A patient asks how to apply transdermal nitroglycerin.
What is the nurse's best response?
"Always apply the transdermal patch over the area of your chest where your heart is.”.
"Keep the previous patch on for 1 full day so you always have two patches on at a time.”.
"Apply the patch to hairless areas of the body.”.
"First apply petroleum jelly to your body; then apply the transdermal patch.”.
The Correct Answer is C
Choice A rationale
While the chest is a common site for patch application, it is not mandatory to apply the patch directly over the heart. The patch can be applied to any hairless area of the body to allow for optimal absorption of the medication through the skin.
Choice B rationale
Transdermal nitroglycerin patches are designed to provide a continuous, sustained release of the medication. Applying two patches at a time can lead to an overdose, resulting in severe hypotension, headache, and dizziness. Patients should be instructed to apply a new patch each day and remove the old one.
Choice C rationale
Hair on the skin can interfere with the adherence of the patch and the absorption of the medication. Applying the patch to a hairless area ensures that the medication is in direct contact with the skin, allowing for proper transdermal delivery and therapeutic effect.
Choice D rationale
Applying petroleum jelly to the skin before applying a transdermal patch can create a barrier that prevents the medication from being absorbed. This would render the patch ineffective. The skin should be clean, dry, and free of any lotions or creams before patch application.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Beta-blockers do not cause vasodilation of the coronary arteries. In some cases, non-selective beta-blockers may even cause unopposed alpha-1 receptor stimulation, leading to vasoconstriction. Their primary benefit post-MI is not related to vasodilation but to their effects on cardiac work.
Choice B rationale
Beta-blockers decrease the force of cardiac contraction (negative inotropic effect) rather than increasing it. This reduction in contractility, along with a decreased heart rate, reduces the heart's workload and oxygen demand, which is beneficial after a myocardial infarction.
Choice C rationale
Beta-blockers slow the heart rate (negative chronotropic effect) by blocking beta-1 receptors in the sinoatrial (SA) node. This action reduces myocardial oxygen demand, decreases the workload on the heart, and prolongs diastole, allowing for improved coronary artery filling. This is the main benefit for a post-MI patient.
Choice D rationale
While beta-blockers are used to treat hypertension and can help maintain blood pressure, the primary benefit for a post-MI patient is the reduction of myocardial oxygen demand by slowing the heart rate and decreasing contractility. This action helps to prevent further damage to the heart muscle.
Correct Answer is C
Explanation
Choice A rationale
A heart rate of 64 beats/min is within the normal range for an adult (60-100 beats/min) and is not a cause for concern. Patients taking beta-blockers often have a lower resting heart rate due to the medication's effect, and this value would typically be considered a therapeutic response.
Choice B rationale
Beta-blocking drugs are generally contraindicated in patients with asthma because they can cause bronchospasm by blocking beta-2 receptors in the lungs. This can worsen asthmatic symptoms and lead to respiratory distress, so these medications are not safe for this patient population.
Choice C rationale
A weight gain of 2 lb in 24 hours or 5 lb in 1 week may indicate fluid retention, a sign of worsening heart failure. Patients with angina may also have underlying heart failure, and beta-blockers can sometimes worsen this condition. It is important to monitor for signs of fluid overload.
Choice D rationale
Grapefruit juice is known to interact with certain medications by inhibiting the cytochrome P450 enzymes, leading to increased drug levels. However, it does not have a significant interaction with most beta-blocking drugs and therefore does not need to be avoided.
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