Nursing Elites

1. A client with angina pectoris is being taught about starting therapy with nitroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication

• A. after each meal and at bedtime.
• B. every 15 minutes during an acute attack.
• C. at the first indication of chest pain.
• D. with 8 oz of water.

Correct answer: C

Rationale: Nitroglycerin (Nitrostat) tablets are used to relieve chest pain associated with angina. The client should take the medication at the first indication of chest pain to help dilate blood vessels and improve blood flow to the heart muscle. Choice A is incorrect because nitroglycerin should not be scheduled after each meal or at bedtime. Choice B is incorrect as taking the medication every 15 minutes during an acute attack is excessive and not recommended. Choice D is incorrect because while it is important to take nitroglycerin with water, the timing of water intake is not as critical as taking the medication at the first sign of chest pain.

2. A nurse is preparing for the hospital admission of a client who is suspected to have active tuberculosis (TB). Which of the following precautions should the nurse plan to implement to safely care for this client?

• A. Staff and visitors should wear gowns, masks, and gloves while in the client's room.
• B. The client should be placed in a private room with a special ventilation system.
• C. The client may be placed in a room with other clients who require droplet isolation precautions.
• D. The protocol for donning and removing personal protective equipment before entering or leaving the room of a client with TB is different than for clients who are in other types of isolation.

Correct answer: B

Rationale: When caring for a client suspected of having active tuberculosis (TB), it is essential to place the client in a private room with a special ventilation system to prevent the spread of TB bacteria to others. Choice A is incorrect because staff and visitors should wear respiratory protection, not just gowns, masks, and gloves. Choice C is incorrect as clients with TB should not be placed in a room with other clients, as they need to be isolated to prevent transmission. Choice D is incorrect because the protocol for donning and removing personal protective equipment for clients with TB is similar to other types of isolation, focusing on proper infection control measures.

3. A nurse at a provider's office receives a phone call from a client who reports unrelieved chest pain after taking a nitroglycerin (Nitrostat) tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?

• A. Tell the client to take an aspirin.
• B. Instruct the client to call 911.
• C. Have the client take another nitroglycerin tablet in 15 minutes.
• D. Advise the client to come to the office.

Correct answer: B

Rationale: In this scenario, the client reporting unrelieved chest pain after taking a nitroglycerin tablet could be indicative of a serious cardiac event. Instructing the client to call 911 is the most appropriate response because immediate medical attention is necessary for chest pain that is not relieved by nitroglycerin. Telling the client to take an aspirin (Choice A) may not address the urgency of the situation, and aspirin might not be appropriate depending on the client's medical history. Having the client take another nitroglycerin tablet (Choice C) without relief could lead to overdosage. Advising the client to come to the office (Choice D) is not the best course of action when dealing with a potential cardiac emergency that requires immediate intervention.

4. A client comes to the emergency department reporting chest pain that is sharp, knife-like, and localized to an area he points to with one finger. The nurse should document this chest pain as which of the following?

• A. Angina pectoris
• B. Cardiogenic pain
• C. Myocardial infarction
• D. Pleuritic pain

Correct answer: D

Rationale: The correct answer is 'Pleuritic pain.' Pleuritic pain is characterized by sharp, knife-like pain that worsens with deep breathing or coughing and is localized to a specific area. This type of pain is often associated with inflammation of the pleura. Choices A, B, and C are incorrect. Angina pectoris is a type of chest pain caused by reduced blood flow to the heart muscle. Cardiogenic pain refers to pain originating from the heart itself. Myocardial infarction is the medical term for a heart attack.

5. During a home visit, a nurse sees a client with COPD receiving oxygen at 2 L/min through a nasal cannula. The client reports difficulty breathing. What is the priority nursing action at this time?

• A. Increase the oxygen flow to 3 L/min.
• B. Evaluate the client's respiratory status.
• C. Call emergency services for the client.
• D. Instruct the client to cough and clear secretions.

Correct answer: B

Rationale: The priority nursing action in this situation is to evaluate the client's respiratory status. When a client with COPD on oxygen therapy experiences difficulty breathing, the nurse should first assess the client's respiratory status to determine the severity of the situation. Increasing the oxygen flow without proper assessment can be harmful if not clinically indicated. While calling emergency services may eventually be necessary, it should not be the immediate action without assessing the client first. Instructing the client to cough and clear secretions is not appropriate as the nurse needs to evaluate the respiratory status before proceeding with interventions.

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