nitroglycerin should be stored in its original container away from heat and light.

2. The nurse is preparing a client for discharge after a myocardial infarction (MI). Which instruction is most important for the nurse to reinforce with the client?

• A. Avoid engaging in sexual activity for at least 6 weeks.
• B. Engage in moderate physical activity daily.
• C. Take prescribed medications even if you feel well.
• D. Return to work only when medically cleared.

Correct answer: C

Rationale: The most critical instruction for a client after a myocardial infarction is to continue taking prescribed medications even if they feel well. This is essential in preventing another myocardial infarction or other complications. Discontinuing medications prematurely can be detrimental to the client's recovery and may increase the risk of further cardiovascular events. Choices A, B, and D are incorrect because engaging in sexual activity, physical activity, or returning to work are important aspects of the client's recovery, but not as crucial as ensuring medication compliance to prevent further cardiac issues.

3. A client is admitted to the hospital with a diagnosis of pericarditis. The nurse reviews the client's record for which sign or symptom that differentiates pericarditis from other cardiopulmonary problems?

• A. Anterior chest pain
• B. Pericardial friction rub
• C. Weakness and irritability
• D. Chest pain that worsens with inspiration

Correct answer: B

Rationale: Pericardial friction rub is a distinctive sign of pericarditis, characterized by a scraping or grating sound heard on auscultation, which helps differentiate pericarditis from other cardiopulmonary conditions. While anterior chest pain may be present in various cardiopulmonary issues, it is not specific to pericarditis. Weakness and irritability are nonspecific symptoms that can be seen in many conditions. Chest pain worsening with inspiration is more indicative of pleuritic conditions such as pleurisy or pneumonia, rather than pericarditis.

4. During an assessment, a client taking valproic acid exhibits elevated liver enzymes. What finding should the nurse report to the provider?

• A. Elevated liver enzymes
• B. Weight loss
• C. Dry mouth
• D. Increased appetite

Correct answer: A

Rationale: Elevated liver enzymes are a critical finding that the nurse should report to the provider when assessing a client taking valproic acid. It can be indicative of hepatotoxicity, a severe side effect associated with valproic acid use. Timely reporting and intervention are essential to prevent further complications and ensure the client's safety and well-being. Choices B, C, and D are not directly related to valproic acid use or the manifestation of hepatotoxicity. Weight loss, dry mouth, and increased appetite are not typically associated with elevated liver enzymes in the context of valproic acid administration.

5. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value should the nurse monitor to assess the effectiveness of the medication?

• A. Activated partial thromboplastin time (aPTT)
• B. Prothrombin time (PT) and international normalized ratio (INR)
• C. Platelet count
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are the laboratory values used to monitor the effectiveness of warfarin therapy. These values help ensure that the client is within the therapeutic range for anticoagulation. PT measures the time it takes for blood to clot, while INR standardizes PT results to minimize variations between laboratories. Monitoring these values is crucial to prevent complications such as bleeding or clot formation. Activated partial thromboplastin time (aPTT) (Choice A) is more commonly used to monitor heparin therapy. Platelet count (Choice C) assesses the number of platelets in the blood and is not specific to warfarin therapy. Erythrocyte sedimentation rate (ESR) (Choice D) is a non-specific marker of inflammation and is not used to monitor the effectiveness of warfarin therapy.

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