ch 46 antianginals

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 should provide further teaching about the nitroglycerin transdermal patch needs to be applied in the morning, and then removed after 10-12 hours, and left off until the next morning. The patch delivers a constant amount of the drug, which without removal of the drug leads to tolerance of the drug, making it ineffective. The client is correct in rotating sites of placement of the transdermal patch and to place it on chest, abdomen, and thighs. The client should avoid lower legs. It is important to fold the patch in half before disposing of it in the trash to prevent a person or pet from encountering the drug that remains in the delivery system. Cleaning the skin is important in removing any residual drug from the skin.

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."

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."

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 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?

1-3min

A client is to take diltiazem (Cardizem) 360 mg/d PO in four divided doses. How many mg will the client take per dose?

90mg

The physician is considering prescribing a beta blocker for a patient who is experiencing angina. For which condition should the patient be assessed before the physician orders the medication?

COPD, diabetes, PVD, asthma

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 Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.

Beta-blockers have what advantage over nitrates in the management of angina?

Clients do not develop tolerance to beta-blockers.

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 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 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 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?

IV

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 Intravenous nitroglycerin is used to manage angina that is unresponsive to organic nitrates via other routes since it quickly increases blood flow to the heart. The use of intravenous morphine sulfate will decrease pain but will not increase needed blood flow. Oral nonsteroidal anti-inflammatory agents will not assist in decreasing pain or increasing needed blood flow. The application of a fentanyl patch will not increase needed blood flow.

Which would a nurse identify as a nitrate?

Isosorbide Isosorbide is a nitrate. Metoprolol is a beta blocker. Nadolol is a beta blocker. Propranolol is a beta blocker.

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.

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

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?

Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker. 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

A 62-year-old client is prescribed sublingual nitroglycerin by the health care provider for the treatment of stable angina. The client contacts the office and reports feeling 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 client having light-headedness?

Nitroglycerin causes relaxation of the arteries and veins, resulting in blood pooling in the extremities and the blood pressure dropping.

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.

When describing angina to a group of clients, what would be most accurate?

Pain due to lack of oxygen in the heart muscle Angina is most accurately described as the body's response to a lack of oxygen in the heart muscle. It commonly is manifested as chest pain, but it can occur at rest or with activity. Angina does not necessarily indicate damage to the heart muscle. Ischemia leads to damage. Prinzmetal angina is a type of angina that is due to vessel spasm.

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.

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 Aspirin, antilipemics, and antihypertensives are used in conjunction with antianginal drugs to prevent 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 The nurse should identify Prinzmetal angina as the condition for which amlodipine is indicated. Prinzmetal angina is a vasospastic angina for which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome, and AV block are the conditions for which amlodipine is contraindicated.

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 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 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 client is at risk for silent ischemia after experiencing a transmural MI. What would the nurse expect the health care provider to order?

beta blockers

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 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

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

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

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

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

inhibiting the influx of calcium through slow channels. Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. None of the other options accurately describes the action of nifedipine.

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

nitrostat Nitrostat is administered for acute relief of angina. Nitro-Dur is used to prevent angina. Procardia and Norvasc are indicated for chronic angina.

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

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 characteristic 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 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 Unstable angina is chest pain that occurs when the client is at rest. Stable angina is chest pain that occurs with activity and is relieved by rest. Prinzmetal angina is chest pain due to vessel spasm. Myocardial infarction indicates ischemia and subsequent necrosis of the heart muscle.