NUR 316- PREP U chap 44, 46
A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route? Oral Sublingual Transdermal Intravenous
Oral Explanation: Propranolol is used orally as treatment for angina.
Which assessment findings may indicate the client is experiencing digitalis toxicity? (Select all that apply.) Abdominal pain Diarrhea Drowsiness Increased appetite Vomiting
Abdominal pain Diarrhea Drowsiness Vomiting Explanation: Signs of digitalis toxicity include anorexia, nausea, vomiting, diarrhea, weakness, lethargy, drowsiness, headache, visual disturbances, and arrhythmias.
What is the most accurate method for preventing adverse effects associated with the use of digoxin? Teach patients to take their digoxin in divided doses with each meal. Assess the patient's heart rate and hold administration if it is less than 60. Teach patients the signs and symptoms of heart failure. Monitor therapeutic effects based on echocardiogram results.
Assess the patient's heart rate and hold administration if it is less than 60. Explanation: Patients should be taught to hold their digoxin if their heart rate is less than 60 (or some other defined heart rate). Divided doses are not normally used and an awareness of heart failure does not preclude adverse effects of digoxin.
A client is at risk for silent ischemia after experiencing a transmural MI. What would the nurse expect the physician to order? Nitrates Calcium channel blockers Antilipidemics Beta-blockers
Beta-blockers Explanation: Beta-blockers are more effective than nitrates or calcium channel blockers in decreasing the likelihood of silent ischemia and improving the mortality rate after transmural MI.
A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe? Bronchospasm Hypoglycemia Pleural effusion Pneumonia
Bronchospasm Explanation: When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung.
Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.) Capsule Injection Ointment Patch Tablet
Capsule Injection Tablet Explanation: Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist.
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 Hypotension Liver dysfunction Hypovolemia
Cerebral hemorrhage Explanation: Nitrates would be contraindicated in patients with cerebral hemorrhage because the relaxation of the cerebral vessels could cause intracranial bleeding. Nitrates should be used cautiously in patients with hypotension, which could be exacerbated by the drug. Nitrates should be used cautiously in patients with liver dysfunction, which could alter the drug's metabolism. Nitrates should be used cautiously in patients with hypovolemia, which could be exacerbated by the drug therapy. bral hemorrhage
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 Chest pain that occurs at rest Chest pain that occurs due to vasospasm Chest pain that occurs with coronary artery disease
Chest pain that is relieved by rest Explanation: Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal's angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.
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? Current respiratory rate Susceptibility of the patient to renal insufficiency Current blood pressure Susceptibility of the patient to intracranial pressure
Current blood pressure Explanation: For a patient receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A patient's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy.
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? Increased heart rate Increased oxygen consumption Decreased cardiac output Increased blood pressure
Decreased cardiac output Explanation: Beta-adrenergic blockers reduce heart rate, cardiac output, and blood pressure. This reduces the heart's oxygen demand, which in turn decreases angina.
The nurse teaches the client that antacids when taken with digoxin may have which interactions? Nausea and vomiting Increased digoxin levels Decreased digoxin levels Anorexia
Decreased digoxin levels Explanation: When antacids are taken combined with digoxin, the client may experience decreased serum digitalis levels. There is no effect on the gastrointestinal system.
When describing the action of ranolazine, which would be most appropriate? Shortens the QT interval Decreases myocardial workload Decreases heart rate Decreases blood pressure
Decreases myocardial workload Explanation: 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
Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism? Increasing conduction to the atrioventricular node, thereby increasing cardiac output Increasing cardiac output, thereby increasing the oxygen supplied to the heart Increasing blood pressure, which increases the amount of blood returned to the heart Decreasing the heart rate, allowing for longer filling time and increased blood to the heart
Decreasing the heart rate, allowing for longer filling time and increased blood to the heart Explanation: Beta-blockers prevent the beta-adrenergic receptors from being stimulated. These drugs have multiple effects on the heart and cardiovascular system, including slowing the heart rate, depressing atrioventricular (AV) conduction, decreasing cardiac output, and reducing systolic and diastolic blood pressure at rest and during exercise. These effects decrease the oxygen demands of the heart and thereby decrease angina.
Administration of a cardiotonic drug is contraindicated in which conditions? (Select all that apply.) Digitalis toxicity Hypertension Cardiac tamponade Hypotension Ventricular tachycardia
Digitalis toxicity Cardiac tamponade Ventricular tachycardia Explanation: The cardiotonics are contraindicated in the presence of digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardimyopathy, or AV block.
Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? The importance of having required laboratory work performed on time The need to take the medication at the same time each day regardless of her heart rate The correct technique for using a home blood pressure cuff Timing household activities to coincide with the administration times of her digoxin
The importance of having required laboratory work performed on time Explanation: Patients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the patient is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for patients who are taking digoxin.
A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's intake and output. blood pressure. cognition. exercise tolerance.
blood pressure. Explanation: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.
Cells of a failing heart due to heart failure often lack the ability to produce the energy needed for effective contraction.
True
A client has had a myocardial infarction and is to receive propranolol. The nurse understands that this drug is being used to: reduce the risk for recurrent anginal attacks. control the risk for vasospasm. prevent reinfarction. prevent the development of hypertension.
prevent reinfarction. Explanation: Propranolol is used after a myocardial infarction to prevent reinfarction. The drug could cause vasospasm and as such would not be indicated for the treatment of Prinzmetal's angina.
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 Decreased effectiveness of the antianginal drug Decreased effectiveness of the antihypertensive A greater incidence of hyperglycemic episodes
A greater incidence of adverse drug effects Explanation: Traditional antianginal drugs that act via hemodynamic mechanisms (e.g., beta-blockers, calcium antagonists, nitrates) can pose a problem in older adults because of the associated higher risk of drug interactions and greater incidence of adverse drug effects.
In heart failure, by what mechanism does the body compensate for decreased circulating blood volume? Activation of the renin-angiotensin-aldosterone system Increasing preload Decreasing afterload Increasing stroke volume
Activation of the renin-angiotensin-aldosterone system Explanation: As circulating volume to the kidneys decreases in CHF, the renin-angiotensin-aldosterone system is activated as the body attempts to "correct" for the low levels of circulating volume.
The nurse recognizes which medications may be the cause of a digoxin level of 2.7 nanograms/mL? Cholestyramine Antacids Methotrexate Amiodarone
Amiodarone Explanation: When combined with digoxin, amiodarone can cause increased serum digitalis levels leading to toxicity. Methotrexate, cholestyramine, and antacids all may cause decreased serum digitalis levels
After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment?
Digoxin Explanation: Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, nitrate, or furosemide also may be used, but these drugs are not the ones most commonly used.
A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered? Acetylsalicylic acid (aspirin) Nesiritide (Natrecor) Felbamate (Felbatol) Digoxin immune fab (Digibind)
Digoxin immune fab (Digibind) Explanation: A patient who has nausea and visual changes while taking digoxin will most likely be administered digoxin immune fab (Digibind). Acetylsalicylic acid is not administered for digoxin toxicity. Nesiritide is not administered when the patient is experiencing digoxin toxicity. Felbamate is administered for the treatment of seizures.
The nurse assesses the client taking nicardipine (Cardene) for which symptoms, which may indicate heart failure? (Select all that apply.) Dyspnea Weight gain Edema Tachycardia Bradycardia
Dyspnea Weight gain Edema Explanation: Symptoms of heart failure include dyspnea, weight gain, peripheral edema, abnormal lung sounds, and jugular vein distention. The heart rate may be increased, but this is not indicative of heart failure.
Beta blockers decrease myocardial oxygen demand by increasing the heart rate and decreasing cardiac contraction.
False Explanation: Beta blockers prevent the activation of sympathetic receptors, which normally would increase the heart rate, increase blood pressure, increase cardiac contraction, and increase the myocardial oxygen demand. Beta blockers block these actions.
The client is taking a calcium-channel blocker. What adverse effects might the client experience? Hypertension and tachycardia Headache and dizziness Flushing and rash Fever and bronchospasm
Headache and dizziness Explanation: Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.
A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug? Edema Hypotension Bradycardia Cyanosis
Hypotension Explanation: When caring for patients taking milrinone, the development of hypotension would necessitate the nurse withholding the drug and notify the practitioner. Hypotension occurs as an adverse effect of milrinone. Edema and cyanosis need to be assessed by the nurse as part of the pre-administration assessment. Edema, bradycardia, and cyanosis are not adverse effects associated with milrinone.
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hypotension Hypertension Hyperkalemia Hypokalemia
Hypotension Explanation: When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.
The nurse explains to the client that with heart failure, what may occur? Increased heart rate Decreased heart rate Visual disturbances Diarrhea
Increased heart rate Explanation: Tachycardia is a symptom related to heart failure. Bradycardia, diarrhea, and visual disturbances are signs of digitalis toxicity.
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
Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Monoket) Topical nitroglycerin Oral nitroglycerin Transdermal nitroglycerin Explanation: All nitroglycerin dosages forms are indicated for the prevention of angina pectoris.
When educating a group of nursing students on the mechanisms of action of digitalis, the nurse identifies what as the pharmacological actions of digitalis? (Select all that apply.)
It increases cardiac output by positive inotropic action It decreases the heart rate through negative chronotropic effect It retards the conduction velocity through the AV node in the heart Explanation: The pharmacological actions of digitalis are increased cardiac output, decreased heart rate, and retarding conduction velocity. Digitalis increases cardiac output by positive inotropic action. It does not have negative inotropic action. It decreases the heart rate through negative chronotropic effect. In atrial fibrillation rapid atrial contractions are seen. Digitalis is used to treat atrial fibrillation.
A client presents with chest pain. The nurse would assess what factors related to pain? (Select all that apply.) Location Cause Relief Intensity Blood pressure
Location Cause Relief Intensity Explanation: It is important that the location, quality, duration, intensity, and perceived cause and remedies used to relieve the pain are assessed. Blood pressure is not a sole indicator of pain.
Which of the following drugs should be avoided by a client taking nitrates? Phosphodiesterase 5 inhibitors Beta-blockers Nonsteroidal anti-inflammatory drugs Cardiac glycosides
Phosphodiesterase 5 inhibitors Explanation: Phosphodiesterase 5 inhibitors, such as sildenafil, tadalafil, or vardenafil used to treat erectile dysfunction, should be avoided if the client is taking nitrates due to the risk of severe hypotension and cardiovascular events. Beta-blockers in combination with nitrates may cause hypotension and should be used cautiously together. Nitrates do not interact with nonsteroidal anti-inflammatory drugs or cardiac glycosides.
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. Decrease serum triglyceride. Prevent angina attacks. Increase high-density lipoproteins (HDL). Treatment chronic stable angina pectoris.
Relieve the pain of acute anginal attacks. Prevent angina attacks. Treatment chronic stable angina pectoris. Explanation: Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.
After teaching a patient who is using isosorbide dinitrate for treatment of angina, the patient demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.) Sildenafil Tadalafil Vardenafil Heparin Ergotamine
Sildenafil Tadalafil Vardenafil Explanation: Sildenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Tadalafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Vardenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Heparin's effectiveness is decreased when combined with nitrates; dosage adjustments may be necessary. Ergot derivatives when combined with nitrates may increase the risk of hypertension and decreased antianginal effects; dosage adjustments may be necessary.
Nitrates are available in which dosage forms? (Select all that apply.) Sublingual Transdermal Parenteral Rectal Inhalation
Sublingual Transdermal Parenteral Inhalation Explanation: Nitrates are available in the following dosage forms sublingual, translingual spray, transdermal, and parenteral. Amyl nitrate is administered by inhalation.
A nurse suspects that a client is experiencing left-sided heart failure. Which would the nurse assess? (Select all that apply.) Tachypnea Hemoptysis Peripheral edema Hepatomegaly Orthopnea Polyuria
Tachypnea Hemoptysis Orthopnea Polyuria Explanation: Left-sided heart failure would be indicated by tachypnea, hemoptysis, orthopnea, increased urine output (polyuria), nocturia, dyspnea, and cough. Peripheral edema and hepatomegaly suggest right-sided heart failure.
The nurse knows that what are the goals of antianginal drug therapy? (Select all that apply.) To relieve acute anginal pain To prevent anginal episodes To improve exercise tolerance and quality of life To prevent MI and sudden cardiac death To increase the vascularity of the heart
To relieve acute anginal pain To improve exercise tolerance and quality of life To prevent MI and sudden cardiac death Explanation: The goals of antianginal drug therapy are to relieve acute anginal pain, to reduce the number and severity of acute anginal attacks, to improve exercise tolerance and quality of life, to delay progression of CAD, to prevent MI, and to prevent sudden cardiac death. Antianginal drug therapy does not increase the vascularity of the heart.
Vasodilators used to treat heart failure include nitrates and ACE inhibitors.
True
A patient presents to the ED with rales, wheezing, and blood-tinged sputum. The nurse suspects the patient is experiencing pulmonary edema. Pulmonary edema stems from: cardiomyopathy. right ventricular failure. valvular heart disease. left ventricular failure.
left ventricular failure. Explanation: Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues.
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." "You might have an irritation that's causing this." "You need a new supply because the drug has deteriorated." "That's a normal report we hear."
"That means that the drug is still potent and working." Explanation: Fizzing indicates potency, not irritation or deterioration.
A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication? "By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump." "This will lessen the workload of your heart by reducing your blood pressure." "Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin." "This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable."
"This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." Explanation: Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction.
Which instructions would be appropriate to include in the teaching plan for a patient taking digoxin at home? (Select all that apply.) "Weigh yourself each day at the same time and wearing the same amount of clothing." "Check your pulse every day before taking the medication." "Notify the doctor if your pulse is below 60 beats per minute." "Call your doctor if you notice an irregular heart rhythm or you feel nauseated." "Take the drug with some type of food to avoid an upset stomach."
"Weigh yourself each day at the same time and wearing the same amount of clothing." "Check your pulse every day before taking the medication." "Notify the doctor if your pulse is below 60 beats per minute." "Call your doctor if you notice an irregular heart rhythm or you feel nauseated." Explanation: This helps to evaluate the effectiveness of the drug and for signs and symptoms of heart failure. This is important in evaluating for digoxin toxicity. A pulse rate below 60 beats/minute might suggest digoxin toxicity. Irregular heart rhythm or nausea may indicate digoxin toxicity. Drug absorption is delayed if the drug is taken with food.
The client tells the nurse he does not like taking his prescription isosorbide because it makes him feel weak, dizzy, flushed, and he gets a severe headache. What is the nurse's best response? "Your physician may need to change your medications." "With time, these adverse reactions often subside." "It is important to take your medications no matter how badly they make you feel." "You are experiencing severe reactions and the medication needs to be stopped immediately."
"With time, these adverse reactions often subside." Explanation: Adverse reactions such as headache, flushing, and postural hypotension that are seen with the administration of the antianginal drugs often become less severe, or even disappear, after a period of time. The client should continue to take the medication.
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." "Do not take any more nitroglycerin. It is increasing your blood pressure." "If you lie down when taking nitroglycerin you will not experience a headache." "Nitroglycerin is dropping your blood pressure and that is causing the headache."
"You may experience headaches as an adverse reaction to nitroglycerin." Explanation: An adverse reaction of nitroglycerin includes headaches. The client should not reduce or stop taking the medication. Lying down will not prevent headaches associated with taking nitroglycerin.
After receiving a loading dose of milrinone (Primacor), what is a client most likely to experience? (Select all that apply.) Hypertension Angina Hyperkalemia Headache Insomnia
Angina Headache Explanation: The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, and hypokalemia.
Mr. Martin, a 52-year-old man, is prescribed amlodipine (Norvasc) for stable angina. What is the reason the physician prescribed this medication? Amlodipine is a calcium channel blocker that decreases the oxygen needs of the heart by a negative inotropic effect. Amlodipine is a calcium channel blocker that decreases the oxygen demands of the heart by a positive chronotropic effect. Amlodipine is a calcium channel blocker that increases the oxygen supply to the heart by a positive inotropic effect. Amlodipine is a calcium channel blocker that increases the blood supply to the heart by a positive dromotropic effect.
Amlodipine is a calcium channel blocker that decreases the oxygen needs of the heart by a negative inotropic effect. Explanation: Inotropic effect is the force of the heart contraction, chronotropic is the heart rate, and dromotropic is the conduction through the heart. Calcium travels to these cells through special channels. Calcium channel blockers inhibit calcium from moving across cell membranes. The effects of this inhibition on the cardiovascular system are decreased contraction, depression of impulse formation (automaticity), and slowing of conduction velocity. These have the effect of decreasing the oxygen needs of the heart. Calcium channel blockers also cause arteriolar dilation, decreasing the afterload. Calcium channel blockers are used in chronic stable angina when the patient cannot tolerate beta-blockers, or if the symptoms are not adequately controlled with this therapy (ACC/AHA, 2002). The calcium channel blockers used for chronic stable angina are verapamil (Calan), amlodipine (Norvasc), bepridil (Vascor), diltiazem (Cardizem), nicardipine (Cardene), and nifedipine (Procardia).
When preparing a care plan for chronic heart failure, the nurse bases recommendations on the newest research about prior treatment for CHF. Based on knowledge of the guidelines, which drug combination therapy has been shown to decrease mortality from CHF? Digoxin, a beta-blocker, and a diuretic Digoxin and a beta-blocker Digoxin and an ACE inhibitor An ACE inhibitor, a beta-blocker, and a diuretic
An ACE inhibitor, a beta-blocker, and a diuretic Explanation: The combination of an ACE inhibitor, a beta-blocker, and a diuretic has been shown to decrease mortality from CHF. This is the recommended therapy. Digoxin does not decrease mortality from CHF but it decreases symptoms and improves exercise tolerance, thereby improving the quality of life.
A physician has ordered 40 mg of isosorbide dinitrate for a patient who reports chest pain. The nurse administers the medication after confirming the absence of what condition? Jaundice Headache Anemia Sinusitis
Anemia Explanation: Contraindications for nitrates, including isosorbide dinitrate, are severe anemia and hypotension. Neither jaundice nor sinusitis are contraindications to use of the drug. Headache is an adverse effect of nitrates and might be expected after administration.
A patient has been admitted to a health care center with reports of dyspnea. Which signs should the nurse monitor for when assessing the patient for left ventricular dysfunction? Nocturia Pitting edema Weight gain Orthopnea
Orthopnea Explanation: The nurse should assess for orthopnea in patients with left ventricular dysfunction. Orthopnea is a condition where the patient experiences difficulty in breathing on lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, or anxiety. Nocturia, pitting edema, and weight gain are associated with right ventricular dysfunction, and not left ventricular dysfunction.
The client is started on a transdermal nitroglycerin system. The nurse teaches the client that the system relieves pain by which action? Dilates the coronary arteries Dilates arteries and veins Decreases the size of the artery Increases the workload of the heart
Dilates arteries and veins Explanation: 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.
When describing the possible adverse effects associated with nitroglycerin, what would the nurse include? Dizziness Hypertension Chills Constipation
Dizziness Explanation: Dizziness is a possible adverse effect. Hypotension is a possible adverse effect. Flushing is a possible adverse effect. Constipation is not associated with nitroglycerin.
A male client does not respond to traditional treatment for his chronic angina. The physician orders ranolazine (Ranexa) and orders a baseline ECG prior to medication administration. Three months later, the physician orders a repeat ECG. For what reason is the physician monitoring the client? Dose-dependent QT prolongation Dose-dependent ST elevation Dose-dependent ectopic beats Dose-dependent premature ventricular beats
Dose-dependent QT prolongation Explanation: Ranolazine (Ranexa) represents a new classification of antianginal medication, metabolic modulators, used in people with chronic angina. The drug is labeled for use in combination with amlodipine, beta-blockers, or nitrates. After oral administration, peak plasma concentrations are reached within 2 to 5 hours. The drug is rapidly and extensively metabolized in the liver. Because of a risk of dose-dependent QT prolongation on electrocardiogram, ranolazine is reserved for the treatment of clients with chronic angina who have not achieved a satisfactory antianginal response with traditional drugs.
Angina pectoris is a clinical syndrome characterized by episodes of chest pain. What other characteristics describe angina pectoris? Choose all that apply. It occurs when there is a deficit in myocardial oxygen supply. It is most often caused by atherosclerotic plaque in the coronary arteries. There are three types of angina: classic, variant, and unstable. It occurs when there is an increase in myocardial oxygen supply.
It occurs when there is a deficit in myocardial oxygen supply. It is most often caused by atherosclerotic plaque in the coronary arteries. There are three types of angina: classic, variant, and unstable. Explanation: Angina pectoris is a clinical syndrome characterized by episodes of chest pain. It occurs when there is a deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand. There are three main types of angina: classic, variant, and unstable. Angina is most often caused by atherosclerotic plaque in the coronary arteries but may also be caused by coronary vasospasm.
The physician prescribes calcium channel blockers for a client who is diagnosed with angina pectoris. What is the action of calcium channel blockers? Induce coronary artery vasospasm Increase blood pressure to increase oxygenation to the myocardium Improve blood supply to the myocardium Prevent anginal episodes
Improve blood supply to the myocardium Explanation: In angina pectoris, calcium channel blockers improve blood supply to the myocardium by dilating coronary arteries and decrease the workload of the heart by dilating peripheral arteries; in variant angina, the drugs reduce coronary artery vasospasm.
What does the use of cardiotonics lead to? (Select all that apply.) Improved myocardial contractility Increased myocardial efficiency Increase in blood pressure Increase in peripheral edema Improved perfusion to all body tissues
Improved myocardial contractility Increased myocardial efficiency Improved perfusion to all body tissues Explanation: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow (perfusion) to all tissues of the body.
Which would a nurse identify as a nitrate? Metoprolol Amlodipine Nicardipine Isosorbide
Isosorbide Explanation: Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers.
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 Gastrointestinal upset Skin color Weight
Location, quality of pain Blood pressure Skin color Explanation: If the client is having chest pain, it is a top priority that the pain, skin color, and vital signs be assessed prior to administration of antianginal medication. Obtaining an accurate weight is important, but it is important the pain be addressed immediately. Gastrointestinal upset is not a priority.
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 the benefits of exercise to decrease the oxygen demands of the heart Discussing circumstances for which the client should seek emergency care Assisting clients to modify factors that contribute to angina
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 Explanation: The home care nurse's responsibilities may include monitoring the client's response to antianginal medications; teaching clients and caregivers how to use, store, and replace medications to ensure a constant supply; and discussing circumstances in which the client should seek emergency care. The client should also be instructed in factors that contribute to angina such as smoking and obesity.
Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which statement is true regarding the use of ranolazine for the treatment of this patient's angina? Ranolazine confers protection from myocardial infarction but does not relieve symptoms of angina. Amlodipine will now be contraindicated in the treatment of Mr. Penny's angina. Mr. Penny will need to be taught to monitor his blood pressure and heart rate. Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.
Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker. Explanation: Ranolazine should be used only in combination with other antianginal therapy (either nitrates, beta blockers (metoprolol or atenolol), or amlodipine, a calcium channel blocker. It does not achieve its effects by lowering the heart rate or the blood pressure. Ranolazine has the potential to prevent MI.
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 Isoxsuprine Papaverine Cilostazol
Nicardipine Explanation: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isoxsuprine, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.
Which statements are true in regards to nitrates? (Select all that apply.) Nitrates relax the smooth muscle layer of blood vessels. Nitrates increase the lumen of the artery or arteriole. Nitrates increase the amount of blood flowing through the vessel. Nitrates slow the conduction velocity of the cardiac impulse. Nitrates depress myocardial contractility.
Nitrates relax the smooth muscle layer of blood vessels. Nitrates increase the lumen of the artery or arteriole. Nitrates increase the amount of blood flowing through the vessel. Explanation: Nitrates relax the smooth muscle of blood vessels, increase the lumen of the artery or arteriole, and increase the amount of blood flowing through the vessel.
Ms. Catril is prescribed sublingual nitroglycerin by her physician for the treatment of stable angina. She contacts the physician office and states that she feels light-headed after taking the medication for an acute episode of chest pain. Based on the nurse's knowledge of nitroglycerin, what is the pathophysiology behind the patient having light-headedness? Nitroglycerin causes dilation of the arteries and veins, thereby increasing the blood flow to the brain. Nitroglycerin causes relaxation of the vascular smooth muscles, thereby preventing adequate blood flow to the brain. Nitroglycerin causes relaxation of the arteries and veins, resulting in blood pooling in the extremities and the blood pressure dropping. Nitroglycerin causes a decrease in venous return, thereby limiting the blood flow to the brain.
Nitroglycerin causes relaxation of the arteries and veins, resulting in blood pooling in the extremities and the blood pressure dropping. Explanation: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will decrease as a result of venous dilation. Reflex tachycardia may follow the drop in blood pressure.
A patient 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 patient's current status? Nitroglycerine will raise the patient's blood pressure. Nitroglycerine will cause decreased cerebral edema. Nitroglycerine will increase intracranial pressure. Nitroglycerine will decrease blood glucose.
Nitroglycerine will increase intracranial pressure. Explanation: Nitroglycerine should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerine will lower blood pressure. Nitroglycerine can increase cerebral edema. Nitroglycerine does not have a direct effect on blood glucose.
The client is experiencing an acute onset of angina. The nurse would administer which medication? Nitrostat Nitro-Dur Norvasc Procardia
Nitrostat Explanation: Nitrostat is administered for acute relief of angina. Nitro-Dur is used to prevent angina. Procardia and Norvasc are indicated for chronic angina.
The nurse recognizes that which finding is associated with right-sided heart failure? Dyspnea Nocturia Orthopnea Crackles in the lungs
Nocturia Explanation: Nocturia is a symptom of right-sided heart failure. Crackles in the lungs, dyspnea, and orthopnea are symptoms related to left-sided heart failure because they are pulmonary symptoms.
The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take? Administer medication Notify the physician Assess the blood pressure Administer half of the dose
Notify the physician Explanation: Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the physician. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages.
What should a client be told in regards to the pain relief anti-anginal drugs provide? (Select all that apply.) Pain will only occur during prolonged exercise. Pain may be less intense. Pain will be completely relieved. Pain may be less frequent. Pain will worsen with continued use.
Pain may be less intense. Pain may be less frequent. Explanation: Angina pain will not be completely relieved in all clients. In some clients pain may be less intense, frequent, or may only occur during prolonged exercise.
When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.) Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics
Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics Explanation: All of the answers are factors to consider when dosing digoxin (Lanoxin).
A male client asks the nurse why the doctor 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 episodic hypertensive crisis and subsequent CVA Prevents cerebral edema and subsequent CVA Prevents progression of myocardial ischemia to MI Reduces afterload that fosters an MI
Prevents progression of myocardial ischemia to MI Explanation: Aspirin, antilipemics, and antihypertensives are used in conjunction with antianginal drugs to prevent progression of myocardial ischemia to MI.
A patient arrives at the community health care center with chest pain. After diagnosis, the health care provider has prescribed amlodipine for the patient's condition. Which condition should the nurse identify as an indication for amlodipine therapy? Cardiogenic shock Prinzmetal's angina Sick sinus syndrome Atrioventricular (AV) block
Prinzmetal's angina Explanation: 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.
Several alternate dosage forms have been developed for nitroglycerin administration to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. Indicate why oral form dosing of nitrates is not the most effective administration route. Select all that apply. Large doses reach systemic circulation quickly. Rapid metabolism by the liver. Slow onset of action doesn't relieve acute pain. Longer duration of action.
Rapid metabolism by the liver. Slow onset of action doesn't relieve acute pain. Explanation: Oral dosage forms are rapidly metabolized in the liver, and relatively small proportions of doses reach the systemic circulation. In addition, oral doses act slowly and do not help relieve acute chest pain. Other choices are incorrect.
Which statement correctly distinguishes between the therapeutic effects of sublingual isosorbide and sublingual nitroglycerin? Sublingual isosorbide has a faster onset and a shorter duration of action than sublingual nitroglycerin. Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Sublingual isosorbide has a lesser sustained effect than sublingual nitroglycerin. Sublingual isosorbide is not as effective as sublingual nitroglycerin.
Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Explanation: Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Because sublingual isosorbide does not relieve chest pain as rapidly as nitroglycerin, isosorbide is limited to treating acute angina in patients intolerant of or unresponsive to sublingual nitroglycerin. Although nitroglycerin may be used occasionally, with adequate monitoring during the early phases of acute MI, isosorbide should never be used, because of its greater sustained effects.
The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports: minimal episodes of angina. that he gets a headache each time the ointment is applied. no episodes of angina since ointment was initiated. dizziness after each application.
no episodes of angina since ointment was initiated. Explanation: Topical nitroglycerin is used to manage angina. The treatment is effective if the client reports no episodes of angina. Headache and dizziness are adverse effects of the medication.
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? The patient will likely have a trial of antiplatelet drugs before being prescribed nitrates. The patient would benefit from a weekly intravenous dose of a beta blocker. The patient's angina may necessitate the use of a calcium channel blocker. The patient indicates a need for daily low-molecular weight heparin therapy
The patient's angina may necessitate the use of a calcium channel blocker. Explanation: 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.
The nurse is caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within: one to three minutes. five to ten minutes. fifteen to twenty minutes. thirty minutes to an hour.
one to three minutes. Explanation: Sublingual nitroglycerin acts within one to three minutes and lasts thirty minutes to an hour.
Which is an adverse reaction associated with cardiotonic medications? Visual disturbances Diarrhea Constipation Restlessness
Visual disturbances Explanation: Adverse reactions associated with the cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias.
