Drug Therapy for Angina

You are caring for a patient who takes nitroglycerin sublingually. When you provide patient education you would tell the patient that they can expect relief of chest pain within what period of time? a) 1 to 3 minutes b) 5 to 10 minutes c) 15 to 20 minutes d) 30 to 60 minutes

Answer: 1 to 3 minutes

A patient has been prescribed diltiazem 360 mg/d PO in four divided doses. What amount of medication will the patient take in each dose? a) 60 mg b) 120 mg c) 30 mg d) 90 mg

Answer: 90 mg

After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as which of the following? a) Chest pain that occurs with coronary artery disease b) Chest pain that is relieved by rest c) Chest pain that occurs at rest d) Chest pain that occurs due to vasospasm

Answer: Chest pain that occurs at rest

People receiving nifedipine (Adalat) should be assessed for which of the following adverse effects? a) Peripheral edema b) Asthma c) Ascites d) Tetany

Answer: Peripheral edema Rationale: Peripheral edema, heart failure, and pulmonary edema can occur with calcium-channel blockers.

A patient arrives at the community healthcare center complaining of chest pain. After diagnosis, the healthcare provider has prescribed amlodipine for the patient's condition. Which of the following conditions should the nurse identify as an indication for amlodipine therapy? a) Cardiogenic shock b) Prinzmetal's angina c) Atrioventricular (AV) block d) Sick sinus syndrome

Answer: Prinzmetal's angina Rationale: The nurse should identify Prinzmetal's angina as the condition where amlodipine is indicated. Prinzmetal's angina is a vasospastic angina in which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome and AV block are the conditions where amlodipine is contraindicated.

A client experiences pain in the chest that radiates to the jaw, occurring when the client is at rest. The nurse would interpret this as which of the following? a) Prinzmetal's angina b) Myocardial infarction c) Unstable angina d) Stable angina

Answer: Prinzmetals' angina

What drug is used for long-term management of angina pectoris caused by atherosclerosis? a) Diltiazem (Cardizem) b) Propranolol (Inderal) c) Isosorbide dinitrate (Isordil) d) Nifedipine (Procardia)

Answer: Propranolol (Inderal) Rationale: Beta-blockers are indicated for long-term management of angina caused by atherosclerosis. Propranolol is a beta-blocker. Diltiazem and nifedipine are calcium channel blockers and are not used for angina caused by atherosclerosis. Isosorbide dinitrate is a nitrate and is not indicated for this condition. (less)

The nurse is aware that the use of ranolazine is contraindicated in clients who have what condition? a) Sinus tachycardia b) QT-interval prolongation c) Arterial claudication d) Congestive heart failure

Answer: QT-interval prolongation Rationale: Ranolazine is contraindicated in clients who have a condition called QT-interval prolongation.

A patient with chronic alcoholism has been admitted to the healthcare center for acute angina management and is started on nitrates. Which of the following conditions should the nurse warn the patient about that may occur with the interaction between alcohol and nitrates? a) Increased hypersensitivity reactions b) Increased risk of hypoglycemia c) Severe hypotension and cardiovascular collapse d) Decreased effectiveness of nitrates

Answer: Severe hypotension and cardiovascular collapse

The physician prescribes a small dose of antianginal medication to a client newly diagnosed with coronary artery disease. What is the reason for starting with a small dose? a) Small doses minimize myocardial enervation. b) Small doses minimize angina. c) Small doses minimize adverse effects. d) Small doses minimize oxygenation to the myocardium.

Answer: Small doses minimize adverse effects.

Which statement correctly distinguishes between the therapeutic effects of sublingual isosorbide and sublingual nitroglycerin? a) Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. b) Sublingual isosorbide has a lesser sustained effect than sublingual nitroglycerin. c) Sublingual isosorbide has a faster onset and a shorter duration of action than sublingual nitroglycerin. d) Sublingual isosorbide is not as effective as sublingual nitroglycerin.

Answer: Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin.

You are teaching your 63-year-old patient about sustained-release oral nitrates, which she has been prescribed for treatment of angina. Which of the following instructions would you offer when teaching her how to properly self-administer the medication? a) Crush the medication and dissolve it in water. b) Crush the medication and mix it with food. c) Take the medication immediately following a meal. d) Take the medication on an empty stomach.

Answer: Take the medication on an empty stomach.

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports which of the following? a) The client reports dizziness after each application. b) The client reports that he gets a headache each time the ointment is applied. c) The client reports no episodes of angina since ointment was initiated. d) The client reports minimal episodes of angina.

Answer: The client reports no episodes of angina since ointment was initiated.

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 patient's angina? a) The patient will likely have a trial of antiplatelet drugs before being prescribed nitrates. b) The patient would benefit from a weekly intravenous dose of a beta blocker. c) The patient's angina may necessitate the use of a calcium channel blocker. d) The patient indicates a need for daily low-molecular weight heparin therapy

Answer: The patient's angina may necessitate the use of a calcium channel blocker. Rationale: Calcium channel blockers are used in chronic stable angina when the patient cannot tolerate beta blockers, or if the symptoms are not adequately controlled while on this therapy. Regularly-scheduled beta blockers are not administered intravenously. Low molecular weight heparin is not typically used in the treatment of stable angina and antiplatelet medications do not need to precede the use of nitrates.

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? a) The woman will need to allow more time between doses in order to facilitate absorption. b) The woman will be more susceptible to hypotension than a younger patient. c) The woman may experience paradoxical vasoconstriction when taking nitroglycerin. d) Decreased saliva production will inhibit the absorption of the drug in her mucosa.

Answer: The woman will be more susceptible to hypotension than a younger patient.

A patient is being discharged after being treated with nitroglycerin for an acute anginal attack. Which of the following instructions should the nurse provide the patient regarding the administration of nitroglycerin ointment? a) Rub the ointment onto the skin. b) Apply on the same site during every application. c) Apply a thick layer of the ointment. d) Use an applicator for applying the ointment.

Answer: Use an applicator for applying the ointment.

The nurse cautions the client taking nitroglycerin to avoid the use of which vitamin? a) Vitamin B b) Vitamin A c) Vitamin E d) Vitamin D

Answer: Vitamin E

You are caring for a patient who is taking a sustained-release oral nitrate. How would you instruct this patient to take their medication? a) With grapefruit juice b) With water c) 1 hour after eating d) With milk or milk products

Answer: With water

A nurse is providing patient teaching to a patient that has been experiencing unstable angina. What will the nurse's explanation of this condition include? a) Your body's response to a lack of oxygen in the heart muscle is pain. b) A coronary vessel has become completely occluded and unable to deliver blood to your heart. c) That there is a pronounced narrowing of the coronary arteries and the heart is experiencing episodes of ischemia or lack of oxygen even when you are resting. d) The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing.

Answer: " That there is a pronounced narrowing of the coronary arteries and the heart is experiencing episodes of ischemia or lack of oxygen even when you are resting.

Mr. Lang, a 52-year-old man who experienced a myocardial infarction, has a physician's order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the patient indicates that he understands the teaching provided? a) "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my physician." b) "I will take three tables every 5 minutes until the chest pain subsides." c) "I will take one tablet and lay down for an hour." d) "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."

Answer: "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."

You are teaching Ms. Keith about the sublingual nitroglycerin that the physician has prescribed for management of her stable angina. Which statement by Ms. Keith indicates that she understands the teaching session? a) "I will take the nitroglycerin once a week to improve my ability to exercise." b) "I will take the nitroglycerin twice a day." c) "I will use the nitroglycerin if I experience chest pain." d) "I will take the nitroglycerin whenever I eat, to help with the absorption of the medication."

Answer: "I will use the nitroglycerin if I experience chest pain."

You are teaching a patient about his new prescription for oral propranolol. If the patient asks you how long it will take for the medication to relieve pain, what will you say in response? a) "It will start working in about a minute." b) "It will start working in about ten minutes." c) "It will start working in about a half hour." d) "It will start working in about fifteen minutes."

Answer: "It will start working in about a half hour."

A man has left his most recent visit to his primary care provider with a new prescription for a transdermal nitroglycerin patch. What patient education should the nurse provide to this patient? a) "Apply one additional patch if you experience a sudden onset of chest pain." b) "Put your patch on a part of your skin that doesn't have too much hair on it." c) "Remove your old patch and put on a new one each morning." d) "If your patch loses its adhesion during the day, replace it with a new one."

Answer: "Put your patch on a part of your skin that doesn't have too much hair on it." Rationale: Transdermal nitroglycerin patches should be applied to a hairless, or nearly hairless, area of the skin to promote absorption. Loose patches should be reinforced rather than replaced. Patches should be discontinued in the evening and they are not used for acute treatment of chest pain. (less)

Angina pectoris is a clinical syndrome characterized by episodes of chest pain. What other characteristics describe angina pectoris? Choose all that apply. a) It occurs when there is a deficit in myocardial oxygen supply. b) It is most often caused by atherosclerotic plaque in the coronary arteries. c) It occurs when there is an increase in myocardial oxygen supply. d) There are three types of angina: classic (stable), variant, and unstable.

Answer: A, B, D

Prior to administering an anti-anginal drug, the nurse should assess the client for which of the following? Select all that apply: a) Auscultates the lungs b) Pain assessment c) Auscultates the heart d) Physical appearance e) Vital signs

Answer: A, B, D, E Rationale: Client pre-assessment for anti-anginal drugs should include a thorough pain assessment, history of medication allergies and disease processes, assessment of physical appearance, auscultates the lungs for adventitious sounds, obtains a baseline electrocardiogram, and obtains vital signs.

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 of the following actions should the nurse do first when he complains of chest pain? a) Have the patient swallow a tablet every 5 minutes for 15 minutes b) Call the physician c) Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided d) Ask the patient to lie back and try to relax

Answer: Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

Organic nitrates are widely used to decrease cardiac workload, effectively decreasing angina. Nitrate efficacy in lowering systolic blood pressure contraindicates its use with which of the following? (Select all that apply.) a) Hypervolemia b) Cerebral hemorrhage c) Phosphodiesterase enzyme type 5 inhibitor d) Variant angina

Answer: B, C

In which of the following situations would a nurse withhold the anti-anginal medication and contact the physician? Select all that apply: a) Respiratory rate below 20 breaths per minute b) Systolic blood pressure below 90 mmHg c) Diastolic blood pressure below 90 mmHg d) Heart rate above 50 bpm e) Heart rate below 50 bpm

Answer: B, E

A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments? a) Blood urea nitrogen (BUN) b) Urinary output c) Blood pressure d) Heart rate

Answer: Blood pressure

The nurse needs to follow which of the following when administering nitroglycerin ointment? Select all that apply: a) Apply entire tube of ointment to client's skin. b) Use the same application site each time ointment is applied. c) The upper arms and legs are areas for appropriate application. d) Cleanse the area of skin before application. e) Wear plastic disposable gloves.

Answer: C, D, E Rationale: The nurse should wear plastic gloves while administering ointment and use application paper to measure and apply ointment to the client's chest, abdomen, or upper arms and legs. The application site should be rotated and cleansed with each application.

Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The physician 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? a) Susceptibility of the patient to renal insufficiency b) Current blood pressure c) Susceptibility of the patient to intracranial pressure d) Current respiratory rate

Answer: Current blood pressure

Beta-adrenergic blockers help to control angina, but can cause what? a) Increased oxygen consumption b) Decreased contraction of the heart c) Increased heart rate d) Decreased urinary output

Answer: Decreased contraction of the heart Rationale: Actions: Competitively blocks beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart; decreases cardiac output which results in a lowered blood pressure and decreased cardiac workload.

A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? a) A reduction in plaque secondary to atherosclerosis b) Decreased oxygenation to the myocardium c) Decreased musculature of the myocardium related to plaque d) Hypertension of the myocardium

Answer: Decreased oxygenation to the myocardium Rationale: Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries.

When describing the action of ranolazine, which of the following would be most appropriate? a) Shortens the QT interval b) Decreases blood pressure c) Decreases myocardial workload d) Decreases heart rate

Answer: Decreases myocardial workload Rationale: Although the exact mechanism of action of the drug is not understood, it does prolong the QT interval. It does not decrease heart rate or blood pressure but does decrease myocardial workload, bringing the supply and demand for oxygen back into balance.

An 83-year-old white man, a resident in the long-term care facility in which you work, has taken nitroglycerin regularly for 15 years for his angina. In the past few years, his angina has decreased but increases as his myocardial workload increases with activity. What would explain the decrease in his resting angina? a) Development of collateral circulation. b) Decrease in number of plaque lesions. c) Auto repair of endothelial injury. d) Decrease in number of lipid-filled macrophages.

Answer: Development of collateral circulation. Rationale: Collateral circulation develops from anastomotic channels that connect the coronary arteries and allow perfusion of an area by more than one artery. All other options are incorrect.

The client is started on a transdermal nitroglycerin system. The nurse teaches the client that the system relieves pain by which of the following actions? a) Increases the workload of the heart b) Dilates the coronary arteries c) Decreases the size of the artery d) Dilates arteries and veins

Answer: Dilates arteries and veins Rationale: Nitrates act by relaxing the smooth muscle of the blood vessels and increasing the amount of blood through the vessel. They also decrease the workload of the heart.

A nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which of the following signs or symptoms would the nurse attribute to being a common adverse effect of this medication? a) Perspiring skin that is cold to the touch b) Bradycardia c) Dizziness d) Diarrhea

Answer: Dizziness

A client is using transdermal nitroglycerin. The nurse would instruct the client to apply a new patch at which frequency? a) Every week b) Before activities that may cause chest pain c) Every day d) Each time he has chest pain

Answer: Every day

Your current patient, an overweight, 61-year-old man with a history of diabetes mellitus, is status post-MI 1 month and has returned for his cardiology follow-up. Included with his dietary changes, the cardiologist recommended which of the following nonpharmacological lifestyle changes to reduce microvascular changes? a) Increased nicotine use b) Increased cholesterol consumption c) Glucose control d) Maintaining weight

Answer: Glucose control Rationale: For patients with diabetes mellitus, glucose and blood pressure control can reduce the microvascular changes associated with the condition. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease.

You are caring for a client who is taking a calcium-channel blocker. What adverse effects would you caution this patient about? a) Itching and rash b) Hypertension and tachycardia c) Nausea and diarrhea d) Headache and dizziness

Answer: Headache and dizziness

Your client is taking a calcium-channel blocker. What adverse effects might the client experience? a) Headache and dizziness b) Fever and bronchospasm c) Hypertension and tachycardia d) Flushing and rash

Answer: Headache and dizziness Rationale: Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.

A 49-year-old client is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. You should observe the client for which of the following adverse effects? a) Hypotension b) Hypokalemia c) Renal insufficiency d) Tachycardia

Answer: Hypotension Rationale: Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or tachycardia.

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? a) Oral b) Chewable tablet c) Intravenous d) Sublingual

Answer: Intravenous

The client is having angina. As the nurse prepares to administer sublingual nitroglycerin it is noted that the client's blood pressure is 82/54. What is the best action of the nurse? a) Notify the physician. b) Administer the medication. c) Ask the client how he feels. d) Withhold medication until blood pressure increases.

Answer: Notify the physician Rationale: The client is having angina and it must be addressed. If the blood pressure is less than 90 systolic, the nurse should not administer the medication and call the physician immediately.

Clients who are taking nifedipine should be monitored for which of the following adverse effects? a) Tetany b) Peripheral edema c) Hyperkalemia d) Asthma

Answer: Peripheral edema

While teaching your patient about sublingual nitroglycerin, you explain proper use and storage. When the patient asks whether the medication ever expires, you respond that it a) has an indefinite shelf life. b) should be replaced every six months. c) should be replaced annually. d) should be replaced monthly.

Answer: should be replaced every six months.