A nurse on a telemetry unit receives change-of-shift report on four clients. Which of the following clients should the nurse assess first?

A client with myasthenia gravis who has bilateral ptosis and a positive edrophonium (Tensilon) test.

A client with Bell's palsy who has an order for prednisone and acyclovir.

A client with Parkinson's disease who has hypokinetic dysarthria and a lack of facial expressions.

A client with multiple sclerosis who has bladder flaccidity and is retaining urine.

Answer and Explanation

The Correct Answer is A

A.   A client with myasthenia gravis who has bilateral ptosis and a positive edrophonium test is likely experiencing a myasthenic crisis, which is a life-threatening condition that requires immediate attention. This client would be the priority because they may require rapid intervention to maintain airway and breathing.
B.   Bell's palsy is characterized by sudden onset of facial paralysis due to inflammation of the facial nerve. While Bell's palsy can be distressing for the client, it does not typically require urgent intervention unless there are complications such as corneal abrasion due to inability to close the eye.
C.   Parkinson's disease is a chronic neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability. While this client requires ongoing assessment and care, the symptoms described do not typically indicate an acute or urgent need for intervention.
D.   A client with multiple sclerosis who has bladder flaccidity and is retaining urine needs assessment and intervention to prevent complications such as urinary tract infections or renal damage. However, this is not as immediately life-threatening as a myasthenic crisis.

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Correct Answer is B

Explanation

A. Headache is a common side effect of nitroglycerin due to its vasodilatory effects, especially in the head. Most headaches associated with nitroglycerin are mild and transient. Patients are generally advised to continue using the medication as prescribed unless the headache is severe or persistent.
B. Nitroglycerin tablets are used for the immediate relief of angina symptoms. If the first tablet does not adequately relieve chest pain within 5 minutes, the patient can take a second tablet. If the pain persists after the second tablet, emergency medical attention should be sought. However, it's important to note that the maximum number of tablets that can be taken within a short period should be specified by the healthcare provider, typically 2 or 3 tablets in 15 to 30 minutes.
C. Nitroglycerin can cause orthostatic hypotension, which is a drop in blood pressure upon standing up. This can lead to dizziness or fainting. Therefore, patients should be advised to stand up slowly after taking nitroglycerin to minimize the risk of falls or injury.
D. Nitroglycerin tablets are sensitive to light, heat, and moisture, which can reduce their effectiveness over time. Therefore, it's recommended to replace nitroglycerin tablets every 3 to 6 months to ensure potency and effectiveness.

A. The client follows a strict vegetarian diet. B. The client takes rosuvastatin for hyperlipidemia. C. The client takes propranolol for hypertension. D. The client uses acetaminophen for headaches

Correct Answer is C

Explanation

A. A vegetarian diet typically does not directly contribute to bronchoconstriction. In fact, a diet rich in fruits and vegetables may provide antioxidants and anti-inflammatory compounds that can be beneficial for respiratory health. Therefore, this option is less likely to be a cause of the client's bronchoconstriction.
B. Rosuvastatin (and other statins) are generally well-tolerated, but some individuals may experience respiratory side effects, including cough or shortness of breath. However, bronchoconstriction as a direct side effect of statins is uncommon and typically not a primary concern unless there is a rare hypersensitivity reaction.
C. Propranolol is a non-selective beta-blocker that can lead to bronchoconstriction, particularly in individuals with asthma or other respiratory conditions. Beta-blockers can block beta-2 receptors in the lungs, potentially causing constriction of the airways and worsening of respiratory symptoms.
D. Acetaminophen (paracetamol) is generally considered safe and does not typically cause bronchoconstriction. It is a non-steroidal anti-inflammatory drug (NSAID) that works differently from medications like beta-blockers, which directly affect the airways.

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A nurse on a telemetry unit receives change-of-shift report on four clients. Which of the following clients should the nurse assess first?

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Naxlex Comprehensive Predictor Exams

A client has been diagnosed with chronic stable angina and has a new prescription for nitroglycerin tablets. Which statement about this medication should the nurse include in the patient education?

Correct Answer is B

Explanation

A nurse is obtaining an admission history on a client who has possible asthma with new-onset wheezing and shortness of breath. Which information may be a cause of the client's bronchoconstriction?

Correct Answer is C

Explanation

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