When should the nurse reassess a client after administering 0.4 mg nitroglycerin sublingual to a client with chest pain?

30 minutes

5 minutes

1 hour

15 minutes

Answer and Explanation

The Correct Answer is B

Choice A reason: This is incorrect because 30 minutes is too long to wait for reassessing a client with chest pain. Nitroglycerin has a rapid onset of action and should relieve chest pain within 5 minutes. If not, the client may need another dose or emergency care.

Choice B reason: This is correct because 5 minutes is the appropriate time to reassess a client after administering nitroglycerin sublingual. The nurse should check the client's blood pressure, heart rate, and pain level. If the pain persists, the nurse should follow the protocol for giving another dose or calling for help.

Choice C reason: This is incorrect because 1 hour is too long to wait for reassessing a client with chest pain. Nitroglycerin has a short duration of action and may need to be repeated every 5 minutes for up to 3 doses. Waiting for an hour may put the client at risk of worsening cardiac ischemia or infarction.

Choice D reason: This is incorrect because 15 minutes is too long to wait for reassessing a client with chest pain. Nitroglycerin should have an effect within 5 minutes. If the pain is not relieved by then, the client may need another dose or emergency care.

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Free Nursing Study Resources

Correct Answer is ["150"]

Explanation

To calculate the IV pump rate for the 0.9% sodium chloride 1,200 mL IV to infuse over 8 hours, we can use the following formula:

IV pump rate (mL/hr) = Total volume (mL) / Time (hr)

Using the given values:

Total volume = 1,200 mL

Time = 8 hours

Plugging these values into the formula:

IV pump rate = 1,200 mL / 8 hr

IV pump rate = 150 mL/hr

So, the nurse should set the IV pump to deliver 150 mL/hr to infuse the 1,200 mL of 0.9% sodium chloride over 8 hours.

A. Atenolol B. Captopril C. Warfarin D. Glipizide

Correct Answer is A

Explanation

Choice A reason: Atenolol is a beta blocker that lowers blood pressure and heart rate. The nurse should hold atenolol for this client because the client's heart rate is already low (52 beats per minute), and giving atenolol could cause bradycardia (slow heart rate), which can lead to dizziness, fainting, or heart failure. The nurse should notify the provider and monitor the client's vital signs and cardiac rhythm.

Choice B reason: Captopril is an ACE inhibitor that lowers blood pressure and prevents kidney damage. The nurse should not hold captopril for this client because the client's blood pressure is still high (138/90 mmHg), and captopril could help lower it to the target range. The nurse should administer captopril as prescribed and monitor the client's blood pressure and renal function.

Choice C reason: Warfarin is an anticoagulant that prevents blood clots and reduces the risk of stroke. The nurse should not hold warfarin for this client because the client's INR (a measure of blood clotting time) is within the therapeutic range (2.0 to 3.0), and warfarin could help prevent post-operative complications such as deep vein thrombosis or pulmonary embolism. The nurse should administer warfarin as prescribed and monitor the client's INR and bleeding signs.

Choice D reason: Glipizide is not a medication for this client. Glipizide is an oral hypoglycemic agent that lowers blood sugar levels in people with diabetes. This client does not have diabetes and does not need glipizide. The nurse should check the medication order and the client's medical history and clarify any discrepancies with the provider.

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When should the nurse reassess a client after administering 0.4 mg nitroglycerin sublingual to a client with chest pain?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer 0.9% sodium chloride 1,200 mL IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["150"]

Explanation

Correct Answer is A

Explanation

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