Chapter 46: course point
A client with chronic angina is prescribed ranolazine, a piperazine acetamide agent. Which information would the nurse include when teaching the client about this medication?
"Avoid grapefruit juice when taking this medication."
The nurse is teaching the client about coronary artery disease (CAD). Which statement by the client indicates that he or she has understood the teaching?
"High fat in the diet and smoking can cause my episodes of chest pain."
A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration?
"I can take up to three tablets at five-minute intervals."
The nurse is assessing a client taking a beta blocker as treatment for angina. Which statement by the client indicates to the nurse that the client is experiencing an adverse effect of the medication?
"I feel so down about my life."
What indicates that a client understands how to use sublingual nitroglycerin?
"I should feel a fizzing or burning sensation."
A client who wears dentures is prescribed buccal nitroglycerin 0.6 mg nitroglycerin. The nurse recognizes this client understands teaching with which statement?
"I will place the tablet above my dentures between my cheek and gum."
A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided?
"I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."
A nurse is teaching a 45-year-old client about the sublingual nitroglycerin that the health care provider has prescribed for management of stable angina. Which statement by the client indicates that the client understands the teaching session?
"I will use the nitroglycerin if I experience chest pain."
The nurse is educating a client on the use of nitroglycerin ointment for use at home. What statement made by the client indicates that further education is required?
"I will use the same site for each application of the ointment."
A client is prescribed sublingual nitroglycerin for treatment of angina. The nurse instructs the client to do what if chest pain occurs?
"If the chest pain doesn't go away after three tablets are given 5 minutes apart, call 911."
A client, diagnosed with erectile dysfunction, is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated?
"Nitroglycerin and sildenafil cause a severe decrease in blood pressure."
A male patient who uses sublingual nitroglycerin tells the nurse that when he puts it under his tongue, he feels a fizzing sensation. Which response by the nurse would be most appropriate?
"That means that the drug is still potent and working."
A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil?
"The combination can cause a severe decrease in blood pressure."
A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client?
"The heart muscle isn't getting enough oxygen."
The nurse is caring for a male client with a history of hypertension and Prinzmetal angina who is currently taking amlodipine 10 mg orally every day, and minoxidil 25 mg orally twice a day. The client stated that he is concerned about a recent enlargement of his breasts. What is the best therapeutic response to the client's concern?
"The increase in breast size is an adverse effect of minoxidil, and I will notify your primary care provider so other options may be explored."
A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond?
"You may experience headaches as an adverse reaction to nitroglycerin."
A nurse is teaching a client who is diagnosed with angina how to properly administer transdermal nitroglycerin. The nurse instructs the client to apply the patch for how long?
10-12 hours
A client may administer a maximum of how many doses of sublingual nitroglycerin in a 15-minute period?
3
A client is to take diltiazem (Cardizem) 360 mg/d PO in four divided doses. How many mg will the client take per dose?
90 mg
A 75-year-old client is being treated for type 2 diabetes, hypertension, gout, angina, coronary artery disease, and peptic ulcer disease. The nurse is concerned because the client is taking a traditional antianginal drug in combination with seven other medications. The nurse understands that what could be the consequence?
A greater incidence of adverse drug effects
A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain?
Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided.
The nurse is providing education to a client who has been prescribed nitroglycerin transdermal spray. What instruction should the nurse provide the client concerning how to administer the spray?
Administer the spray as soon as chest pain develops.
The client has been prescribed a nitroglycerin patch for anginal pain. The nurse is teaching the client about safe and proper use of the nitroglycerin patch. What should the nurse caution the client to avoid?
Alcoholic beverages
The physician is considering prescribing a beta blocker for a patient who is experiencing angina. For which condition should the patient be assessed before the physician orders the medication?
All the above
Which agent would be most appropriate for a client with Prinzmetal angina?
Amlodipine
The nurse is caring for a client that reports chest pain that is relieved by nitroglycerin. The client has a history of angina and asks why this keeps occurring. What is the best response by the nurse?
Angina occurs when the hearts demand for oxygen exceeds the supply
A client reports substernal chest pain that radiates to the neck. The pain lasts 5 minutes and then subsides with relaxation. What is the most likely cause of the chest pain?
Angina pectoris
A female client has used long-acting nitroglycerin pills, which the health care provider prescribed at a dosage of twice per day, for the last 6 months. She contacts the provider's office and states that the medication is not working as well as when she started taking the medication. What would be the most appropriate nursing action?
Ask the client how she is currently taking the medication so that you can determine whether she is taking the medication properly.
A 64-year-old client took one 0.4 mg nitroglycerin sublingual tablet 5 minutes before walking across the parking lot into a primary care clinic. The nurse meets the client, who is holding their hand over their sternum and reporting chest pressure and tightness, at the clinic door and identifies the bottle of nitroglycerine tablets in the breast pocket of the client's shirt. What is the best first nursing action for this client?
Ask the client to take another nitroglycerin tablet.
The nurse is caring for a male client in the emergency department who is experiencing a sudden onset of angina, rated as 8/10 on pain scale with blood pressure 88/50 mm Hg. Which is the priority action?
Assess if the client has taken sildenafil.
Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?
Blood pressure
A client is admitted to the emergency department with reports of anginal pain. Which assessment(s) should the nurse prioritize? Select all that apply.
Blood pressure Apical pulse Radial pulse Respiratory rate
The client is taking a calcium channel blocker. Which assessment findings would the nurse expect?
Bradycardia
A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe?
Bronchospasm
An asthmatic client on a beta blocker should be observed for which adverse reaction?
Bronchospasm
When caring for a client with angina, the nurse instructs the client to place the nitroglycerin tablet between the cheek and the gums. Which form of nitroglycerin is the nurse administering?
Buccal
When caring for a patient with angina, the nurse instructs the patient to place the nitroglycerin tablet between the cheek and the gums. Which route of administration is the nurse referring to?
Buccal
The 47-year-old client is experiencing chest pain and has taken three sublingual nitroglycerin tablets, but the pain remains. What should the client do next?
Call 911.
After teaching a group of students about nitrates, the instructor determines that the teaching was successful when the students identify what as a contraindication?
Cerebral hemorrhage
Which would be important to do when administering nitroglycerin transbuccally?
Check the inside of the cheeks for ulcers or breakdown.
After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as:
Chest pain that is relieved by rest
Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose?
Current blood pressure
A patient has been prescribed a beta-adrenergic blocker to help control angina. What effect might the patient experience as a result of the drug therapy?
Decreased cardiac output
A client with angina is prescribed atenolol. Following absorption of the drug, the nurse should monitor the client for what anticipated effect?
Decreased heart rate
Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism?
Decreasing the heart rate, allowing for longer filling time and increased blood to the heart
A male client does not respond to traditional treatment for his chronic angina. The health care provider orders ranolazine (Ranexa) and orders a baseline ECG prior to medication administration. Three months later, the health care provider orders a repeat ECG. For what reason is the provider monitoring the client?
Dose-dependent QT prolongation
The nurse is preparing to complete a preadministration assessment on a client who has presented to the clinic with reports of chest pain. Which information should the nurse prioritize in this assessment? Select all that apply.
Events that relieve anginal pain Events that trigger anginal pain Description of the pain Whether the pain radiates
The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack?
Every 5 minutes
A client should be instructed to take sublingual NTG how often if he experiences chest pain?
Every 5 minutes times 3
The client is taking a calcium-channel blocker. What adverse effects might the client experience?
Headache and dizziness
A client with diabetes is prescribed propranolol. For what should the client be assessed?
Hypoglycemia
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for:
Hypotension
A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client?
Hypotension
The nurse is caring for a client experiencing an acute angina attack. Sublingual nitroglycerin has been administered. The nurse assesses the client's vital signs for which reason?
Identify hypotension.
A client is prescribed oral nitrate for occasional anginal pain. The nurse should point out that nitrates must be stored in which manner(s)? Select all that apply.
In its original container With the container lid tightly sealed Away from light exposure
A client receiving amlodipine for angina is now reporting dizziness. Which intervention should the nurse prioritize to help alleviate the condition?
Instruct the client to lie down.
A patient receiving amlodipine for angina reports dizziness. Which intervention should the nurse implement to help alleviate the condition?
Instruct the patient to lie down.
A group of students are reviewing information about isosorbide dinitrate. The students demonstrate the need for additional study when they identify that this drug is available in which form?
Intravenous
The nurse is caring for a client whose chest pain has not been relieved with sublingual organic nitrate. What medication does the nurse suspect will most likely be prescribed by the health care provider?
Intravenous nitroglycerine
A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker?
Isosorbide
Which would a nurse identify as a nitrate?
Isosorbide
A health care provider has prescribed sublingual nitroglycerin and the nitroglycerin patch for a client. When the nurse explains the medications to the client, what advantage of the patch might the nurse mention?
It has a longer duration of action than sublingual tablets.
The nurse determines a client has a nursing diagnosis of acute pain related to angina. When teaching the client about antianginal drugs, the nurse would point out which information about the pain? Select all that apply.
May be less intense May not be completely relieved May be less frequent
After teaching a group of students about drugs used as antianginal agents, the instructor determines that the teaching was successful when the students identify which as a beta-blocker antianginal agent?
Nadolol
A client arrives at the urgent care center reporting chest pain and is diagnosed with angina pectoris. Which drug would the nurse expect to be prescribed?
Nicardipine
A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina?
Nicardipine
After teaching a group of nursing students about antianginal drugs, the instructor determines that the teaching was successful when the students correctly choose which drugs as a calcium channel blocker?
Nifedipine
For relief of acute angina and for prophylaxis before events that cause acute angina, what is the primary drug of choice?
Nitroglycerin
A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets?
Nitroglycerin will increase intracranial pressure.
The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?
Nitrostat
A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route?
Oral
When describing angina to a group of clients, what would be most accurate?
Pain due to lack of oxygen in the heart muscle
The nurse is teaching a client and caregiver the proper technique for administering the prescribed nitroglycerin ointment. Which method should the nurse point out is the best way to determine the amount of ointment to apply?
Paper applicator
A client, age 55 years, is started on calcium channel blockers for anginal attacks. The nurse would assess the client for which reaction? Select all that apply.
Peripheral edema Jugular vein distention Breathing difficulty
A nurse is preparing to administer nitrate to a client. The nurse will carefully monitor the client for severe hypotension if the client is also prescribed which additional medication? Select all that apply.
Phosphodiesterase inhibitors Alcohol
A male client asks the nurse why the health care provider has added combined aspirin, antilipemics, and antihypertensives to his medication regimen when he feels fine and hasn't experienced an anginal episode in a year. The nurse explains that this combination of drugs is given for what reason?
Prevents progression of myocardial ischemia to MI
A nurse is assessing a client with angina who has received diltiazem. Which finding should the nurse prioritize and notify the health care provider for further instructions?
Pulse rate is 45 beats per minute
Which electrocardiogram change should prompt the nurse to question the use of ranolazine for the treatment of a client diagnosed with chronic angina?
QT prolongation
The nurse is preparing to teach discharge instructions to a client with angina. Which instruction should the nurse prioritize giving the client when teaching about the prescribed oral nitroglycerin?
Recap the container tightly after taking out the capsules.
A patient is being discharged after being treated with nitroglycerin for angina. Which instructions should the nurse include in the teaching plan for the patient?
Recap the container tightly after taking the capsules.
A nursing instructor overhears a group of nursing students comparing various drugs used for cardiac disorders. The instructor determines the previous class was successful when the students correctly determine antianginals provide which action(s)? Select all that apply.
Relief of pain of acute anginal attacks Prevention of anginal attacks Treatment of chronic stable angina pectoris
Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.)
Relieve the pain of acute anginal attacks. Prevent angina attacks. Treatment chronic stable angina pectoris.
The nurse would avoid administering nitrates to clients using which medication?
Sildenafil
What should the nurse tell the client about storage of oral nitroglycerin products? (Select all that apply.)
Store oral nitroglycerin in the original container. Store oral nitroglycerin with the container lid tightly sealed. Store oral nitroglycerin away from light exposure.
Which statement correctly distinguishes between the therapeutic effects of sublingual isosorbide and sublingual nitroglycerin?
Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin.
A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this client's angina?
The client's angina may necessitate the use of a calcium channel blocker.
Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin?
The woman will be more susceptible to hypotension than a younger patient.
The nurse instructs the client that he can repeat the dose of nitroglycerin every 5 minutes up to a maximum total of how many doses?
Three
A client is being discharged after being treated with nitroglycerin for an acute anginal attack. The nurse should include which instruction when providing the client with discharge instructions concerning how to properly administer nitroglycerin ointment at home?
Use an applicator for applying the ointment.
Which client is at greatest risk for developing angina?
a client diagnosed with atherosclerosis of the coronary arteries
A client with a diagnosis of angina has been prescribed nifedipine sustained-release 30 mg orally once per day. Prior to administration, the nurse will perform which assessment?
blood pressure
A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem?
bronchospasm
A 45-year-old man enters the emergency department with chest pain. The nurse has an order to administer amyl nitrite. The nurse will:
crush the capsule and ask the patient to inhale the vapors.
The chest pain and pressure a client experiences during an anginal attack is caused by which of the following?
decreased oxygen supply to the heart.
When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?
inhibiting the influx of calcium through slow channels.
A client is being discharged home with a prescription for sublingual nitroglycerin. The nurse will instruct the client and family to do which?
keep the tablets in the original dark bottle.
The nurse is performing a history for a black client that is concerned about developing coronary artery disease since it "runs in the family." What risk factor, that is modifiable, does the nurse identify when taking the history?
obese 40% over total body weight
What effect, if any, would extensive facial and oral trauma have on a client's sublingual nitroglycerin therapy prescribed to manage the angina?
route changed to transdermal
While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it:
should be replaced every six months.
Several forms of nitroglycerin have been developed to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. What characteristic(s) of nitrate therapy can contribute to the ineffectiveness of the medication when prescribed via the oral route? Select all that apply.
slow onset of action delayed pain relief rapid metabolism by the liver
