To evaluate the effectiveness of nitroglycerin 0.4 mg SL administered to a client diagnosed with angina pectoris, the nurse should:
Assess if the client's urine output has increased.
Ask the client if chest pain is relieved.
Take the client's blood pressure.
Ask the client to ambulate and assess for the absence of dyspnea.
The Correct Answer is B
Choice A Reason
Increased urine output is not a direct indicator of the effectiveness of nitroglycerin for angina pectoris. Nitroglycerin is a vasodilator used primarily to relieve chest pain by improving blood flow to the heart muscle, not to influence urine production.
Choice B Reason
Asking the client if their chest pain has been relieved is the most direct method of evaluating the effectiveness of nitroglycerin. Relief of chest pain indicates that the medication is working as intended, reducing the ischemia that causes angina.
Choice C Reason
While taking the client's blood pressure is important, especially since nitroglycerin can cause hypotension, it is not the primary method for evaluating the effectiveness of the medication in relieving angina. Blood pressure measurements are more of a safety check to monitor for adverse effects.
Choice D Reason
Ambulation and assessing for the absence of dyspnea can be part of an overall evaluation of the client's cardiovascular status, but they are not specific to evaluating the effectiveness of nitroglycerin for angina relief. Dyspnea may be a symptom of heart failure or other conditions, not specifically angina pectoris.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Reviewing the diet and exercise guidelines with the client is an important step, but it may not address the immediate issue of the weight loss plateau. It's essential to first understand if the client has adhered to the guidelines before reviewing them.
Choice B reason:
Asking the client about any changes in diet or exercise patterns is the first step in identifying potential causes for the weight loss plateau. Changes in lifestyle, stress levels, eating habits, or physical activity can all contribute to a halt in weight loss. Understanding these factors can help the nurse tailor further advice and support.
Choice C reason:
Recommending a further reduction in calorie intake might not be the best initial approach. It's important to ensure that the client is not already consuming too few calories, which can slow metabolism and hinder weight loss. Moreover, drastic calorie reduction can be unsustainable and lead to nutritional deficiencies.
Choice D reason:
Instructing the client to record weights weekly is a useful tool for monitoring progress, but it does not address the current issue of the weight loss plateau. It's a supportive action that should follow after understanding and addressing the reasons behind the plateau.
Correct Answer is ["A","C","D"]
Explanation
Choice A Reason:
Stopping NSAIDs is crucial for clients with PUD because NSAIDs can cause injury to the lining of the stomach or intestine, making it more vulnerable to damage from stomach acid. This can lead to the development or exacerbation of ulcers.
Choice B Reason:
Continuing aspirin may not be advisable for clients with PUD, as aspirin is an NSAID and can contribute to the development of peptic ulcers by inhibiting prostaglandin synthesis, reducing the protective mucosal layer, and increasing susceptibility to injury.
Choice C Reason:
Limiting caffeine is recommended for clients with PUD. Caffeine stimulates gastric acid secretion, which can exacerbate ulcer symptoms and impede the healing process.
Choice D Reason:
Avoiding alcohol is advised for clients with PUD. While there is mixed evidence on alcohol directly causing stomach ulcers, heavy alcohol consumption is considered a risk factor for developing stomach ulcers and can worsen the symptoms of existing ulcers.
Choice E Reason:
Eating large meals is not recommended for clients with PUD. It is better to eat smaller, more frequent meals to avoid overfilling the stomach and increasing gastric pressure, which can exacerbate symptoms.
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