A hospitalized patient complains of acute chest pain, which he ...

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A hospitalized patient complains of acute chest pain, which he rates as a 9 on a scale of 0 to 10. The nurse administered a 0.4 mg sublingual nitroglycerin tablet, and now finds his vital signs to be stable. The nurse's next step is to
 
  a. provide a second dose of nitroglycerin in 5 minutes.
  b. continue dosing at 10-minute intervals.
  c. obtain a transcutaneous pacer.
  d. increase the dose to 1 mg.

Question 2

A patient with stable angina uses a nitroglycerin transdermal patch, and efforts are being made to prevent drug tolerance. Which statement made by the patient best demonstrates an understanding of the transdermal patch? I will apply my patch
 
  a. at 8:00 AM and remove it at 8:00 PM.
  b. at 8:00 PM and remove it when I wake up.
  c. at 7:00 AM and remove it at 8:00 PM.
  d. as soon as I remove my old one.

[ryhom]

Answer to Question 1

ANS: A
An initial dose of sublingual nitroglycerin is given, and if the chest pain persists, such as in this case, the patient should take another dose of NTG in 5 minutes.
Dosing at 10-minutes interval is incorrect, because the time span is too long.
A transcutaneous pacer would be indicated for an abnormal heart rhythm, but there is no indication the heart rhythm is abnormal.
SL nitroglycerin is available in 0.3 to 0.6 mg doses, not 1 mg.

Answer to Question 2

ANS: A
Tolerance develops if patches are used continuously (24 hours a day). A daily patch free interval of 10 to 12 hours is recommended. This can be accomplished by applying a new patch each morning, leaving it in place for 12 to 14 hours, and then removing it in the evening.
It is more effective to be using the patch during awake hours plus answer 2 does not specify what time the patient will be waking up so the time may be too short or too long for the patch to be in place.
Application of the patch at 7:00 AM and removal at 8:00 PM does not allow a long enough interval between applications.
This answer is incorrect because one the patch is removed there must be a patch free interval of time of at least 10 to 12 hours.

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Gracias!

[Kedrick2014]

TYSM