A nurse is teaching about sublingual nitroglycerin to a client who had a myocardial infarction. Which of the following information should the nurse include?

"Avoid eating or drinking until the medication is absorbed."

"Keep the medication bottle in your pocket for easy access."

"Do not take a second dose of the medication before 15 minutes has passed."

"You can keep the medication tablets in a plastic, sorting container."

Answer and Explanation

The Correct Answer is A

Rationale:

A. "Avoid eating or drinking until the medication is absorbed." Eating or drinking can interfere with the full absorption of sublingual nitroglycerin, which needs to dissolve completely under the tongue for rapid onset. Clients should let the tablet dissolve undisturbed for optimal effectiveness.

B. "Keep the medication bottle in your pocket for easy access." Body heat and moisture can degrade nitroglycerin tablets. They should be stored in their original dark glass container with the cap tightly closed, away from heat, light, and humidity.

C. "Do not take a second dose of the medication before 15 minutes has passed." A second dose can be taken after 5 minutes if chest pain persists, and up to three doses can be taken at 5-minute intervals. Waiting 15 minutes delays needed symptom relief and increases the risk of cardiac damage.

D. "You can keep the medication tablets in a plastic, sorting container." Plastic pill organizers can expose the tablets to moisture and light, which degrades their potency. Nitroglycerin should remain in its original manufacturer-supplied glass container.

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Correct Answer is A

Explanation

Rationale:

A. Review the proposed change against current medication administration guidelines: Before implementing a new practice, the committee must ensure that the change aligns with evidence-based standards and regulatory guidelines. This review helps identify conflicts or risks and confirms that the proposal supports safe, legal, and effective care.

B. Evaluate the results of the change in medication administration practice: Evaluation should occur after the change has been implemented and sufficient data have been collected. Doing this step prematurely would mean there is no outcome data yet to assess.

C. Develop a plan to analyze the data for the new administration practice: While data analysis is crucial, it comes after implementation. Planning how to analyze data is not the immediate next step following the formulation of a proposed change.

D. Implement the proposed change in the facility's medication administration guidelines: Implementation should not occur until the proposal has been reviewed for consistency with current standards and proven to be safe and effective. Jumping to implementation could introduce risk without adequate vetting.

A. There are wide QRS complexes. B. There are no discernable P waves. C. There are constant R-R intervals. D. There are wide PR intervals.

Correct Answer is B

Explanation

Rationale:

A. There are wide QRS complexes: Wide QRS complexes are typically associated with ventricular conduction delays or ventricular arrhythmias. In atrial fibrillation, the QRS complexes are usually narrow unless there is an underlying bundle branch block or preexisting conduction defect.

B. There are no discernable P waves: In atrial fibrillation, the atria quiver rather than contract in a coordinated manner. This results in the absence of identifiable P waves on the ECG, replaced by irregular, chaotic atrial electrical activity.

C. There are constant R-R intervals: Atrial fibrillation is characterized by an irregularly irregular rhythm, meaning there is no consistent pattern to the R-R intervals. The ventricular response is unpredictable, which is a hallmark ECG finding.

D. There are wide PR intervals: PR intervals reflect atrioventricular conduction time. In atrial fibrillation, because coordinated atrial depolarization does not occur, PR intervals cannot be consistently measured, and they are not typically wide.

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A nurse is teaching about sublingual nitroglycerin to a client who had a myocardial infarction. Which of the following information should the nurse include?

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