A nurse is teaching a client who has a new prescription for nitroglycerin sublingual tablets for treating angina. Which of the following instructions should the nurse include in the teaching?
"Call 911 if pain persists 30 minutes after taking one tablet."
"Place the tablet under the tongue until dissolved."
"Store the tablets in a refrigerator in a plastic container."
"Take a tablet every 10 minutes until the pain subsides."
The Correct Answer is B
A) "Call 911 if pain persists 30 minutes after taking one tablet": This instruction is not accurate and could potentially delay appropriate medical intervention for angina. Nitroglycerin sublingual tablets are rapid-acting vasodilators used to relieve acute angina symptoms. If chest pain persists after taking one tablet, the client should take another tablet after 5 minutes. If the pain persists after a total of three tablets, the client should seek emergency medical assistance.
B) "Place the tablet under the tongue until dissolved": This instruction is correct. Nitroglycerin sublingual tablets should be placed under the tongue and allowed to dissolve completely. Sublingual administration allows for rapid absorption of the medication into the bloodstream, providing quick relief of angina symptoms.
C) "Store the tablets in a refrigerator in a plastic container": This instruction is incorrect. Nitroglycerin sublingual tablets should be stored in their original container at room temperature, away from moisture and heat. Storing them in the refrigerator could alter their effectiveness.
D) "Take a tablet every 10 minutes until the pain subsides": This instruction is incorrect and potentially dangerous. Nitroglycerin sublingual tablets should be taken as directed by the healthcare provider or based on the client's angina management plan. Typically, the client should take one tablet at the onset of angina symptoms and repeat the dose every 5 minutes if the pain persists, up to a maximum of three tablets within 15 minutes. Taking a tablet every 10 minutes without regard to symptom relief or maximum dosage limits could lead to hypotension and other adverse effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) The client has an increased creatinine level: While an increased creatinine level may indicate renal impairment, it is not specific to a vancomycin infusion reaction. Elevated creatinine levels may occur due to various factors, including underlying kidney disease or dehydration.
B) The client is experiencing hypotension: This is the correct answer. Hypotension, or low blood pressure, can be a manifestation of a vancomycin infusion reaction. Vancomycin infusion reactions may include anaphylaxis or anaphylactoid reactions, which can lead to systemic vasodilation and subsequent hypotension.
C) The client's IV site is red and edematous: Redness ’nd edema at the IV site may indicate phlebitis or infiltration, which are local complications rather than systemic reactions to vancomycin infusion.
D) The client reports ringing in their ears: Ringing in the ears, also known as tinnitus, is a potential side effect of vancomycin, particularly with high doses or prolonged use. However, it is not specific to a vancomycin infusion reaction and may occur independently of the infusion process.
Correct Answer is A
Explanation
A) Wear gloves when handling the medication: This is the correct action to take when preparing to administer a hazardous IV medication. Wearing gloves helps protect the nurse from direct contact with the medication, reducing the risk of exposure to potentially harmful substances.
B) Administer the medication in a negative pressure room: While some hazardous medications may require administration in a negative pressure room to prevent the spread of airborne contaminants, this is not a standard precaution for administering IV medications. Negative pressure rooms are typically used for airborne infection isolation rather than for medication administration.
C) Administer the medication while wearing protective footwear: While wearing appropriate footwear is important for general safety in healthcare settings, it is not specifically required for administering hazardous IV medications. Protective footwear may be necessary in certain situations, such as when handling biohazardous materials or when there is a risk of spills, but it is not directly related to IV medication administration.
D) Wear an N95 respiratory mask when administering the medication: While respiratory protection may be necessary when handling certain hazardous substances, such as those that produce airborne particles or aerosols, it is not typically required for administering IV medications. N95 masks are primarily used for respiratory protection in situations where there is a risk of inhaling airborne contaminants, such as infectious agents or hazardous chemicals.
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