Nursing Elites

1. A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, 'My chest still hurts.' Select the appropriate actions that the nurse should take.

• A. Call a code blue.
• B. Contact the registered nurse.
• C. Contact the client's family.
• D. Assess the client's pain level.

Correct answer: B

Rationale: The correct action for the nurse to take in this situation is to contact the registered nurse. When a client with coronary artery disease experiences chest pain and does not achieve relief after the initial administration of nitroglycerin, it is crucial to inform the registered nurse promptly. Following the usual guideline for nitroglycerin administration, the nurse may administer a second tablet after assessing the client's pain level. The nurse should continue to assess the client's pain and monitor vital signs before each dose administration. Calling a code blue is not warranted at this point, as the client's condition does not indicate an immediate life-threatening emergency. Contacting the client's family is not necessary unless requested by the client.

2. A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication?

• A. Oranges and pineapple
• B. Coffee, cola, and chocolate
• C. Oysters, lobster, and shrimp
• D. Cottage cheese, cream cheese, and dairy creamers

Correct answer: B

Rationale: Theophylline is a xanthine bronchodilator. Xanthines are found in coffee, cola, and chocolate. These foods should be limited while taking theophylline to prevent potential drug interactions or adverse effects.

3. A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy?

• A. Adventitious breath sounds
• B. Temperature of 99.4°F orally
• C. Blood pressure of 198/110 mm Hg
• D. Respiratory rate of 28 breaths/min

Correct answer: C

Rationale: The correct answer is C. Streptokinase therapy is contraindicated in severe uncontrolled hypertension due to the risk of cerebral hemorrhage. A blood pressure of 198/110 mm Hg indicates severe hypertension, which needs to be addressed before initiating streptokinase to prevent potential complications.

4. A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question?

• A. Cyclobenzaprine (Flexeril)
• B. Alendronate (Fosamax)
• C. Allopurinol (Zyloprim)
• D. Prednisone

Correct answer: D

Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, reducing the body's ability to withstand stress. During surgery, the dosage may need to be adjusted due to its impact on the body's stress response. Choices A, B, and C are not typically contraindicated before surgery and do not have the same potential impact on the body's stress response.

5. Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

• A. Platelet count
• B. Triglyceride level
• C. Complete blood count
• D. White blood cell count

Correct answer: B

Rationale: Before administering Isotretinoin, it is important to check the client's triglyceride levels. Isotretinoin is known to elevate triglyceride levels, hence monitoring them before and periodically during treatment is essential to prevent potential adverse effects.

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