NUR 2144 Pharmacology II Chapter 46: Antianginal Agents
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."
What indicates that a client understands how to use sublingual nitroglycerin?
"I should feel a fizzing or burning sensation."
The nurse provides client teaching for a client diagnosed with angina about the prescribed nitroglycerin transdermal patch. Which client statement establishes the need for further teaching?
"I will apply the patch for 24 hours and then remove it, and place another transdermal patch."
The nurse is teaching a client diagnosed with angina how to properly store and use nitroglycerin sublingual tablets. Which statement made by the client establishes a need for additional teaching by the nurse?
"I will keep the bottle of nitroglycerin in my pants pocket."
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."
When teaching the client to safely administer nitroglycerin ointment, the nurse should convey which instruction?
"Make sure you squeeze the ointment on to a paper measuring scale before applying it."
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 was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse?
"Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage
"Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage."
"Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage."
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 client is experiencing chest pain and self-administers nitroglycerine sublingually. When should the client expect to notice relief of the chest pain?
1 to 3 minutes
A client is using nitroglycerin in translingual spray form. The nurse would inform the client that the drug would begin working within which time frame?
1- 3 minutes
A client may administer a maximum of how many doses of sublingual nitroglycerin in a 15-minute period?
3
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.
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
When describing the effects of a myocardial infarction, the nurse understands that the majority of deaths related to this condition result from:
Arrhythmias
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
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
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.
What would contraindicate the use of nitrates?
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 desired effect?
Decreased heart rate
A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina?
Decreased oxygenation to the myocardium
When describing the action of ranolazine, which would be most appropriate?
Decreases myocardial workload
The nurse is providing education to a client who has been prescribed bisoprolol. During teaching, the nurse explains that the drug achieves a therapeutic effect in what way?
Decreasing heart rate
A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina?
Decreasing the heart rate, allowing for longer filling time and increased blood to the heart
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
The client is started on a transdermal nitroglycerin patch system. The nurse teaches the client that the system relieves pain by which action?
Dilates arteries and veins
Which agents should be avoided in a patient receiving ranolazine? (Select all that apply.)
Diltiazem Ketoconazole Erythromycin
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
When describing the possible adverse effects associated with nitroglycerin, what would the nurse include?
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
A current client, an overweight 61-year-old with a history of diabetes mellitus, is status post-MI 1 month and has returned for a cardiology follow-up. Along with dietary changes, the nurse will discuss which nonpharmacologic lifestyle modification to reduce microvascular changes?
Glucose control
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
The nurse knows that nitroglycerin can be administered in what ways? (Select all that apply.)
IV Transmucosal Transdermal
The health care provider prescribes calcium channel blockers for a client who is diagnosed with angina pectoris. What is the action of calcium channel blockers?
Improve blood supply to the myocardium
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.
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
Which would a nurse identify as a nitrate?
Isosorbide
Which anti-anginal medications are indicated for the prevention of angina pectoris? (Select all that apply.)
Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Monoket) Topical nitroglycerin Oral nitroglycerin Transdermal nitroglycerin
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
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
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
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.
Which of the following drugs should be avoided by a client taking nitrates?
Phosphodiesterase 5 inhibitors
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 client arrives at the urgent care center complaining of chest pain. After diagnosis, the health care provider prescribes amlodipine for the client's condition. The nurse understands that this drug is indicated for which condition?
Prinzmetal angina
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 aware that the use of ranolazine is contraindicated in clients who have what condition?
QT-interval prolongation
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 provides client education on how to use translingual nitroglycerin. The client has an angina attack. The client uses the drug. At which step during the client usage would the nurse intervene?
Shakes the canister gently before using.
The nurse would avoid administering nitrates to clients using which medication?
Sildenafil
After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.)
Sildenafil Tadalafil Vardenafil
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 characteristics 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
A nurse is preparing to administer a prescribed nitrate to a client with angina. The nurse understands that nitrates are available in which dosage forms? Select all that apply.
Sublingual Transdermal Parenteral
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.
An older adult client whose medical history includes angina experiences a sudden onset of chest pain. This client would most likely administer a dose of nitroglycerin by what route?
Transmucosal spray
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:
Unstable angina
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.
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
increased heart rate and decreased blood pressure.
When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?
inhibiting the influx of calcium through slow channels.
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.
A client has had a myocardial infarction and is to receive propranolol. The nurse understands that this drug is being used to:
prevent reinfarction.
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.
