Nursing Elites

1. 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.

2. The client is receiving anticoagulant therapy for atrial fibrillation. Which laboratory test should be monitored to determine the effectiveness of the therapy?

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

Correct answer: A

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of anticoagulant therapy in clients with atrial fibrillation. These tests help ensure that the client is within the therapeutic range and are commonly used to assess the clotting ability of the blood. Monitoring PT and INR levels allows healthcare providers to adjust anticoagulant dosages as needed to prevent complications such as bleeding or thrombosis. Activated partial thromboplastin time (aPTT) is more commonly used to monitor heparin therapy, not anticoagulant therapy for atrial fibrillation. Platelet count assesses the number of platelets in the blood and is not a direct indicator of anticoagulant therapy effectiveness. Erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and is not used to monitor anticoagulant therapy.

3. A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following statements should the nurse include?

• A. Avoid using a soft toothbrush.
• B. Report any signs of bleeding.
• C. Increase your intake of leafy green vegetables.
• D. Take the medication with food.

Correct answer: B

Rationale: The correct answer is B: 'Report any signs of bleeding.' When a patient is prescribed warfarin, it is essential to monitor for signs of bleeding as warfarin is an anticoagulant that increases the risk of bleeding. Choices A, C, and D are incorrect. Avoid using a soft toothbrush is not directly related to warfarin therapy, increasing the intake of leafy green vegetables can interfere with warfarin's effectiveness due to its vitamin K content, and taking warfarin with food is unnecessary as it can be taken with or without food.

4. A client is taking furosemide. Which of the following findings should the nurse report to the provider?

• A. Weight gain
• B. Dry cough
• C. Hypokalemia
• D. Increased appetite

Correct answer: C

Rationale: Furosemide is a loop diuretic that can lead to potassium loss, resulting in hypokalemia. Hypokalemia is a serious electrolyte imbalance that can cause various cardiac and muscular issues. Therefore, the nurse should promptly report hypokalemia to the healthcare provider for appropriate management. Choices A, B, and D are incorrect because weight gain, dry cough, and increased appetite are not typically associated with furosemide use and are not immediate concerns that require urgent reporting.

5. A client with a history of myocardial infarction (MI) is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse reinforce?

• A. Store the tablets in a cool, dry place away from light.
• B. Take a tablet every 5 minutes if chest pain occurs.
• C. Place the tablets under the tongue for sublingual absorption.
• D. Take the tablets without water for faster effect.

Correct answer: A

Rationale: The correct answer is A. Nitroglycerin tablets are light and moisture-sensitive, so they should be stored in a cool, dry place away from light to maintain their effectiveness. Option B advises taking a tablet every 5 minutes, which may lead to overdose as this frequency is too high. Option C emphasizes the correct administration route for sublingual tablets. Option D is incorrect as water is not needed for the tablets to take effect.

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