Nokea
A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient™s BP. Which form of nitroglycerin is most appropriate?
- A. Sublingual spray
- B. Transdermal patch
- C. Oral capsule
- D. IV infusion
Correct Answer: D
Rationale: In the emergency management of a patient with extremely high blood pressure, intravenous (IV) administration of nitroglycerin is the most appropriate form of delivery. IV infusion provides rapid and precise control of blood pressure by allowing the medication to take effect quickly and be titrated to the desired blood pressure level. This route of administration is crucial in acute settings like the emergency department, where immediate blood pressure management is needed. Other forms of nitroglycerin, such as sublingual spray, transdermal patch, or oral capsule, may not provide the rapid onset of action required in this critical situation.
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A patient asks how to apply transdermal nitroglycerin. What is the nurse™s best response?
- A. Always apply the transdermal patch over the area of your chest where your heart is.
- B. Keep the previous patch on for 1 full day so you always have two patches on at a tim
- C.
- D. Apply the patch to hairless areas of the body.
Correct Answer: D
Rationale: Transdermal nitroglycerin patches should be applied to clean, dry, hairless areas of the body to ensure proper absorption of the medication. Hair can interfere with the absorption of the medication through the skin. Commonly recommended areas for application include the chest, upper arm, or abdomen. It is important to rotate application sites to prevent skin irritation and to follow the specific instructions provided by the healthcare provider or pharmacist.
The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
- A. Increased heart rate
- B. Increased blood vessel dilation
- C. Increased force of cardiac contractions
- D. Increased conduction of electrical impulses across the heart
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor that works by increasing the levels of cyclic adenosine monophosphate (cAMP) within cardiac myocytes. This leads to enhanced calcium influx into the cells, ultimately resulting in increased force of cardiac contractions (positive inotropic effect). This increased contractility helps improve cardiac output without necessarily increasing heart rate or affecting blood vessel dilation.
A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered
- A. . The patient asks the nurse why the medication is ordere
- B. What is the nurse™s best response?
- C. It will increase your heart rat
- D.
Correct Answer: B
Rationale: The correct response is to inform the patient that the medication, likely an antiarrhythmic agent such as digoxin immune fab (Digibind), helps to convert the irregular heart rhythm caused by digoxin toxicity to a more normal rhythm. This explanation provides a clear understanding of why the medication is being administered in cases of digoxin toxicity. It is important for the nurse to educate the patient about the purpose of the medication and how it will help manage the symptoms of digoxin toxicity.
Acyclovir has been ordered for a patient with genital herpes. Which nursing interventions are appropriate for this patient? (Select all that apply.)
- A. Monitor the patient’s blood urea nitrogen and creatinine.
- B. Monitor the patient’s blood pressure for hypertension.
- C. Administer intravenous acyclovir over 30 minutes.
- D. Advise maintenance of adequate fluid intake.
Correct Answer: A
Rationale: Acyclovir can cause nephrotoxicity, so monitoring blood urea nitrogen (BUN) and creatinine levels is essential. Hypertension is not a common side effect of acyclovir. Intravenous acyclovir should be administered over at least 1 hour to prevent renal toxicity. Adequate fluid intake helps prevent crystalluria and nephrotoxicity.
A nurse is providing administration instruction to the wife of a client going home on intermittent enteral nutrition. Which information should the nurse include?
- A. Clean the equipment between each feeding administration
- B. Once mixed, enteral feeding should hang no more than 8 hours
- C. Refrigerate any feeding that is not needed for a feeding
- D. Keep the area around the insertion site clean
Correct Answer: A
Rationale: Cleaning equipment between each enteral feeding is vital to prevent bacterial contamination, as residual formula can foster microbial growth, risking infections like gastroenteritis in a client already nutritionally compromised. While limiting hang time is important, evidence suggests a 4-hour maximum, not 8, to minimize spoilage-though this isn't the focus here. Refrigerating unused feeding preserves its integrity, preventing degradation or bacterial proliferation, which is critical for safety. Keeping the insertion site clean reduces infection risk at the tube entry, a common complication in enteral therapy. Cleaning equipment stands out as a proactive step the wife can take between feedings, directly impacting hygiene and client safety, whereas other points address storage or site care, which, while essential, are secondary to the immediate post-feeding action of equipment maintenance in this context.