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 D
Explanation
Choice A reason: Blurred vision is not a common or serious side effect of simvastatin, as it does not affect the eyes or the vision. Blurred vision may be caused by other factors, such as diabetes, hypertension, or eye disorders.
Choice B reason: Orthostatic hypotension is not a common or serious side effect of simvastatin, as it does not affect the blood pressure or the vascular tone. Orthostatic hypotension may be caused by other factors, such as dehydration, anemia, or medication interactions.
Choice C reason: Urinary retention is not a common or serious side effect of simvastatin, as it does not affect the urinary tract or the bladder function. Urinary retention may be caused by other factors, such as prostate enlargement, infection, or nerve damage.
Choice D reason: Muscle weakness is a common and serious side effect of simvastatin, as it can indicate muscle damage or rhabdomyolysis. Rhabdomyolysis is a life-threatening condition that causes the breakdown of muscle tissue and the release of myoglobin into the bloodstream, which can lead to kidney failure. Muscle weakness may be accompanied by muscle pain, tenderness, or dark urine. The nurse should monitor the client's creatine kinase (CK) levels and report any signs of muscle damage to the provider.
Correct Answer is D
Explanation
Choice A reason: The extra letters after the name of the medication do not mean it is a stronger dose, but that it is a combination of two different medications. Metoprolol is a beta-blocker that lowers blood pressure and heart rate, while hydrochlorothiazide is a diuretic that reduces fluid retention and blood volume. The combination of these two medications may have a synergistic effect and lower blood pressure more effectively than either one alone.
Choice B reason: The client will have to do some things differently because it is not the same medication, but a combination of two medications. The client will have to monitor their blood pressure, weight, fluid intake, and electrolyte levels more closely, as the addition of hydrochlorothiazide may increase the risk of dehydration, hypotension, and hypokalemia. The client will also have to avoid alcohol, salt, and potassium supplements, as they may interact with the medication and affect its efficacy or safety.
Choice C reason: The client will still have to diet to lose weight, as the medication does not cause weight loss, but may cause weight gain due to fluid retention. The client will have to follow a healthy diet that is low in sodium, fat, and cholesterol, as these may worsen hypertension and increase the risk of cardiovascular complications. The client will also have to exercise regularly, as this may help lower blood pressure and improve overall health.
Choice D reason: The client may experience fewer side effects with the new medication, as the combination of metoprolol and hydrochlorothiazide may lower the dose and frequency of each medication, and reduce the adverse effects of each one. For example, metoprolol may cause fatigue, dizziness, or bradycardia, while hydrochlorothiazide may cause dry mouth, headache, or gout. The combination of these two medications may balance out these effects and improve the client's tolerance and compliance.
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