A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?

Administer aspirin.

Measure blood pressure.

Administer nitroglycerin.

Initiate IV access.

Answer and Explanation

The Correct Answer is C

Choice A reason: Administering aspirin is one of the first interventions for a client experiencing acute angina because aspirin has antiplatelet properties that help prevent blood clots, which can reduce the risk of a heart attack.

Choice B reason: Measuring blood pressure is important but not the first action to take. It provides valuable information about the cardiovascular status of the client and can influence further treatment decisions.

Choice C reason: Administering nitroglycerin is a priority action for acute angina as it helps to dilate the coronary arteries and relieve chest pain. However, it is typically administered after aspirin unless contraindicated.

Choice D reason: Initiating IV access is an important step in the management of acute angina, as it allows for the administration of medications and fluids if needed. However, it is not the first action to take during an acute angina episode.

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Correct Answer is C

Explanation

Choice A reason: A respiratory rate of 24/min is slightly higher than the normal range (12-20 breaths per minute) and does not necessarily indicate the effectiveness of furosemide in treating pulmonary edema.

Choice B reason: Adventitious breath sounds, such as crackles or wheezes, are often present in pulmonary edema and would not indicate that the furosemide is effective. The resolution of these sounds would be a better indicator of improvement.

Choice C reason: Weight loss of 1.8 kg (4 lb) in the past 24 hours likely indicates a reduction in fluid retention, which is a desired effect of furosemide in the treatment of pulmonary edema. This diuretic effect reduces the fluid overload, thereby improving the symptoms of pulmonary edema.

Choice D reason: An elevation in blood pressure is not an expected outcome of effective furosemide therapy for pulmonary edema. Furosemide is a diuretic and would more likely lead to a reduction in blood pressure due to fluid loss.

A. Glycosylated hemoglobin level B. Postprandial blood glucose level C. Fasting blood glucose level D. Oral glucose tolerance test results

Correct Answer is A

Explanation

Choice A reason: Glycosylated hemoglobin, also known as hemoglobin A1C, reflects the average blood glucose levels over the past two to three months. It is a crucial indicator of long-term glycemic control in individuals with diabetes. The American Diabetes Association recommends that the A1C level be checked at least two times a year in patients who are meeting treatment goals and have stable glycemic control. An A1C level below 7% is generally considered good control, and achieving this target can reduce microvascular complications of diabetes.

Choice B reason: Postprandial blood glucose levels indicate the amount of glucose in the blood after a meal. While it's an important measure, it reflects only the immediate response to food intake and does not provide information about long-term glycemic control.

Choice C reason: Fasting blood glucose levels measure the amount of glucose in the blood after an overnight fast. This test is used to detect diabetes or prediabetes but is less effective than the A1C test for monitoring long-term glycemic control.

Choice D reason: The oral glucose tolerance test (OGTT) measures blood glucose levels before and two hours after consuming a glucose-rich drink. This test is primarily used for diagnosing diabetes and gestational diabetes, not for long-term monitoring.

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A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which of the following assessment findings indicates to the nurse that the medication is effective?

Correct Answer is C

Explanation

A nurse is caring for a client who has diabetes mellitus and has been following a treatment plan for 3 months. Which of the following laboratory results should the nurse monitor to determine long-term glycemic control?

Correct Answer is A

Explanation

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