A client with stable angina secondary to ischemic heart disease receives a prescription for sublingual nitroglycerin prior to discharge from the hospital. During discharge teaching, the client assures the nurse a plan to fill the prescription via online mail order service as soon as arriving at home. How should the nurse respond?

Confirm that a family member also knows how to administer the medication.

Document the client's plans to fill the prescription on the discharge teaching plan.

Explain the importance of obtaining the medication before leaving the hospital.

Schedule a follow-up visit with the healthcare provider for one week after discharge.

Answer and Explanation

The Correct Answer is C

A. Confirm that a family member also knows how to administer the medication:
It is helpful for family members to be informed, but the priority is ensuring the client has immediate access to nitroglycerin.

B. Document the client's plans to fill the prescription on the discharge teaching plan:
Documentation is important, but it does not address the urgent need for access to medication. Relying on post-discharge mail delivery may result in a delay that compromises the client’s safety.

C. Explain the importance of obtaining the medication before leaving the hospital:
Nitroglycerin is used for the rapid relief of chest pain and must be readily available at all times. Clients should not leave the hospital without this critical rescue medication.

D. Schedule a follow-up visit with the healthcare provider for one week after discharge:
While follow-up is essential for monitoring treatment efficacy and adjustments, it does not resolve the immediate need for having nitroglycerin accessible in case of angina.

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Correct Answer is D

Explanation

A. Fever of 102.2°F (39°C): A fever may suggest an infectious process such as pneumonia but is not a hallmark of pulmonary edema. While infection can exacerbate heart failure, the presence of fever alone does not indicate pulmonary fluid accumulation.

B. Hacking, dry cough: A dry cough may be an early symptom of left-sided heart failure, but it is nonspecific and does not confirm pulmonary edema. As fluid accumulates, the cough becomes productive and is accompanied by other symptoms like dyspnea and crackles.

C. Peripheral pitting edema: Peripheral edema is more closely associated with right-sided heart failure. Although some clients with left-sided failure can develop right-sided symptoms, peripheral edema does not directly signal pulmonary congestion or edema.

D. Bilateral crackles in all lung fields: Crackles heard throughout the lung fields indicate fluid in the alveoli, a defining feature of pulmonary edema. This finding signifies worsening left-sided heart failure and impaired gas exchange, requiring prompt medical intervention.

A. Obtain hemoglobin and hematocrit levels. B. Measure and record the client's IV fluid intake. C. Compare pedal pulse volume bilaterally. D. Perform guaiac tests on the client's next stools.

Correct Answer is A

Explanation

A. Obtain hemoglobin and hematocrit levels: A PTT of 152 seconds is significantly elevated, indicating a high risk of spontaneous bleeding. Monitoring hemoglobin and hematocrit helps detect internal or occult bleeding early.

B. Measure and record the client's IV fluid intake: While maintaining hydration is important, fluid intake does not directly address the risk associated with excessive anticoagulation. It is a routine measure, not a priority in this context.

C. Compare pedal pulse volume bilaterally: Assessing pedal pulses is important for evaluating perfusion, but it does not directly relate to the current risk of bleeding from excessive anticoagulation. It would be more relevant in the initial PE assessment.

D. Perform guaiac tests on the client’s next stools: Testing for occult blood is helpful in identifying gastrointestinal bleeding. However, waiting for the next bowel movement could delay detection. Hemoglobin and hematocrit offer more immediate insight into bleeding risk.

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Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who is admitted with left-sided heart failure. Which finding indicates that the client is progressing into pulmonary edema?

Correct Answer is D

Explanation

Correct Answer is A

Explanation

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