A nurse is teaching a client about self-administration of sublingual nitroglycerin. Which of the following statements should the nurse include?

"You should take a dose every night at bedtime."

“You should take this medication with food."

"You may repeat a dose after five minutes."

“You may crush this medication if needed"

Answer and Explanation

The Correct Answer is C

A. "You should take a dose every night at bedtime." Sublingual nitroglycerin is not taken on a routine schedule like bedtime. It is used as needed at the onset of chest pain or before activities that might trigger angina, not as a preventive nightly dose.
B. “You should take this medication with food." Sublingual nitroglycerin is placed under the tongue and absorbed directly into the bloodstream, bypassing the gastrointestinal system. It does not require administration with food.
C. "You may repeat a dose after five minutes." If chest pain persists after the first dose, the client may take one tablet every 5 minutes, up to a total of three doses within 15 minutes. If the pain continues after the third dose, emergency services should be contacted.
D. “You may crush this medication if needed." Sublingual tablets should never be crushed or swallowed, as this would prevent proper absorption through the oral mucosa and reduce the medication’s effectiveness in relieving acute chest pain.

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Correct Answer is B

Explanation

A. "My home has running water and electricity." This statement suggests adequate access to basic utilities, which supports hygiene and reduces risk for illness. It does not indicate a health risk.
B. "I eat vegetables directly from the field where I work." This poses a significant health risk due to potential pesticide exposure and contamination with harmful chemicals or microbes. Produce should be properly washed before consumption to reduce the risk of illness or poisoning.
C. "I wear a hat and long sleeves while I am working." This is a protective behavior, helping to reduce sun exposure, skin damage, and pesticide contact, and is not a health risk.
D. "I am currently sharing my home with two roommates." While crowded living conditions can pose some risk, this alone does not indicate a major health concern, especially if basic sanitation and ventilation are adequate.

A. Vital signs B. Prescribed diet C. Skin appearance D. Blood glucose level E. WBC count

Correct Answer is ["A","C","D"]

Explanation

A. Vital signs. The client has a significantly elevated heart rate (110/min) and elevated blood pressure (178/82 mm Hg), both of which can be associated with autonomic responses in dumping syndrome. The dizziness and desire to lie down after eating are also classic symptoms. These signs reflect the body’s reaction to rapid gastric emptying and fluid shifts.
B. Prescribed diet. While a bland, soft diet is generally safe post-gastrectomy, it may not prevent dumping syndrome unless it includes specific modifications like low carbohydrate intake and small, frequent meals. However, this option alone does not directly indicate dumping syndrome.
C. Skin appearance. The client is noted to be diaphoretic and pale, which are common symptoms of dumping syndrome due to the vasomotor response and hypoglycemia that can follow rapid gastric emptying.
D. Blood glucose level. The client's fasting blood glucose dropped to 65 mg/dL, which is below the normal range. Hypoglycemia is a hallmark of late dumping syndrome, resulting from excessive insulin release after rapid carbohydrate absorption in the small intestine.
E. WBC count. The WBC count is within normal range (9,000/mm³) and does not indicate dumping syndrome or an infectious process. It is not relevant in this context.

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A nurse is teaching a client about self-administration of sublingual nitroglycerin. Which of the following statements should the nurse include?

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Naxlex Comprehensive Predictor Exams

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