A nurse in a provider's clinic is assessing a client who takes sublingual nitroglycerin for stable angina. The client reports getting a headache each time he takes the medication. Which of the following statements should the nurse make?

"Take only one dose of nitroglycerin to reduce the risk of getting a headache."

"There's nothing that can be done to relieve the headaches that nitroglycerin causes."

"We will ask the provider to prescribe a diﬀerent medication for you."

"Try taking a mild analgesic to relieve the headache."

Answer and Explanation

The Correct Answer is D

Nitroglycerin is a vasodilator that relaxes smooth muscle in blood vessels and reduces myocardial oxygen demand. It is used to treat and prevent angina atacks. A common side eﬀect of nitroglycerin is headache, which is caused by cerebral vasodilation. The nurse should advise the client to take a mild analgesic, such as acetaminophen, to relieve the headache. The headache usually subsides with continued use of nitroglycerin.

The other options are not correct because:

"Take only one dose of nitroglycerin to reduce the risk of getting a headache." This statement is incorrect because it may compromise the eﬀectiveness of nitroglycerin in relieving angina. The client should follow the prescribed dosage and frequency of nitroglycerin, which is usually one tablet every 5 minutes for up to three doses, as needed for chest pain.

"There's nothing that can be done to relieve the headaches that nitroglycerin causes." This statement is incorrect because it is discouraging and dismissive of the client's concern. The nurse should acknowledge the client's

discomfort and oﬀer suggestions for managing the side eﬀect, such as taking a mild analgesic or lying down in a dark room.

"We will ask the provider to prescribe a diﬀerent medication for you." This statement is incorrect because it implies that nitroglycerin is not suitable for the client and may cause unnecessary anxiety or confusion. The nurse should explain that nitroglycerin is an eﬀective and safe medication for angina and that the headache is a common and transient side eﬀect that can be managed with simple measures. The nurse should also inform the client that there are other forms of nitroglycerin, such as patches or sprays, that may have less headache-inducing eﬀects. However, changing the medication or the route of administration should be done only after consulting with the provider.

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Correct Answer is A

Explanation

The nurse should explain that cardiac enzyme studies measure the levels of certain enzymes, such as troponin, creatine kinase, and lactate dehydrogenase, that are released into the bloodstream when the heart muscle is damaged by an MI. These tests help determine the degree of damage to the heart tissues, as well as the timing and severity of the MI.

"These tests will enable the provider to determine the heart structure and mobility of the heart valves." is wrong because cardiac enzyme studies do not provide information about the heart structure and mobility of the heart valves. Other tests, such as echocardiography or cardiac catheterization, may be used for this purpose.

"Cardiac enzymes will identify the location of the MI." is wrong because cardiac enzyme studies do not indicate the specific location of the MI within the heart. Other tests, such as electrocardiography or coronary angiography, may be used for this purpose.

"Cardiac enzymes assist in diagnosing the presence of pulmonary congestion." is wrong because cardiac enzyme studies do not directly assess the presence of pulmonary congestion, which is a complication of heart failure. Other signs and symptoms, such as dyspnea, crackles, and chest x-ray findings, may be used for this purpose.

Correct Answer is ["50"]

Explanation

To calculate the gt/min, the nurse should use the following formula:

gt/min = (mL/hr x drop factor) / 60

Plugging in the given values, we get:

gt/min = (150 mL/hr x 20 gt/mL) / 60

gt/min = 3000 gt/hr / 60 gt/min = 50 gt/min

Therefore, the nurse should set the manual IV infusion to deliver 50 gt/min.

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A nurse in a provider's clinic is assessing a client who takes sublingual nitroglycerin for stable angina. The client reports getting a headache each time he takes the medication. Which of the following statements should the nurse make?

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Naxlex Comprehensive Predictor Exams

A nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzyme studies?

Correct Answer is A

Explanation

A nurse is caring for a client who is postoperative following an appendectomy and is prescribed 1 L lactated Ringer's at 150 mL/hr by continuous IV infusion for 12 hr. The drop factor of the manual IV tubing is 20 gt/mL. The nurse should set the manual IV infusion to deliver how many gt/min?

Correct Answer is ["50"]

Explanation

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