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A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take?

Instruct the client to drink water.

Hold the next dose.

Initiate oxygen therapy.

Administer PRN acetaminophen.

Answer and Explanation

The Correct Answer is D

A. Drinking water is not likely to alleviate the headache caused by the nitrate.

B. Holding the next dose is not necessary unless the headache becomes severe or is associated with other symptoms.

C. Initiating oxygen therapy is unnecessary for a headache caused by nitrate use.

D. A headache is a common side effect of nitrate administration due to the vasodilation effect. Administering PRN acetaminophen can help relieve the headache.

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Correct Answer is C

Explanation

A. Blood glucose elevation is a concern for statins, but it is not a primary reason for questioning the order.

B. A history of high cholesterol is common and would not trigger concern regarding lovastatin.

C. Lovastatin can cause liver toxicity, so elevated liver enzymes are a contraindication or cause for concern when prescribing this medication. The nurse should verify this before starting the medication.

D. A history of peptic ulcers is unrelated to the use of lovastatin and would not be a concern in this case.

A. The lumps are smaller and less painful after starting oral contraceptives. B. The lumps get more painful before the clients menstrual period. C. Firm and moveable lumps are in the upper outer breast quadrants. D. An area on the breast is hot, pink, and tender to the touch.

Correct Answer is D

Explanation

A. A reduction in lump size and pain with oral contraceptives is expected and does not indicate a need to change the treatment plan.

B. Increased lump pain before menstruation is typical for fibrocystic changes and not a cause for concern.

C. Firm, movable lumps in the upper outer breast quadrants are characteristic of fibrocystic changes and do not suggest an alternative condition.

D. An area that is hot, pink, and tender indicates inflammation or possible infection (e.g., mastitis or abscess), requiring further evaluation and potentially altering the treatment plan.

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A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After reviewing the client's chart upon admission to the unit, the nurse consults the healthcare provider about a new order for lovastatin (Mevacor). What triggered the nurse's action?

Correct Answer is C

Explanation

A 36-yr-old client who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan?

Correct Answer is D

Explanation

A client with extensive electrical burn injuries is admitted to the emergency department. Which prescribed intervention should the nurse implement first?

Which assessment finding in a 36-year-old client is most indicative for further evaluation?

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