A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take?
Instruct the client to drink water.
Hold the next dose.
Initiate oxygen therapy.
Administer PRN acetaminophen.
The Correct Answer is D
A. Drinking water is not likely to alleviate the headache caused by the nitrate.
B. Holding the next dose is not necessary unless the headache becomes severe or is associated with other symptoms.
C. Initiating oxygen therapy is unnecessary for a headache caused by nitrate use.
D. A headache is a common side effect of nitrate administration due to the vasodilation effect. Administering PRN acetaminophen can help relieve the headache.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "I will make sure that my partner takes all the prescribed medication.": This is the correct answer. Expedited partner therapy involves treating the partner(s) without an initial clinical visit, so ensuring they take all prescribed medications is essential to prevent reinfection.
B. "I will have my partner take the antibiotics if any STI symptoms occur.": This is incorrect because the partner should take the antibiotics regardless of symptoms to effectively treat the infection.
C. "I will have my partner use a condom until I finish the antibiotics.": While condom use is important, it does not replace the need for the partner to receive treatment.
D. "I will tell my partner that it is important to be examined at the clinic.": Although important, expedited partner therapy aims to provide treatment without a clinic visit.
Correct Answer is A
Explanation
A. A 19-year-old client with menorrhagia who has been using superabsorbent tampons and has fever with weakness: This is the correct choice. Fever and weakness in the context of menorrhagia suggest a possible infection (e.g., toxic shock syndrome) or severe blood loss, which requires immediate evaluation and intervention.
B. A 35-year-old client with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month ago: Spotting after IUD insertion is common and does not suggest an immediate threat to the client’s health.
C. A 39-year-old client who is complaining of 4/10 pain after an abdominal hysterectomy: Mild pain after a hysterectomy is expected and not an emergency.
D. A 42-year-old client with secondary amenorrhea who says that her last menstrual cycle was 3 months ago: While secondary amenorrhea requires evaluation, it is not as urgent as a client with signs of possible infection or blood loss.
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