When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?

Correct Answer: A

Rationale: The correct instruction by the nurse when applying transdermal nitroglycerin patches is to "Rotate application sites with each dose." This is important to prevent skin irritation and tolerance to the medication. It is recommended to apply the patch to a different, clean, hairless area of skin for each dose to ensure proper absorption and effectiveness of the medication. Additionally, rotating application sites helps reduce the risk of skin reactions such as redness, itching, or rash.

Correct Answer: C

Rationale: It is important to remove the transdermal Nitroglycerine patch for 10-12 hours every night to prevent the development of tolerance. Tolerance can occur when the body becomes less responsive to the medication over time, reducing its effectiveness. By allowing a break in Nitroglycerine administration overnight, tolerance development can be minimized, ensuring the medication remains effective for the patient when needed. This nursing intervention helps to maintain the efficacy of Nitroglycerine in managing anginal attacks for the patient.

Correct Answer: D

Rationale: Phenytoin is an antiepileptic medication that is used to treat seizures. It has a narrow therapeutic range, and a blood level of 25 mcg/ml is considered to be high. At this level, patients are at risk for developing symptoms of phenytoin toxicity. Nystagmus, which is an involuntary rapid eye movement, is a common symptom of phenytoin toxicity. Other symptoms of phenytoin toxicity may include ataxia, diplopia, slurred speech, confusion, and drowsiness. It is important to monitor phenytoin blood levels regularly to avoid toxicity and adjust the dose accordingly.

Correct Answer: D

Rationale: Metformin is contraindicated in severe renal failure due to the risk of lactic acidosis, a rare but potentially fatal side effect.

Correct Answer: D

Rationale: TCA overdose (QT prolongation, seizures, acidosis) requires sodium bicarbonate . It corrects acidosis and stabilizes cardiac membranes. Ammonium chloride worsens acidosis. Atropine and Flumazenil are irrelevant. N-acetylcysteine (E) is for acetaminophen. Bicarbonate addresses her acute toxicity.