A nurse is reinforcing teaching with a client who has angina and a new prescription of nitroglycerin sublingual. Which of the following statements by the client indicates an understanding of the teaching?

"If my pain is not relieved in 20 minutes, I will take a second tablet."

"I will keep my tablets on a shelf in the bathroom."

"I should be sure to swallow the tablet whole."

“If my mouth is dry, I will take a sip of water before I take the tablet.”

Answer and Explanation

The Correct Answer is D

A. "If my pain is not relieved in 20 minutes, I will take a second tablet." Sublingual nitroglycerin should be taken at 5-minute intervals, up to a maximum of three doses within 15 minutes. If chest pain persists after three doses, emergency medical assistance is necessary, as this may indicate a myocardial infarction. Delaying a second dose for 20 minutes may lead to worsening of the condition and delay appropriate treatment.

B. "I will keep my tablets on a shelf in the bathroom." Nitroglycerin is highly sensitive to heat, light, and moisture, which can cause it to lose potency. Storing it in the bathroom, where temperature and humidity fluctuate, can degrade the medication. It should be kept in its original dark glass container with the lid tightly closed and stored in a cool, dry place away from moisture and heat sources.

C. "I should be sure to swallow the tablet whole." Sublingual nitroglycerin is designed to dissolve under the tongue for rapid absorption into the bloodstream. Swallowing it whole delays its effect because it would need to pass through the digestive system before being absorbed, reducing its ability to quickly relieve angina. Clients should be instructed to place the tablet under the tongue and allow it to dissolve completely without chewing or swallowing.

D. “If my mouth is dry, I will take a sip of water before I take the tablet.” A dry mouth can slow the dissolution of the sublingual tablet, delaying its absorption and effectiveness. Taking a sip of water before administration ensures the tablet dissolves properly under the tongue, allowing for rapid relief of angina symptoms. However, clients should avoid drinking excessive amounts of water that might wash the tablet down before it dissolves.

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Correct Answer is B

Explanation

A. Jaundice. Jaundice, or yellowing of the skin and eyes, is a sign of liver dysfunction and may indicate hepatotoxicity rather than an allergic reaction. Some medications can cause drug-induced liver injury (DILI), but jaundice is not a typical symptom of an immediate hypersensitivity reaction.

B. Urticaria. Urticaria (hives) is a classic allergic reaction that appears as raised, red, itchy welts on the skin. It occurs due to the release of histamine in response to an allergen, which increases capillary permeability and leads to swelling and itching. Urticaria may be accompanied by angioedema, respiratory distress, or anaphylaxis, requiring immediate intervention if severe.

C. Bradycardia. Bradycardia (slow heart rate) is not a typical manifestation of an allergic reaction. While anaphylaxis can cause hypotension and tachycardia due to systemic vasodilation, bradycardia is more commonly associated with beta-blockers, heart block, or vagal stimulation rather than an allergic response.

D. Hypertension. Allergic reactions, especially severe ones like anaphylaxis, typically cause vasodilation and hypotension, not hypertension. While stress or anxiety related to an allergic episode may lead to a temporary rise in blood pressure, persistent hypertension is not a direct sign of an allergic reaction.

A. Varenicline B. Diazepam C. Clonidine D. Methadone

Correct Answer is B

Explanation

A. Varenicline. Varenicline is used to aid smoking cessation by reducing nicotine cravings and withdrawal symptoms. It does not have a role in managing acute alcohol withdrawal and would not be effective in preventing withdrawal-related complications.

B. Diazepam. Diazepam, a benzodiazepine, is commonly used to manage acute alcohol withdrawal by preventing seizures, reducing agitation, and alleviating autonomic hyperactivity (e.g., tachycardia, hypertension). It enhances GABA activity, which helps counteract the excitatory effects of alcohol withdrawal, reducing the risk of delirium tremens (DTs).

C. Clonidine. Clonidine is an alpha-2 agonist that helps control autonomic symptoms such as elevated blood pressure and heart rate. While it may be used as an adjunct therapy, it does not prevent seizures or delirium, making it insufficient as a primary treatment for alcohol withdrawal.

D. Methadone. Methadone is used for opioid withdrawal and maintenance therapy in opioid dependence. It does not alleviate alcohol withdrawal symptoms or prevent complications such as seizures or delirium, making it inappropriate for this condition.

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A nurse is reinforcing teaching with a client who has angina and a new prescription of nitroglycerin sublingual. Which of the following statements by the client indicates an understanding of the teaching?

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