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3 Cards in this Set
- Front
- Back
- 3rd side (hint)
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1. The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG), a coronary vasodilator. Which statement indicates the client needs more medication teaching?
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1. “I will always carry my nitroglycerin in a dark-colored bottle.”
2. “If I have chest pain, I will put a tablet underneath my tongue.” 3. “If my pain is not relieved with one tablet, I will get medical help.” 4. “I should expect to get a headache after taking my nitroglycerin.” |
1. If the NTG is not kept in a dark-colored bottle, it will lose its potency. This statement shows the client’s understanding of the medication teaching and that more teaching on that topic is not necessary.
2. Sublingual NTG is placed under the client’s tongue when chest pain first occurs. The patient understands the teaching. 3. The client should put one tablet under the tongue every 5 minutes and, if the chest pain is not relieved after taking three tablets, the client should seek medical attention. This statement indicates the client needs more teaching about the medication. 4. Nitroglycerin causes vasodilatation and will cause a headache. The client understands this. |
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2. The nurse is preparing to administer nitroglycerin, a coronary vasodilator transdermal patch, to the client diagnosed with a myocardial infarction. Which intervention should the nurse implement?
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1. Question applying the patch if the client’s B/P is less than 110/70.
2. Use nonsterile gloves when applying the transdermal patch. 3. Date and time transdermal patch prior to applying to client’s skin. 4. Place the transdermal patch on the site where the old patch was removed. |
1. Nitroglycerin causes hypotension and the nurse should question administering a transdermal patch if the client’s blood pressure is less than 90/60 but not if it is less than 110/70.
2. The nurse should use gloves when applying nitroglycerin paste, not a transdermal patch. The patch will not cause any medication to be absorbed through the nurse’s skin 3. The nurse should remove the old patch, wash the client’s skin, note the date and time the new patch is applied, and apply it in a new area that is not hairy. 4. The transdermal patch must be rotated so that skin irritation will not occur. |
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3. The client is complaining of severe chest pain radiating down the left arm and is nauseated and diaphoretic. The HCP suspects the client is having a myocardial infarction (MI) and has ordered morphine sulfate (MS), a narcotic analgesic, for the pain. Which intervention should the nurse implement?
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1. Administer the morphine intramuscularly in the ventral gluteal muscle.
2. Dilute the MS to a 10-mL bolus with normal saline and administer intravenous push. 3. Question the order because MS should not be administered to a client with an MI. 4. Assess the client’s pain prior to administering the medication orally. |
1. Morphine sulfate should not be administered intramuscularly to a client with a suspected MI because it will take longer for the medication to take effect and it can skew the cardiac enzyme results.
2. Morphine sulfate is the drug of choice for chest pain, and it is administered intravenously so that it acts as soon as possible, within 10-15 minutes. Intravenous push medications should be diluted to help decrease the pain when it is administered and to prevent irritation to the vein. An intravenous push also allows the nurse to inject the medication more accurately over the 5-minute administration time. 3. Morphine sulfate should not be questioned; it is the medication of choice and the nurse should know it is always administered intravenously for a client with a myocardial infarction. 4. The nurse should not assess the pain any further; the pain medication should be administered immediately. |
