A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing “heartburn.” How should the nurse respond?

Ask the client to describe how she takes the medication.

Suggest use of an antacid two hours after the medication.

Remind the client to take the medication with plenty of water.

Advise the client to go to the nearest emergency department.

Answer and Explanation

The Correct Answer is A

A) Asking the client to describe how she takes the medication is the most appropriate initial response by the nurse. “Heartburn” reported after taking risedronate raises concerns about potential esophageal irritation or gastroesophageal reflux disease (GERD) exacerbation. Understanding the client’s administration technique (e.g., whether she takes the medication with a full glass of water and remains upright for at least 30 minutes afterward) can help identify potential causes of the reported symptoms.

B) While suggesting the use of an antacid two hours after the medication may provide symptomatic relief, it does not address the underlying issue of potential esophageal irritation or GERD exacerbation related to risedronate administration. Moreover, if the client’s symptoms are due to esophageal irritation, using an antacid may mask the symptoms without addressing the cause.

C) Reminding the client to take the medication with plenty of water is a standard recommendation for bisphosphonate administration to minimize the risk of esophageal irritation and ensure proper drug absorption. However, since the client is already experiencing “heartburn,” further assessment of the client’s medication administration technique is warranted before providing this reminder.

D) Advising the client to go to the nearest emergency department is not appropriate at this stage, as the reported symptom of “heartburn” does not suggest an immediate life-threatening emergency. However, if the client experiences severe chest pain, difficulty swallowing, or signs of a severe allergic reaction (e.g., swelling of the face or throat, difficulty breathing), emergency medical attention would be necessary.

Therefore, the nurse should first assess the client’s medication administration technique to determine if improper administration may be contributing to the reported symptoms. Based on this assessment, appropriate interventions can be provided to address potential esophageal irritation or GERD exacerbation.

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Correct Answer is C

Explanation

A) Applying another transdermal patch is not recommended without healthcare provider approval. Doubling the dose of nitroglycerin could increase the risk of hypotension and other adverse effects.

B) Withholding further doses of nitroglycerin without healthcare provider guidance may lead to inadequate control of angina symptoms. However, in this scenario, the client has already received a dose of transdermal nitroglycerin, so withholding further doses may not be appropriate if the client’s symptoms persist.

C) Leaving the patch in place and administering a sublingual dose of nitroglycerin is the correct action in this situation. Sublingual nitroglycerin provides rapid relief of angina symptoms by dilating blood vessels and improving myocardial oxygen supply. The transdermal patch may not have reached therapeutic levels yet, but the sublingual form can provide more immediate relief.

D) While it’s important to reassure the client, especially during an episode of chest pain, relying solely on the transdermal patch to take effect may not provide timely relief. Administering sublingual nitroglycerin allows for faster absorption and symptom relief.

A. Sensitivity to the sun can develop. B. Hard candy can be used for a dry mouth. C. Insomnia may occur while taking the medication. D. Another form of contraception is not needed.

Correct Answer is D

Explanation

A) Sensitivity to the sun can develop: St. John's wo’t can increase photosensitivity, making the skin more prone to sunburn. Therefore, clients should be advised to use sunscreen and protective clothing when exposed to sunlight.

B) Hard candy can be used for a dry mouth: Dry mouth is a common side effect of St. John's wo’t. Suggesting the use of hard candy can help alleviate the discomfort associated with dry mouth by stimulating saliva production.

C) Insomnia may occur while taking the medication: St. John's wo’t may cause insomnia or exacerbate existing sleep disturbances. Clients should be informed about this potential side effect so they can monitor their sleep patterns and seek appropriate management if needed.

D) Another form of contraception is not needed: This statement requires further instruction. St. John's wo’t can decrease the effectiveness of hormonal contraceptives, including birth control pills, patches, and rings. Therefore, clients using hormonal contraceptives should be advised to use additional or alternative methods of contraception to prevent unintended pregnancy.

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A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing “heartburn.” How should the nurse respond?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

Correct Answer is C

Explanation

A female client with mild depression reports to the nurse of recently starting St. John's wo’t. Which information provided by the client requires further instruction?

Correct Answer is D

Explanation

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