A nurse at a provider's office receives a telephone call from a client who reports nausea and has unrelieved chest pain after taking a nitroglycerin tablet 5 min ago. Which of the following is an appropriate response by the nurse?
Advise the client to come into the office.
Advise the client to take an antacid.
Instruct the client to call 911.
Tell the client to take another nitroglycerin tablet in 15 min.
The Correct Answer is C
A. Advise the client to come into the office. The client needs immediate emergency intervention, not a routine office visit.
B. Advise the client to take an antacid. Chest pain unrelieved by nitroglycerin may indicate myocardial infarction; an antacid would not help.
C. Instruct the client to call 911. Persistent chest pain unrelieved by nitroglycerin warrants emergency attention due to potential heart attack.
D. Tell the client to take another nitroglycerin tablet in 15 min. The protocol allows taking an additional dose in 5 minutes, but emergency services should be called for unrelieved chest pain.
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Correct Answer is ["A","B","C","D"]
Explanation
A. Smoking: Smoking is a modifiable risk factor as quitting smoking reduces the risk of atherosclerosis.
B. Hypertension: High blood pressure can be managed through lifestyle changes and medication, making it a modifiable risk factor.
C. Hypercholesterolemia: High cholesterol levels can be controlled through diet, exercise, and medications, making it modifiable.
D. Obesity: Obesity is a modifiable risk factor, as weight loss through diet and exercise can reduce the risk of atherosclerosis.
E. Genetic predisposition: Genetic predisposition is non-modifiable, meaning individuals cannot change their inherited risk for atherosclerosis.
Correct Answer is D
Explanation
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.