Nursing Elites

1. The nurse is caring for a client with hypertension who is prescribed a thiazide diuretic. The nurse should check which parameter before administering the medication?

• A. Serum potassium level
• B. Blood pressure
• C. Heart rate
• D. Serum sodium level

Correct answer: B

Rationale: Before administering a thiazide diuretic to a client with hypertension, the nurse should check the blood pressure. Thiazide diuretics are prescribed to lower blood pressure, so assessing the client's blood pressure prior to administration helps to monitor the effectiveness of the medication and to ensure the client's safety. Checking the serum potassium level (Choice A), heart rate (Choice C), or serum sodium level (Choice D) are also important parameters in the care of a client on a thiazide diuretic, but the priority assessment before administering the medication is the blood pressure to evaluate the drug's effectiveness in managing hypertension.

2. The client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin. Which action should the nurse take next?

• A. Administer another dose of nitroglycerin.
• B. Notify the healthcare provider immediately.
• C. Have the client lie down and rest.
• D. Encourage the client to take deep breaths.

Correct answer: B

Rationale: When a client with a history of angina pectoris reports chest pain unrelieved by nitroglycerin, it may indicate a myocardial infarction, also known as a heart attack. In this situation, the nurse should immediately notify the healthcare provider to ensure prompt evaluation and appropriate intervention. Delay in seeking medical attention for chest pain unrelieved by nitroglycerin can be life-threatening, as it might be a sign of a more serious cardiac event. Administering another dose of nitroglycerin (Choice A) without further evaluation can be risky, as the client's condition may require a different intervention. Having the client lie down and rest (Choice C) or encouraging deep breaths (Choice D) are not appropriate actions in this scenario where a more serious cardiac event needs to be ruled out.

3. A client with known coronary artery disease (CAD) begins to experience chest pain while getting out of bed. What action should the nurse take?

• A. Obtain a prescription for pain medication.
• B. Have the client stop and lie back down in bed.
• C. Report the complaint to the healthcare provider.
• D. Instruct the client to continue getting out of bed and into a chair.

Correct answer: B

Rationale: When a client with CAD experiences chest pain, it indicates myocardial ischemia. The nurse should have the client stop the activity and lie back down in bed to reduce the heart's oxygen demand, decrease myocardial workload, and prevent further ischemia. This action helps in improving blood flow to the heart and can potentially alleviate the chest pain. Option A is incorrect as pain medication should not be the initial action for chest pain in CAD. Option C is incorrect because the nurse should first intervene directly to address the chest pain. Option D is incorrect as continuing the activity can worsen the myocardial ischemia and chest pain.

4. A hypertensive client who has been taking metoprolol (Lopressor) has been prescribed to decrease the dose of the medication. The client asks the nurse why this must be done over a period of 1 to 2 weeks. In formulating a response, the nurse incorporates the understanding that abrupt withdrawal could affect the client in which way?

• A. Result in hypoglycemia
• B. Give the client insomnia
• C. Precipitate rebound hypertension
• D. Cause enhanced side effects of other prescribed medications

Correct answer: C

Rationale: Abruptly stopping metoprolol can lead to rebound hypertension, causing a sudden increase in blood pressure due to the sudden withdrawal of the medication. Gradually tapering the dose helps the body adjust and reduces the risk of this adverse effect. Choices A, B, and D are incorrect. Stopping metoprolol suddenly is not known to result in hypoglycemia, insomnia, or enhanced side effects of other medications.

5. A client has a new prescription for atenolol. Which of the following instructions should be included?

• A. Take the medication with food.
• B. Monitor heart rate daily.
• C. Avoid eating foods high in potassium.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct answer is to monitor heart rate daily. Atenolol is a beta-blocker that can lead to bradycardia, a condition characterized by a slow heart rate. Monitoring the heart rate daily is essential to detect any abnormal changes promptly, allowing for timely medical intervention if necessary. Choice A is incorrect because atenolol can be taken with or without food. Choice C is irrelevant as atenolol does not interact with potassium-rich foods. Choice D is incorrect as atenolol is usually taken in the morning to help manage blood pressure throughout the day.

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