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.

A) Activated partial thromboplastin time (aPTT): This test is primarily used to monitor the effectiveness of heparin therapy, not warfarin. While aPTT measures the intrinsic pathway of coagulation, it is not the standard test for monitoring warfarin, which affects the extrinsic pathway and vitamin K-dependent clotting factors.

B) Platelet count: This test measures the number of platelets in the blood and is used to diagnose and monitor conditions related to platelet function, such as thrombocytopenia. However, it does not provide information about the anticoagulant effect of warfarin, which works by inhibiting vitamin K-dependent clotting factors.

C) White blood cell count (WBC): This test measures the number of white blood cells in the blood and is used to diagnose and monitor infections and inflammatory conditions. It is not relevant for monitoring the anticoagulant effect of warfarin, as WBC levels are not influenced by warfarin therapy.

D) Prothrombin time (PT): This is the correct test to monitor the effect of warfarin therapy. PT measures the extrinsic pathway of coagulation, which is directly influenced by warfarin. The international normalized ratio (INR) is derived from the PT and is used to standardize PT results, making it the most reliable indicator of warfarin’s anticoagulant effect. Regular monitoring of PT/INR helps ensure therapeutic levels are maintained while minimizing the risk of bleeding complications.

A) BP of 132/82 mm Hg: This blood pressure reading is within the normal range for most adults and does not typically indicate a need to withhold digoxin or report to the provider. Digoxin's primary concerns are related to heart rate and electrolyte levels rather than blood pressure.

B) Heart rate of 66/min: A heart rate of 66 beats per minute is within the normal range for adults. While digoxin is used to manage heart rate, particularly in atrial fibrillation, this heart rate does not indicate an immediate need to report to the provider or withhold the medication.

C) Digoxin level of 1.2 ng/mL: This digoxin level falls within the therapeutic range, which is typically 0.8 to 2.0 ng/mL for most patients. Therefore, this finding does not indicate digoxin toxicity or a need to report to the provider.

D) Potassium level of 3.0 mEq/L: A potassium level of 3.0 mEq/L is below the normal range (3.5-5.0 mEq/L) and indicates hypokalemia. Hypokalemia can increase the risk of digoxin toxicity, as low potassium levels can enhance digoxin's effects on the heart. Therefore, this finding is significant and should be reported to the provider to prevent potential adverse effects and complications.

A) "I might not get relief from my pain for 3 to 4 weeks.": This statement is correct because nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen can take several weeks to achieve their full therapeutic effect, particularly in chronic conditions like rheumatoid arthritis.

B) "I can take these pills with my meals.": Taking naproxen with meals is appropriate and helps to minimize gastrointestinal irritation, which is a common side effect of NSAIDs. Therefore, this statement does not indicate a need for further teaching.

C) "I am taking this type of medication so it dissolves in my intestine, not my stomach.": This is correct as enteric-coated medications are designed to pass through the stomach intact and dissolve in the intestines to reduce gastrointestinal side effects.

D) "It's okay to crush a tablet as long as I make sure it dissolves completely in water before swallowing it.": This statement indicates a need for further teaching. Enteric-coated tablets should not be crushed or chewed because crushing them destroys the coating designed to protect the stomach from irritation and the drug from stomach acid, potentially leading to increased side effects and reduced effectiveness.

A) "Heparin enhances the effects of the warfarin.": This statement is incorrect. Heparin and warfarin work through different mechanisms. Heparin acts quickly by inhibiting clot formation through antithrombin, while warfarin acts slower by inhibiting vitamin K-dependent clotting factors. They do not directly enhance each other's effects.

B) "Both heparin and warfarin work together to dissolve the clots.": This is inaccurate. Neither heparin nor warfarin dissolve existing clots; they prevent new clots from forming and existing clots from growing. The body's natural processes will eventually dissolve the clot.

C) "Heparin will be continued until the warfarin reaches a therapeutic level!": This is correct. Heparin is used initially because it acts quickly. Warfarin takes several days to reach therapeutic levels. Overlapping the two ensures continuous anticoagulation until warfarin is effective.

D) "I will ask the charge nurse to call your provider and get an explanation.": While involving the provider for further explanation can be helpful, it does not directly answer the client’s question. Providing accurate information about the overlapping use of heparin and warfarin is more appropriate in this context.

A) "I take my alendronate at the same day every week with an 8-ounce glass of milk":
Taking alendronate with a full glass of plain water, not milk or any other beverage, is recommended to optimize absorption and minimize the risk of esophageal irritation. Using milk may interfere with the absorption of the medication.

B) "I sit up and read the morning paper after taking my alendronate,":
While it's important to remain upright (sitting or standing) for at least 30 minutes after taking alendronate to prevent esophageal irritation and optimize absorption, reading the morning paper doesn't necessarily ensure the client remains in an upright position. This statement indicates a need for further instruction regarding the importance of post-dose positioning.

C) "I will need to have a bone density test occasionally while taking this medication":
Monitoring bone density periodically is recommended while on alendronate to assess treatment effectiveness and bone health status. This statement shows understanding of the need for ongoing monitoring and does not require further instruction.

D) "I take my other pills at least 30 min after my alendronate,":
Taking other medications at least 30 minutes after alendronate helps to avoid interactions that may reduce its effectiveness. This statement demonstrates correct timing and understanding of medication administration instructions.

A) "Apply the ointment in a thin line into the conjunctival sac":
This instruction is correct for applying ophthalmic ointments. Placing the ointment in a thin line along the conjunctival sac ensures proper distribution and contact with the affected area.

B) "Keep your eye open for 30 sec after instilling the ointment":
Keeping the eye open for a brief period after instillation helps the ointment spread across the eye surface. This statement indicates understanding of the proper technique for applying ophthalmic ointments and does not require further instruction.

C) "Use a sterile glove and applicator to apply the antibiotic ointment":
Using a sterile glove and applicator ensures that the application is done in a sterile manner, reducing the risk of introducing further infection. This statement indicates a need for further instruction, as ophthalmic ointments are typically applied using clean hands or disposable, sterile applicators rather than sterile gloves.

D) "Always wipe from the outer to the inner canthus when wiping away secretions":
Wiping from the outer to the inner canthus helps prevent contamination of the unaffected eye. This statement demonstrates understanding of proper eye care techniques and does not require further instruction.

A) Pantoprazole:
Pantoprazole is a proton pump inhibitor used to reduce stomach acid. It does not typically require withholding before radiological studies with IV contrast dye.

B) Simvastatin:
Simvastatin, a statin medication used to lower cholesterol, does not need to be withheld before radiological studies with IV contrast dye.

C) Valsartan:
Valsartan, an angiotensin II receptor blocker used for hypertension, does not typically need to be withheld before radiological studies with IV contrast dye.

D) Metformin:
Metformin, an oral antidiabetic medication, should be withheld before radiological studies with IV contrast dye. There is a risk of lactic acidosis when metformin interacts with IV contrast dye, particularly in clients with impaired renal function.

A) "This medication prevents gastric acid secretion in the stomach":
Sucralfate does not affect gastric acid secretion. It works by forming a protective barrier over ulcers, adhering to the ulcer surface and shielding it from gastric acid and other digestive enzymes. This mechanism helps to promote healing of duodenal ulcers by providing a protective environment for the ulcer to heal without exposure to gastric acid.

B) "This medication kills the bacteria which cause ulcers":
Sucralfate does not possess antibacterial properties and does not target bacteria like Helicobacter pylori, which can cause ulcers. Its action is focused on providing a physical barrier to protect the ulcer from further damage.

C) "This medication neutralizes gastric acid after it is secreted":
Neutralizing gastric acid is the role of antacids, not sucralfate. Sucralfate acts by adhering to the ulcer site and forming a protective layer, which is distinct from the mechanism of neutralizing acid after secretion.

D) "This medication adheres to the ulcer and protects it from gastric acid":
Sucralfate forms a protective barrier over ulcers by adhering to the ulcer surface. This adherence helps to shield the ulcer from gastric acid and other digestive juices, promoting healing by creating an environment conducive to tissue repair.

A) Ask the client to rate her pain on a scale from 0 to 10:
Assessing the client's pain intensity is the first essential step in managing postoperative pain. Understanding the severity of pain will guide the nurse in determining the appropriate intervention and whether immediate pain relief measures or further assessment are needed.

B) Reposition the client and offer her a back rub:
Repositioning and providing comfort measures like a back rub can help alleviate discomfort, but assessing the pain level first is crucial to prioritize interventions effectively.

C) Determine the time the client last received pain medication:
Knowing the timing of the last pain medication dose is important but assessing current pain intensity takes precedence to determine if the client needs immediate pain relief.

D) Measure the client's vital signs, including temperature:
While vital signs are important for overall assessment, addressing pain management and comfort should be the initial focus after the client reports incisional pain postoperatively.