A nurse is reinforcing teaching with a client who has angina pectoris about starting therapy with nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?

"I will take the first tablet when the pain becomes severe."

"I will take no more than four tablets in 10 min."

"I will chew the tablet before swallowing."

"I will dial 911 if one tablet does not relieve my pain."

Answer and Explanation

The Correct Answer is D

A) "I will take the first tablet when the pain becomes severe.": This statement is incorrect because nitroglycerin should be taken at the onset of chest pain, not when it becomes severe. Early administration can help prevent the pain from worsening and reduce the risk of a heart attack. Waiting until the pain is severe may delay relief and increase the risk of serious complications.

B) "I will take no more than four tablets in 10 min.": This is incorrect as the standard protocol for nitroglycerin sublingual tablets typically involves taking one tablet every 5 minutes, up to three doses in 15 minutes, if needed. Taking four tablets in 10 minutes exceeds the recommended dosage and could lead to severe hypotension, dizziness, and fainting. It’s crucial to follow the prescribed limits to avoid these adverse effects.

C) "I will chew the tablet before swallowing.": This is incorrect because nitroglycerin sublingual tablets are designed to dissolve under the tongue for rapid absorption into the bloodstream. Chewing or swallowing the tablet would decrease its effectiveness and delay pain relief. The sublingual route allows the medication to bypass the digestive system and work quickly to relieve chest pain.

D) "I will dial 911 if one tablet does not relieve my pain.": This is the correct response. If chest pain is not relieved within 5 minutes after taking the first nitroglycerin tablet, it may indicate a more serious condition such as a heart attack. The client should call 911 to seek immediate medical assistance. Prompt action is critical in managing potential cardiac events and improving outcomes for the client.

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Correct Answer is D

Explanation

A) Shave excess hair from skin before applying a nitroglycerin patch:
Shaving excess hair is not necessary for applying a nitroglycerin patch. The patch should be applied to a clean, dry, and hairless area of skin to ensure proper adhesion and absorption of medication.

B) Keep a nitroglycerin patch in place 24 hr. per day:
Nitroglycerin patches are typically worn for a specified period (usually 12 to 14 hours) and then removed for a "patch-free" interval to prevent tolerance development. Continuous use can lead to tolerance, reducing the effectiveness of the medication.

C) Put a second patch in place if angina pain occurs:
Applying a second nitroglycerin patch is not recommended without consulting a healthcare provider. Increasing the dosage of nitroglycerin without proper medical advice can lead to hypotension and other adverse effects. The client should follow the prescribed regimen and seek medical assistance if angina pain is not relieved.

D) Fold used patch with medication area to the inside and discard in a closed receptacle:
This is the correct instruction. Used nitroglycerin patches should be folded with the adhesive side together (medication area inside) to prevent accidental exposure and disposed of in a closed receptacle. This helps ensure safe disposal and prevents unintentional contact with the medication by others.

A. Peripheral edema B. Diarrhea C. Dry mouth D. Headache

Correct Answer is B

Explanation

A) Peripheral edema:
Peripheral edema is not a common adverse effect of lactulose. Lactulose is typically used to treat constipation by increasing the water content and softening stools.

B) Diarrhea:
Diarrhea is a common adverse effect of lactulose due to its osmotic effect in the colon, which increases water retention and softens stools. Monitoring for diarrhea is important to prevent dehydration and electrolyte imbalances.

C) Dry mouth:
Dry mouth is not a common adverse effect of lactulose. Lactulose works by drawing water into the colon to soften stools, which does not typically affect salivary gland function or cause dry mouth.

D) Headache:
Headache is not a common adverse effect of lactulose. While rare, excessive diarrhea or dehydration resulting from lactulose use could potentially lead to headache, but it is not a direct effect of the medication itself.

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A nurse is reinforcing teaching with a client who has angina pectoris about starting therapy with nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?

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