Nursing Elites

1. A client has a new prescription for transdermal nitroglycerin patches. Which of the following instructions should be included for proper use?

• A. Apply the patch to the same site each day.
• B. Place the patch on an area of skin away from skin folds and joints.
• C. Keep the patch on 24 hours per day.
• D. Replace the patch every 72 hours.

Correct answer: B

Rationale: Placing the nitroglycerin patch on an area of skin away from skin folds and joints is crucial to ensure optimal absorption and effectiveness of the medication. Placing the patch on skin folds or joints can interfere with absorption, potentially reducing the patch's efficacy. Therefore, it is essential to follow this instruction to maximize the therapeutic benefits of the nitroglycerin patches. The other options are incorrect because applying the patch to the same site each day can lead to skin irritation, keeping the patch on 24 hours per day may not be necessary depending on the specific patch instructions, and replacing the patch every 72 hours is not the standard frequency for nitroglycerin patches.

2. The nurse is assisting with the care of a client diagnosed with heart failure. Which finding should the nurse report to the healthcare provider immediately?

• A. Weight gain of 2 pounds in 2 days
• B. Increased urination at night
• C. Mild shortness of breath on exertion
• D. Decreased appetite and fatigue

Correct answer: A

Rationale: A weight gain of 2 pounds in 2 days is concerning in a client with heart failure as it can indicate fluid retention and worsening of the condition. This finding requires immediate medical attention to prevent further complications. Increased urination at night (choice B) may be due to various reasons like diuretic use and is not an immediate concern. Mild shortness of breath on exertion (choice C) is expected in clients with heart failure and may not require immediate reporting. Decreased appetite and fatigue (choice D) are common symptoms in heart failure but are not as urgent as sudden weight gain.

3. A client has been prescribed ciprofloxacin and is receiving discharge teaching. Which of the following instructions should be included by the healthcare provider?

• A. Take the medication with milk.
• B. Avoid exposure to sunlight.
• C. Take the medication at bedtime.
• D. Increase your intake of vitamin K.

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid exposure to sunlight. Ciprofloxacin can increase the risk of photosensitivity, making it important to protect the skin from sunlight to prevent skin reactions. This precaution can help prevent skin damage and discomfort in individuals taking ciprofloxacin. Choices A, C, and D are incorrect. Taking ciprofloxacin with milk is not recommended as it may reduce the absorption of the medication. There is no specific instruction to take ciprofloxacin at bedtime. Increasing vitamin K intake is not directly related to ciprofloxacin therapy.

4. A client with hypertension is prescribed enalapril (Vasotec). The nurse should monitor the client for which adverse effect?

• A. Hypotension
• B. Hypertension
• C. Tachycardia
• D. Hyperglycemia

Correct answer: A

Rationale: Enalapril, an ACE inhibitor, can lead to hypotension, particularly following the initial dose or dosage escalation. This effect is due to the medication's mechanism of action in dilating blood vessels, which can result in lowered blood pressure. Monitoring for hypotension is crucial to prevent complications such as dizziness, lightheadedness, or fainting in clients taking enalapril. Choices B, C, and D are incorrect because enalapril does not typically cause hypertension, tachycardia, or hyperglycemia as adverse effects.

5. A client has a new prescription for nitroglycerin. Which of the following instructions should the nurse include?

• A. Store the medication in a cool, dry place.
• B. Take the medication as directed by the healthcare provider.
• C. Take the medication 30 minutes before meals.
• D. Take the medication at the first sign of chest pain.

Correct answer: D

Rationale: Instructing the client to take nitroglycerin at the first sign of chest pain is crucial for immediate relief of angina symptoms. Nitroglycerin is a fast-acting medication that helps dilate blood vessels, improving blood flow to the heart muscle. Therefore, prompt administration at the onset of chest pain is essential to alleviate anginal episodes effectively. Choices A, B, and C are incorrect because storing the medication properly, taking it as directed, or before meals are not specific instructions for managing acute anginal episodes, which require immediate action for symptom relief.

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