An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

Instruct the client that since the hematocrit remains low, the daily injections are still necessary.

Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced.

Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.

Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Answer and Explanation

The Correct Answer is D

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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Correct Answer is A

Explanation

A. Leave the patch in place and administer a PRN dose of sublingual nitroglycerin: It is appropriate to administer a PRN dose of sublingual nitroglycerin for immediate relief of acute angina while leaving the transdermal patch in place. The sublingual nitroglycerin acts quickly to relieve chest pain, while the transdermal patch provides a longer, more sustained effect.
B. Reassure the client that the patch will begin to take effect within a few minutes: The transdermal patch generally takes 30 to 60 minutes to reach therapeutic levels, which is not suitable for immediate relief of acute chest pain. Therefore, reassurance alone may not address the current symptoms effectively.
C. Withhold further doses of nitroglycerin until contacting the healthcare provider: Withholding further doses of nitroglycerin without assessing the situation can delay appropriate relief of chest pain. Immediate intervention is necessary, and it is appropriate to use sublingual nitroglycerin as needed.

D. Obtain another transdermal patch and position it on the patient's left upper chest: Applying an additional transdermal patch is not necessary and could lead to excessive nitroglycerin exposure. The current patch should be left in place, and sublingual nitroglycerin can be used for acute symptoms.

A. Chronotropic effect. B. Diuresis C. Vasodilation. D. Sympatholytic action.

Correct Answer is C

Explanation

A) Chronotropic effect: This term refers to changes in heart rate. Angiotensin II receptor antagonists like valsartan primarily affect blood pressure and vascular tone, rather than directly altering heart rate.
B) Diuresis: Diuresis involves increased urine production. Although some antihypertensives can have a diuretic effect, valsartan primarily works through mechanisms other than increasing urine output.
C) Vasodilation: Angiotensin II receptor antagonists such as valsartan work by blocking the action of angiotensin II, which leads to vasodilation. This reduction in vascular resistance helps to lower blood pressure and is the primary therapeutic effect of valsartan.
D) Sympatholytic action: This refers to the suppression of sympathetic nervous system activity. Valsartan does not primarily act through sympathetic nervous system modulation but rather through direct vasodilation by blocking angiotensin II receptors.

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Naxlex Comprehensive Predictor Exams

A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

Correct Answer is A

Explanation

The nurse is administering the angiotensin II receptor antagonist valsartan. Which physiological response causes its therapeutic effect?

Correct Answer is C

Explanation

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