Chapters 22 HTN & Chapter 24 Angina

When teaching a patient with angina how to use nitroglycerin translingual spray, which instructions would the nurse provide?

"Do not swallow the spray." "Do not shake the container." "Do not use near fire."

When the nurse is performing a central nervous system assessment of a patient who is experiencing angina, which question would help the nurse assess the patient for syncope?

"Do you find it difficult to stand upright?"

When a nurse is assessing a patient who is suspected to have experienced angina pectoris, which questions are most appropriate for obtaining the patient's nutritional history?

"Do you have any edema in your ankles?" "Are you receiving any treatment for high cholesterol?" "Do you experience fatigue or shortness of breath after eating?"

Which instruction would a nurse provide to a patient who is prescribed nitroglycerin for the treatment of angina pectoris?

"Follow the specific administration technique for the type of medication prescribed."

When the nurse is teaching about the correct use of nitroglycerin paste, which statement by the patient indicates a need for further teaching?

"I will choose a convenient site for application and use it consistently."

A registered nurse is teaching a licensed practical nursing student about the cardiovascular system assessment of patients experiencing angina pectoris. Which statements made by the student indicate effective learning?

"I will record the patient's blood pressure." "I will check the patient's skin color and temperature." "I will count and record the rate, rhythm, and quality of the patient's pulse."

When the nurse is educating a patient with angina about required lifestyle modifications while undergoing treatment, which statements by the patient indicate a need for further education?

"I will refrain from sexual activity." "I will seek help from my caregiver for activities of daily living."

Which statement by a patient indicates a correct understanding of the use of transdermal nitroglycerin?

"If the patch becomes dislodged, I will replace it with a new patch."

Which instructions would be beneficial to a patient taking perindopril (Aceon)?

"Take the medication on an empty stomach." "Avoid capsaicin in your diet." "Report immediately if any sore throat develops."

A patient prescribed a nitrate transmucosal patch removes the patch after 12 hours. After how much time should the patient apply a new patch? 3 to 5 minutes 6 hours 7 hours 12 hours

12 hours

Which patient who is prescribed nitrates for the treatment of angina pectoris is at risk of developing hypotension?

A patient who consumes alcohol A patient taking beta-adrenergic blockers A patient taking sildenafil (Viagra) to treat erectile dysfunction

In which patient would the use of eplerenone (Inspra) be contraindicated?

A patient who is taking strong metabolic inhibitors A patient who is taking potassium-sparing diuretics

Which symptom might a patient experience when taking sildenafil and nitrates together?

A significant drop in blood pressure

Which statement correctly differentiates angiotensin-converting enzyme (ACE) inhibitors from sodium channel blockers?

ACE inhibitors aim to reduce the frequency of recurrent myocardial infarction whereas sodium channel inhibitors aim to reduce the use of nitroglycerin during acute anginal attacks.

A nurse is providing home care to a patient receiving an angiotensin-converting enzyme (ACE) inhibitor for the treatment of angina. The patient develops dizziness, tachycardia, and fainting 2 hours after taking the medication. Which action would the nurse take immediately to manage the patient's condition?

Allow the patient to lie down

Which action of nitroglycerin (Nitro-Bid) supports the rationale for the nurse's use of an applicator paper during administration? Select all that apply. Allows measurement of the proper dose Facilitates rubbing the ointment on the skin Helps the nurse apply a thin, uniform layer of the ointment Prevents absorption of the medication through the fingertips Can be used to cover the area of skin after application of the ointment

Allows measurement of the proper dose Helps the nurse apply a thin, uniform layer of the ointment Prevents absorption of the medication through the fingertips

Which patient will benefit from propranolol treatment?

An obese patient with angina An obese patient has a high risk of hypertension. Propranolol is a beta blocker that is a first-line medication in treating hypertension. A 60-year-old patient who is physically active has a lower risk of hypertension.

Which class of antianginal drug helps prevent thrombus formation by promoting vasodilation and minimizing platelet cell aggregation?

Angiotensin-converting enzyme inhibitors

Which symptoms support the diagnosis of lithium (Lithobid) toxicity in a patient taking eplerenone (Inspra)?

Anorexia Fine tremors Profuse diarrhea

Which assessments would the nurse implement before administering an angiotensin-converting enzyme (ACE) inhibitor?

Apical pulse Persistent cough

when the nurse is evaluating a student who is preparing to administer a beta-adrenergic blocker to a patient with angina, which interventions by the student indicate effective learning?

Assessing the patient for a history of asthma Assessing the patient for a history of diabetes mellitus Obtaining baseline blood pressure in the supine and standing positions

Which agent does the nurse anticipate will be ordered by the healthcare provider to treat hypertension in a patient who suffered a heart attack?

Beta-adrenergic blocker

Which agent does the nurse anticipate will be ordered by the healthcare provider to treat hypertension in a patient who suffered a heart attack? Beta-adrenergic blocker Diuretic Central-acting alpha-2 agonists Angiotensin II receptor blockers (ARBs)

Beta-adrenergic blocker

Which class of antianginal drugs is contraindicated in patients with chronic bronchitis?

Beta-adrenergic blockers

By which action does aliskiren (Tekturna) reduce blood pressure?

Blocking the release of renin

Which antihypertensive medication is more effective in African Americans and older adult patients? Beta blockers Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors ACE II inhibitors

Calcium channel blockers

Which antihypertensive medications are prescribed as first-line or second-line medications to patients with hypertension and coexisting angina?

Calcium channel blockers

Which antihypertensive medications are prescribed as first-line or second-line medications to patients with hypertension and coexisting angina? Direct vasodilators Calcium channel blockers Central-acting alpha-2 agonists Aldosterone-receptor blocking agents

Calcium channel blockers

Which class of medications is most beneficial to an African-American patient in the treatment of low-renin hypertension?

Calcium channel blockers

Which statement is accurate regarding the difference in antianginal action between calcium channel blockers and nitrates?

Calcium channel blockers increase the total coronary blood flow

Which medication when combined with angiotensin-converting enzyme (ACE) inhibitor therapy can exacerbate an existing cough?

Capsaicin

Which statement is true regarding diuretics?

Carbonic anhydrase inhibitor class diuretics are weak antihypertensive agents.

Which statements about chronic stable angina are correct? Select all that apply. Chronic stable angina is unpredictable. Chronic stable angina lasts only a few minutes. Chronic stable angina occurs while the patient is at rest. Chronic stable angina is usually caused by a fixed atherosclerotic obstruction in the coronary arteries. Chronic stable angina is caused by a combination of atherosclerotic narrowing, vasospasm, and thrombus formation.

Chronic stable angina lasts only a few minutes. Chronic stable angina is usually caused by a fixed atherosclerotic obstruction in the coronary arteries.

Which intervention by the healthcare provider will benefit a patient who has been on nifedipine and has a blood pressure of 150/90 mm Hg? increasing the dose of the medication Combining the medication with a diuretic Increasing the frequency of the medication Advising the patient to take the medication before breakfast

Combining the medication with a diuretic

Which complication may occur when a patient takes both methyldopa (Aldopam) and haloperidol (Haldol)?

Dementia

Which adverse effect may occur in a patient who has been prescribed oral clonidine (Catapres)?

Depression

which premedication assessments should be performed when a patient is prescribed doxazosin (Cardura)?

Determining whether the patient has a history of gastritis Determining whether the patient has a history of coronary arteriosclerosis

Which side effects are common of angiotensin-converting enzyme (ACE) inhibitors? Select all that apply. Diarrhea Angioedema Swelling of the tongue Difficulty breathing Orthostatic hypotension

Diarrhea orthostatic hypotension

Which medication when given with amlodipine (Norvasc) should prompt the nurse to notify the healthcare provider?

Digoxin Amlodipine (Norvasc) is a calcium channel blocker that may increase serum levels of digoxin (Lanoxin).

Which description accurately explains how a calcium ion antagonist works to help angina?

Dilates coronary arteries and peripheral blood vessels, thereby increasing myocardial blood flow and decreasing workload

Which drug is a calcium channel blocker? Atenolol (Tenormin) Metoprolol (Lopressor) Ranolazine (Ranexa) Diltiazem (Cardizem)

Diltiazem (Cardizem)

Metoprolol (Lopressor) can be safely administered to a patient with which condition?

Elevated serum renin level

The nurse preparing to administer ranolazine for treatment of chronic stable angina would be concerned if the patient is also taking which medication?

Erythromycin

Which drugs are long-acting dihydropyridines? Select all that apply. Felodipine Verapamil Diltiazem Amlodipine Nifedipine

Felodipine amlodipine nifedipine

Which symptoms represent immunologic or inflammatory responses associated with hydralazine (Apresoline)? Select all that apply. Fever Chills Palpitations Tachycardia Muscle pain

Fever, chills, and muscle pain are immunologic or inflammatory responses associated with hydralazine (Apresoline)

Which medication would the nurse suspect to be prescribed to a patient with attention-deficit/hyperactivity disorder who develops hypertension?

Guanfacine (Intuniv)

Which drugs are central-acting alpha-2 agonists?

Guanfacine (Intuniv) Clonidine (Catapres)

Which serious adverse effects can occur in a patient taking eplerenone (Inspra)? Select all that apply. Gynecomastia Vaginal bleeding

Gynecomastia Vaginal bleeding

Which medication can be given to a patient who is experiencing toxemia associated with pregnancy?

Hydralazine (Apresoline)

A patient with which condition should be closely monitored while undergoing eplerenone (Inspra) therapy?

Hypercholesterolemia

Which medication when taken with a beta blocker decrease its effectiveness in treating hypertension?

Indomethacin (Indocin)

By which route does the nurse administer nitroprusside sodium (Nitropress)? Intradermal Intravenous Intramuscular Subcutaneous

Intravenous

Which antianginal medication needs to be administered to a patient through an infusion pump? Verapamil Nifedipine Nitroglycerin Intravenous nitroglycerin

Intravenous nitroglycerin

which medication when taken concurrently with eplerenone (Inspra) may cause hyperkalemia?

Lisinopril (Prinivil)

Which medication(s) should be avoided in a patient whose blood pressure is 168/110 mm Hg?

Lisinopril and irbesartan

Which medication could be responsible for a patient who is on antihypertensive therapy and has purple, mottled skin?

Metoprolol (Lopressor)

Which medication increases the therapeutic effect of aliskiren (Tekturna)?

Metoprolol (Lopressor)

Which is the clinical advantage of beta blockers in the treatment of hypertension?

Minimal postural hypotension

Which is the clinical advantage of beta blockers in the treatment of hypertension? Lack of aggravation of asthma Minimal postural hypotension Infrequency of orthostatic hypotension Lack of adverse sexual effects

Minimal postural hypotension

Which drugs are also known as coronary vasodilators?

Nitrates

Which classes of medication are most effective in relieving ischemia and angina?

Nitrates Beta blockers Calcium channel blockers

Which classes of medication are most effective in relieving ischemia and angina? Select all that apply. Nitrates Beta blockers Calcium channel blockers Sodium channel blockers Angiotensin-converting enzyme inhibitors

Nitrates Beta blockers Calcium channel blockers

Which medication for angina prevention is a transmucosal nitrate patch? Nitroglycerin (Nitrostat) Nitroglycerin (Nitro-Dur) Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Monoket)

Nitroglycerin (Nitro-Dur)

When the nurse instructs a student to use "nitro tubing" to administer a nitrate to a patient, the nurse is referring to which medication? Nitroglycerin (Nitrostat) Nitroglycerin (Nitro-Bid) Nitroglycerin (Nitrolingual) Nitroglycerin (Nitroglycerin IV)

Nitroglycerin (Nitroglycerin IV)

Which antianginal agent is available as a translingual spray? Amlodipine (Norvasc) Nicardipine (Cardene) Nitroglycerin (Nitrolingual) Isosorbide mononitrate (Monoket)

Nitroglycerin (Nitrolingual)

Which nitrates are available as sustained-release capsules? Select all that apply. Nitrolingual Nitroglycerin (Nitrostat) Nitroglycerin (Nitro-Bid) Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Imdur)

Nitroglycerin (Nitrostat) Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Imdur)

Which antihypertensive medication is used in patients with sudden severe hypertensive crisis? Lisinopril (Prinivil) Captopril (Capoten) Perindopril (Aceon) Nitroprusside (Nitropress)

Nitroprusside (Nitropress)

Which patients are more susceptible to neutropenia with administration of angiotensin-converting enzyme (ACE) inhibitors?

Patients who have lupus erythematosus Patients who have impaired renal function Patients who are exposed to corticosteroids

Which antihypertensive medications' metabolism are enhanced by cimetidine? Select all that apply. Pindolol Timolol Nadolol Atenolol Metoprolol

Pindolol Timolol Metoprolol

Which antihypertensive medication elicits its action by blocking alpha-1 adrenergic receptors?

Prazosin

Which antihypertensive medication elicits its action by blocking alpha-1 adrenergic receptors? Lisinopril Aliskiren Prazosin Nifedipine

Prazosin

Which medications reduce the therapeutic effect of methyldopa (Aldopam)? Select all that apply. Verapamil (Calan) Carvedilol (Coreg) Prazosin (Minipress) Trazodone (Desyrel) Amitriptyline (Elavil)

Prazosin (Minipress) Trazodone (Desyrel) Amitriptyline (Elavil)

During a follow-up visit, a patient who had been prescribed an antianginal drug reports the absence of any expected therapeutic outcome. The healthcare provider prescribes another antianginal that is used to treat chronic stable angina and reduce the use of nitroglycerin during anginal attacks. Which complication would the nurse anticipate in the patient?

Prolonged Q-T interval

Which drug reduces symptoms of angina by modifying metabolism in the myocardial cells to reduce the oxygen demand of the contracting heart muscles?

Ranolazine Ranolazine is a sodium channel blocker that reduces the symptoms of angina by modifying metabolism in the myocardial cells to reduce the oxygen demand of the contracting heart muscles.

Which medication is a sodium channel blocker? Verapamil (Calan) Ranolazine (Ranexa) Amlodipine (Norvasc) Nicardipine (Cardene)

Ranolazine (Ranexa)

A patient experiencing chest pain takes one sublingual nitroglycerin dose, and the pain is not relieved after 5 minutes. Which action should be the patient's priority in this situation, according to the American Heart Association?

Seek emergency medical attention.

Which drugs are used to prevent angina episodes?

Statins Beta blockers

When educating a group of patients at risk for developing coronary artery disease about preventive measures for angina attacks, which statements would the nurse include in the lesson?

Stop smoking cigarettes." "Eat small, frequent meals." "Avoid drinking caffeine-containing beverages."

Which statement is an advantage of beta-adrenergic blocking agents over other antihypertensive medications?

They cause minimal postural or exercise hypotension.

Which drug therapy is best used to treat hypertension in non-African-American patients? Renin inhibitors Thiazide diuretics Central-acting alpha-2 agonists Alpha-1 adrenergic blocking agents

Thiazide diuretics

In preparing to administer ranolazine (Ranexa) to a patient with chest pain, the nurse finds that the patient is also taking clarithromycin (Biaxin). Which complication(s) would the nurse expect?

Toxicity because of increased serum drug level

n preparing to administer ranolazine (Ranexa) to a patient with chest pain, the nurse finds that the patient is also taking clarithromycin (Biaxin). Which complication(s) would the nurse expect?

Toxicity because of increased serum drug level

which form of nitroglycerin may be used for both the prophylaxis and acute treatment of anginal attacks?

Translingual sprays

Which principle does the nurse follow when preparing to administer intravenous (IV) nitroglycerin?

Use an infusion pump to administer nitroglycerin. An infusion pump is used to administer nitroglycerin because the dose must be administered precisely and is titrated. IV nitroglycerin should not be mixed with other medications because drug interactions may occur.

Which medication blocks the conversion of angiotensin I to angiotensin II by blocking receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal glands?

Valsartan (Diovan)

Which medication would be beneficial to a patient with hypertension and experiencing dysrhythmias?

Verapamil

Which behavior modifications can a patient implement to help control hypertension?

Weight reduction diet Smoking cessation Increased exercise Stress reduction

ACE inhibitors should not be coadministered with

angiotensin II receptor blockers because this combination may enhance renin-angiotensin-aldosterone system blockade and result in adverse antihypertensive effects

When nitrates are used for antianginal effects, they first

induce the relaxation of the peripheral vascular smooth muscles to relieve angina pectoris. This results in the dilation of the arteries and veins. Dilation of the blood vessels reduces venous blood return to the heart. This action leads to decreased oxygen demands of the heart. Next, the nitrates dilate the large coronary arteries and redistribute blood flow, thereby increasing the myocardial oxygen supply. This results in enhanced oxygen supply to ischemic areas.