Pharmacology II Prep U Chapter 46: Antianginal Agents

The nurse should monitor for what in a client receiving a calcium channel blocker? (Select all that apply.)

• Crackles • Dyspnea • Peripheral edema

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.

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."

What indicates that a client understands how to use sublingual nitroglycerin?

"I should feel a fizzing or burning sensation."

A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement?

"I will take a pill every 15 minutes until the pain subsides."

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."

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 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 (Viagra)?

"Nitroglycerine and Viagra 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 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's 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's angina pectoris is being successfully treated on an outclient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication?

"This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."

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 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.

When a client is prescribed nitroglycerin transdermal spray, what instructions should the nurse provide the client concerning how to administer the spray?

Administer the spray as soon as chest pain develops.

The client is taking a calcium channel blocker. Which assessment findings would the nurse expect?

Bradycardia

The 47-year-old client is experiencing chest pain and has taken three sublingual nitrogylcerin tablets, but the pain remains. What should the client do next?

Call 911

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

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

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 nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which sign or symptom would the nurse attribute to being a common adverse effect of this medication?

Dizziness

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

A client is using transdermal nitroglycerin. The nurse would instruct the client to apply a new patch at which frequency?

Every day

Beta blockers decrease myocardial oxygen demand by increasing the heart rate and decreasing cardiac contraction.

False

The client is taking a calcium-channel blocker. What adverse effects might the client experience?

Headache and dizziness

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

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 the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker?

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.

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

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.

A male client has sustained a head injury in a motor vehicle accident. He has nitroglycerine tablets for chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerine have on the client's current status?

Nitroglycerine will increase intracranial pressure.

The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?

Nitrostat

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

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 would avoid administering nitrates to clients using which medication?

Sildenafil

A health care provider has ordered 40 mg of isosorbide dinitrate for a client who reports chest pain. The nurse administers the medication after confirming the absence of what condition?

anemia

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 client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

decreased heart rate

The nurse should administer bisoprolol with an understanding that it achieves a therapeutic effect in what way?

decreasing heart rate

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?

inhibiting the influx of calcium through slow channels.

What medication will most likely be prescribed for a client whose chest pain that is not relieved with sublingual organic nitrate?

intravenous nitroglycerine

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports:

no episodes of angina since ointment was initiated.

The nurse is caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within:

one to three minutes.

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.

A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe?

Bronchospasm

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 nurse is aware that the use of ranolazine is contraindicated in clients who have what condition?

QT-interval prolongation

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.

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.

Angina pectoris occurs when the myocardial demand for oxygen exceeds that which can be supplied.

True

The client is experiencing chest pain. What should be assessed just prior to the administration of antianginal medication? Select all that apply.

• Location, quality of pain • Blood pressure • Skin color

What are the home care nurse's responsibilities in the care of clients who are receiving antianginal medications? (Select all that apply.)

• Monitoring the client's response to antianginal medications • Teaching clients and caregivers how to use, store, and replace medications to ensure a constant supply • Discussing circumstances for which the client should seek emergency care • Assisting clients to modify factors that contribute to angina

What should a client be told in regards to the pain relief anti-anginal drugs provide? (Select all that apply.)

• Pain may be less intense. • Pain may be less frequent.

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.