A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching?
Apply a new transdermal patch when chest pain is experienced.
Apply the transdermal patch in the morning.
Apply the transdermal patch in the same location as the previous patch.
Apply a new transdermal patch once a week.
The Correct Answer is B
Choice A reason: Applying a new transdermal patch when chest pain is experienced is not a correct instruction, as it may delay the relief of the pain and increase the risk of adverse effects. Transdermal nitroglycerin is a long-acting form of nitrate that is used for the prevention of angina attacks, not for the treatment of acute episodes. The client should use a short-acting form of nitrate, such as sublingual or spray, for the immediate relief of chest pain.
Choice B reason: Applying the transdermal patch in the morning is a correct instruction, as it helps to maintain a steady level of nitrate in the blood throughout the day and prevent angina attacks. Transdermal nitroglycerin has a duration of action of about 12 to 24 hours, depending on the dose and the individual response. The client should apply the patch in the morning and remove it at night, to allow a nitrate-free interval of at least 8 hours and prevent the development of tolerance.
Choice C reason: Applying the transdermal patch in the same location as the previous patch is not a correct instruction, as it may cause skin irritation and reduce the absorption of the medication. Transdermal nitroglycerin should be applied to a clean, dry, and hairless area of the skin, preferably on the chest, upper arm, or back. The client should rotate the application sites and avoid areas that are exposed to heat, moisture, or friction.
Choice D reason: Applying a new transdermal patch once a week is not a correct instruction, as it may not provide adequate protection against angina attacks and increase the risk of rebound angina. Transdermal nitroglycerin should be applied daily, with a nitrate-free interval of at least 8 hours, to maintain a therapeutic level of nitrate in the blood and prevent the loss of efficacy. The client should follow the prescribed dosing schedule and consult the provider before making any changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Infection is the correct condition that the client is at increased risk for. Agranulocytosis is a severe decrease in the number of granulocytes, which are a type of white blood cell that fight infection. Propylthiouracil is an antithyroid drug that can cause agranulocytosis as a rare but serious side effect. The client with agranulocytosis is more susceptible to bacterial and fungal infections, and may present with fever, sore throat, mouth ulcers, and skin lesions.
Choice B reason: Excessive bleeding is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the platelets, which are the blood cells that help with clotting. Propylthiouracil does not cause bleeding disorders, although it may interact with anticoagulants and increase their effect.
Choice C reason: Hyperglycemia is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the insulin, which is the hormone that regulates blood glucose levels. Propylthiouracil does not cause hyperglycemia, although it may interfere with the metabolism of oral hypoglycemic agents and decrease their effect.
Choice D reason: Ecchymosis is not the correct condition that the client is at increased risk for. Ecchymosis is a bruise caused by bleeding under the skin. Agranulocytosis does not cause ecchymosis, as it does not affect the blood vessels or the platelets. Propylthiouracil does not cause ecchymosis, although it may increase the risk of skin rash and pruritus.
Correct Answer is B
Explanation
Choice A reason: Taking this medication with 8 ounces of water is not necessary. Sublingual nitroglycerin tablets are designed to dissolve under the tongue and be absorbed quickly into the bloodstream. Drinking water may interfere with the absorption and effectiveness of the medication.
Choice B reason: Taking one tablet at the first indication of chest pain is the correct instruction. Sublingual nitroglycerin tablets are used to relieve anginal pain by dilating the coronary arteries and improving blood flow to the heart. The client should place one tablet under the tongue as soon as chest pain occurs and wait for it to dissolve.
Choice C reason: Taking one tablet every 15 minutes during an acute attack is not the correct instruction. Sublingual nitroglycerin tablets have a short duration of action and may not provide adequate relief for a prolonged anginal attack. The client should follow the rule of three: take one tablet every 5 minutes for up to three doses. If the pain is not relieved after three doses, the client should call 911 or seek emergency medical attention.
Choice D reason: Taking this medication after each meal and at bedtime is not the correct instruction. Sublingual nitroglycerin tablets are not used for the prevention of angina. They are only used for the treatment of acute anginal episodes. Taking this medication regularly may cause tolerance and reduce its effectiveness.
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