A nurse is caring for a client who had a stroke and has dysphagia. For which of the following complications should the nurse monitor the client?

Choice A: Topical ointment Topical ointment forms of nitroglycerin are used for their long-acting effects. The medication is absorbed slowly through the skin, providing a steady level of drug in the bloodstream. This form is not designed for rapid relief of acute angina attacks but rather for prevention.

Choice B: Sustained-release Sustained-release forms of nitroglycerin are designed to release the medication slowly over an extended period. This route is also not suitable for treating acute symptoms because it does not provide immediate relief but is used for long-term management of angina pectoris. Nitroglycerin is a medication used primarily to treat angina pectoris (chest pain) and heart failure. It works by relaxing the smooth muscles and dilating the blood vessels, which increases blood flow to the heart and decreases its workload. The route of administration can significantly affect the onset and duration of the medication’s action.

Choice C: Sublingual The sublingual route, where the medication is placed under the tongue, allows for rapid absorption into the bloodstream through the rich supply of blood vessels found in the area. This form of nitroglycerin acts quickly, usually within 1 to 3 minutes, and is the preferred choice for immediate relief of angina pain. When rapid onset is required for relief from acute angina symptoms, the sublingual route is the most appropriate choice for administering nitroglycerin. It provides quick absorption and fast action, making it an essential treatment option for patients experiencing chest pain due to angina.

Choice D: Transdermal patch Transdermal patches release nitroglycerin slowly through the skin and into the bloodstream. Like topical ointments and sustained-release forms, they are used for long-term prophylaxis of angina and not for rapid relief.

Choice A: Hypokalemia, or low potassium levels in the blood, is not typically associated with CKD. In fact, patients with advanced CKD are more likely to experience hyperkalemia, which is an elevated potassium level, due to the kidneys’ decreased ability to excrete potassium. The normal range for serum potassium is 3.5 to 5.0 mmol/L.

Choice B: Anemia is a common finding in CKD and is due to the kidneys’ reduced production of erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells. Symptoms of anemia include fatigue, weakness, and pale skin. The normal range for hemoglobin in adults is 13.8 to 17.2 grams per deciliter for men and 12.1 to 15.1 grams per deciliter for women.

Choice C: Hypertension, or high blood pressure, is both a cause and a complication of CKD. The kidneys play a crucial role in regulating blood pressure, and as their function declines, hypertension becomes more common. The normal range for blood pressure is typically considered to be 120/80 mmHg.

Choice D: Crackles in the lungs Crackles in the lungs are not a direct manifestation of CKD, but they can occur if the condition leads to fluid overload and heart failure, resulting in pulmonary edema. This is a secondary complication rather than a direct symptom of CKD.

Choice E: Lethargy and a general feeling of malaise are common in CKD due to the buildup of toxins and waste products in the blood that the kidneys can no longer effectively filter out. This can also lead to decreased mental sharpness and a reduced quality of life.

Choice F: Proteinuria, or the presence of excess protein in the urine, is a hallmark sign of CKD. It indicates damage to the kidneys’ filtering units, allowing protein that would normally be retained to leak into the urine. Persistent proteinuria is a sign of chronic kidney damage.