Nokea
A patient will be receiving metoprolol 5 mg IV push. The medication is available in a strength of 1 mg/mL. Identify how much medication will the nurse draw up for each dose.
Correct Answer: 5 mL
Rationale: To calculate: 1 mg/1 mL = 5 mg/x mL. Cross-multiply: (1 * x) = (1 * 5); x = 5 mL.
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A calcium channel blocker is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct?
- A. Chew the tablet for faster release of the medication.
- B. To increase the effect of the drug, take it with grapefruit juice.
- C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
- D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
Correct Answer: D
Rationale: Calcium channel blockers (CCBs) can cause constipation, which can be mitigated by a high-fiber diet and fluids. Chewing tablets, taking with grapefruit juice (which increases drug levels), or abrupt discontinuation are incorrect and unsafe.
When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?
- A. To treat acute chest pain
- B. To relieve shortness of breath
- C. To prevent the occurrence of angina
- D. To keep the heart rate from rising too high during exercise
Correct Answer: C
Rationale: Transdermal nitroglycerin patches are used for long-term prophylaxis to prevent angina, not for acute chest pain, shortness of breath, or heart rate control during exercise.
A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?
- A. Take up to 5 doses at 15-minute intervals for an angina attack.
- B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
- C. If the chest pain is not relieved after one tablet, call 911 immediately.
- D. Wait 1 minute between doses of sublingual tablets, up to 3 doses.
Correct Answer: C
Rationale: Current guidelines advise calling 911 if chest pain persists 5 minutes after one sublingual nitroglycerin tablet, as it may indicate a myocardial infarction. Additional tablets can be taken every 5 minutes up to three total, and tablets should dissolve under the tongue, not be chewed.
The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, 'What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you.' Which actions by the patient are appropriate in this situation? (Select all that apply.)
- A. Stop the activity, and lie down or sit down.
- B. Call 911 immediately.
- C. Call 911 if the pain is not relieved after taking one sublingual tablet.
- D. Call 911 if the pain is not relieved after taking three sublingual tablets in 30 minutes.
- E. Place a tablet under the tongue.
- F. Place a tablet in the space between the gum and cheek.
- G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.
Correct Answer: A,C,E,G
Rationale: Appropriate actions include stopping activity, sitting or lying down, placing a sublingual tablet under the tongue, calling 911 if pain persists after one tablet, and taking additional tablets every 5 minutes up to three total. The buccal route (gum and cheek) is incorrect, and waiting 30 minutes for three tablets is too long.
When the nurse is administering topical nitroglycerin ointment, which technique is correct?
- A. Apply the ointment on the skin on the forearm.
- B. Apply the ointment only in the case of a mild angina episode.
- C. Remove the old ointment before new ointment is applied.
- D. Massage the ointment gently into the skin, and then cover the area with plastic wrap.
Correct Answer: C
Rationale: Removing old nitroglycerin ointment before applying a new dose ensures proper dosing and prevents accumulation. The ointment should be applied to the upper arms or body, not massaged, and is used for prophylaxis, not acute angina treatment.