Chronic Stable Angina AQ
A patient with chronic stable angina has received a prescription for sublingual (SL) nitroglycerin. The nurse tells the patient that orthostatic hypotension is a side effect of the drug. What should the nurse include in the patient's teaching about preventing complications associated with the side effect? Multiple choice question "Take your blood pressure daily and record the measurement." "Take the medication with each meal, while you are in a seated position." "Avoid sudden changes in position after taking nitroglycerin to prevent falls." "If the medication causes a tingling sensation, this indicates that the hypotension will be more severe."
"Avoid sudden changes in position after taking nitroglycerin to prevent falls." Nitrates cause vasodilatation, which in turn causes peripheral pooling of blood. If a patient changes position suddenly (from recumbent to erect posture), there is a sudden drop of blood pressure, which is known as orthostatic hypotension. This decreases the blood supply to the brain, which may lead to dizziness and falling. Taking the blood pressure daily will not prevent orthostatic hypotension. The medication should be taken as needed, not with each meal. If there is no tingling sensation when taking the drug, then the medication may be expired or ineffective; the sensation is not associated with the degree of severity of the hypotension.
A patient with stable angina receives a prescription for isosorbide dinitrate. What medication education should the nurse provide to the patient? Select all that apply. Multiple selection question "Change positions slowly after taking this medication." "This is a short-acting nitrate that may produce a headache." "You cannot take sublingual nitroglycerin while taking this medication." "You will be scheduled for a 10- to 14-hour nitrate-free period every day." "You should take this medication as needed when experiencing chest pain."
"Change positions slowly after taking this medication." "You will be scheduled for a 10- to 14-hour nitrate-free period every day." The patient receiving nitrates is often scheduled for a 10- to 14-hour nitrate-free period every day to limit tolerance to the long-acting nitroglycerin (NTG). Orthostatic hypotension is caused by venous dilation, and patients should be provided with instructions about safety precautions while taking the medication. Remind patients that taking a long-acting NTG preparation should not keep them from using a translingual or sublingual (SL) NTG if angina develops. The medication is a long-acting nitrate that is taken regularly. The short-acting nitrates are taken as needed. The nurse should warn the patient that headache is a side effect but should not tell the patient that the medication is a short-acting nitrate.
The nurse provides medication teaching to a patient who has been prescribed sublingual (SL) nitroglycerin (NTG) tablets. Which statement made by the patient indicates the need for further education? Multiple choice question "When I put the tablet under my tongue, I should feel a tingling sensation." "I can take as many tablets as needed until the pain goes away, each five minutes apart." "I will need to be careful when I stand up because nitroglycerin can cause dizziness." "If chest pain occurs, I will stop what I'm doing and place one tablet under my tongue."
"I can take as many tablets as needed until the pain goes away, each five minutes apart." The recommended dose for the patient for whom NTG has been prescribed is one tablet taken SL or one metered spray for symptoms of angina. If symptoms are unchanged or worse after five minutes, the patient should contact the emergency medical services (EMS) system before taking additional NTG. Tell the patient to place an NTG tablet under the tongue and allow it to dissolve. NTG should cause a tingling sensation when administered; otherwise it may be outdated. Warn the patient that a headache, dizziness, or flushing may occur. Caution the patient to change positions slowly after NTG use because orthostatic hypotension may occur.
Which statement made by the student nurse indicates effective learning regarding the instructions to be given to a patient that receives a prescription for nitroglycerin? Multiple choice question "I should direct the patient to inhale the spray containing medication." "I should ask the patient to change position rapidly after the medication use." "I should instruct the patient to report changes in the pattern of pain to the health care provider." "I should encourage the patient to administer the medication every 30 minutes sublingually if symptoms persist."
"I should instruct the patient to report changes in the pattern of pain to the health care provider." Short-acting nitrates such as nitroglycerin (NTG) are first-line medications for angina. The nurse has to instruct the patient on NTG to report any changes in the pattern of pain, frequency of attack, or nocturnal angina to the health care provider. The nurse must direct the patient to spray the medication on his or her tongue. The nurse should ask the patient to slowly change positions after NTG use to avoid the effects of orthostatic hypotension. The nurse should ask the patient to take NTG every five minutes for a maximum of three doses if symptoms are not resolved.
Which statement made by the student nurse indicates effective learning about cardiovascular disease? Multiple choice question "Nicotine stimulates catecholamine release." "Isometric exercise provides relief from angina." "Manifestations of angina often occur in the late evenings." "Decreased heart rate increases myocardial oxygen demand."
"Nicotine stimulates catecholamine release." Chronic stable angina occurs due to insufficient blood flow in the coronary arteries due to atherosclerosis. Nicotine is a precipitating factor that provokes the angina attack because nicotine use stimulates catecholamine release, causing vasoconstriction and increased heart rate. Isometric exercise, such as lifting heavy objects, promotes the onset of angina; the patient should take nitroglycerin 5 to 10 minutes before beginning activities that are known to cause angina. Manifestations of angina occur in the early mornings due to a change in the circadian rhythm patterns. Increased heart rate due to exertion reduces the time the heart spends in diastole, resulting in increased myocardial oxygen demand.
A patient states, "I have episodes of sharp and stabbing chest pain that last 10 minutes and that occur primarily when I am restocking shelves while at work." The patient is diagnosed with chronic stable angina. Which instruction should the nurse give to the patient to prevent anginal pain while at work? Multiple choice question "Perform 30 minutes of moderate exercise before going to work." "Take nitroglycerin 5 to 10 minutes before restocking the shelves." "Take nitroglycerin every 5 minutes throughout the task until the work is complete." "Take a dose of the medication 30 minutes after restocking the shelves to maintain vasodilation.
"Take nitroglycerin 5 to 10 minutes before restocking the shelves." Reports of ten minutes of a sharp, stabbing pain when performing strenuous work indicate that the patient is experiencing an attack of chronic stable angina. The patient should be advised to take nitroglycerin prophylactically, 5 to 10 minutes before engaging in the activity. Patients with Prinzmetal's angina may get relief from chest pain by performing moderate exercise. The maximum number of nitroglycerin (NTG) tablets the patient can take is three. Taking the medication after the activity will not prevent the pain.
Which statement made by the student nurse indicates effective learning about microvascular angina? Multiple choice question "Pain may occur during rapid eye movement (REM) sleep." "Pain occurs at night and is triggered by the patient lying down." "This type of angina is more common in patients with diabetic neuropathy." "This type of angina is more common in women and is triggered by activities of daily living."
"This type of angina is more common in women and is triggered by activities of daily living." Microvascular angina is a chest pain associated with abnormalities of the coronary microcirculation, occurring especially in postmenopausal women. Often the angina is prolonged and brought on by physical exertion. Silent ischemia occurs in the patient with diabetic neuropathy due to the damage of nerves of the cardiovascular system. Nocturnal angina sets in when the patient lies down and is relieved upon standing or sitting. With Prinzmetal's angina, pain may occur during rapid eye movement (REM) sleep.
Which drug breaks up the fibrin meshwork in clots? Multiple choice question Nadolol Alteplase Valsartan Nicardipine
Alteplase Alteplase is a thrombolytic agent that breaks up the fibrin meshwork in clots. Nadolol is a β-adrenergic blocker that inhibits sympathetic nervous stimulation of the heart. Valsartan is an angiotensin II receptor blocker, which inhibits the binding of angiotensin II to angiotensin I receptors. Nicardipine is a calcium channel blocker that prevents calcium entry into the vascular smooth muscles and cardiac cells.
Which drugs may be prescribed for patients with chronic stable angina to help optimize myocardial perfusion? Select all that apply. Multiple selection question Aspirin Atenolol Captopril Atorvastatin Nitroglycerin
Atenolol Captopril Nitroglycerin Angiotensin-converting enzyme inhibitors such as captopril, β-adrenergic blockers such as atenolol, and nitrates such as nitroglycerin are used to optimize myocardial perfusion. Aspirin is an antiplatelet drug, and atorvastatin is a lipid-lowering drug. These drugs are used in patients with angina for managing coronary artery disease.
The nurse provides care to a patient that undergoes intracoronary stent placement along with balloon angioplasty. Which drugs are used during the procedure to prevent platelet aggregation within the stent? Select all that apply. Multiple selection question Verapamil Bivalirudin Eptifibatide Morphine sulfate Isosorbide dinitrate
Bivalirudin Eptifibatide A balloon angioplasty is performed in a patient with angina to dilate the coronary blood vessels. A stent is placed to keep the vessel open after the angioplasty. Drugs commonly used during the procedure are unfractionated heparin (UH) or low-molecular weight heparin (LMWH), a direct thrombin inhibitor (e.g., bivalirudin), and/or a glyocoprotein IIb/IIIa inhibitor (e.g., eptifibatide). Verapamil is a calcium channel blocker that is given to a patient with beta blocker intolerance. Morphine sulfate is an analgesic and promotes vasodilation, reducing preload and myocardial oxygen consumption. Isosorbide dinitrate is the first line drug for treatment of angina.
A patient with a history of diabetes is diagnosed with chronic stable angina. The nurse recalls that which drug that decreases endothelial dysfunction would be beneficial to this patient? Multiple choice question Diltiazem Sirolimus Captopril Bivalirudin
Captopril A patient with a history of diabetes who has chronic stable angina has a high risk for a cardiac event. An angiotensin-converting enzyme (ACE) inhibitor, such as captopril, can be safely used in this patient; it decreases endothelial dysfunction and prevents conversion of angiotensin I to angiotensin II, resulting in vasodilation. Beta blockers such as diltiazem mask the signs of hypoglycemia and are used cautiously in patients with diabetes. Sirolimus is used in drug-eluting stents that prevent the overgrowth of new intima, the primary cause of stent restenosis. Bivalirudin helps prevent the abrupt closure of the stents during percutaneous coronary intervention.
Which drug binds to antithrombin III, enhancing its effects? Multiple choice question Warfarin (Coumadin) Bivalirudin (Angiomax) Dalteparin (Fragmin) Ticagrelor (Brilinta)
Dalteparin Dalteparin binds to antithrombin III, enhancing its effect. Warfarin interferes with hepatic synthesis of vitamin K-dependent clotting factors, producing an anticoagulant effect. Bivalirudin acts by directly inhibiting the clotting factor, thrombin. Ticagrelor inhibits platelet aggregation and is used along with aspirin.
A patient with stable angina takes a short-acting nitrate. The nurse recognizes that it is important to monitor the patient for what? Multiple choice question Decrease in heart rate Decreased ejection fraction Decrease in blood pressure Prolonging of the QT interval
Decrease in blood pressure The patient has symptoms of unstable angina. The patient on short-acting nitrates such as nitroglycerin may experience orthostatic hypotension, so the blood pressure of the patient should be monitored regularly and the patient asked to make slow movements. A patient on fluoxetine must undergo monitoring for QT interval prolongation because this medication prolongs the QT interval. The patient on beta-adrenergic blockers may experience bradycardia and should be monitored for a decrease in the heart rate. The patients with heart failure should be monitored for ejection fraction.
Which drugs act by decreasing the contractility of the heart? Select all that apply. Multiple selection question Captopril (Capoten) Diltiazem (Cardizem) Valsartan (Diovan) Carvedilol (Coreg) Morphine
Diltiazem Carvedilol Diltiazem is a calcium channel blocker that reduces the heart rate, contractility, and blood pressure. Carvedilol is a β-adrenergic blocker that also reduces the heart rate, contractility, and blood pressure. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that causes vasodilation by preventing conversion of angiotensin I to angiotensin II. Valsartan is an angiotensin II receptor blocker that causes vasodilation by inhibiting the binding of angiotensin II to angiotensin I receptors. Morphine is an opioid analgesic that acts as a vasodilator and reduces preload and myocardial oxygen consumption.
Which drug causes vasodilation by preventing conversion of angiotensin I to angiotensin II? Multiple choice question Enalapril Losartan Amlodipine Nitroglycerin
Enalapril Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, resulting in vasodilation. Losartan is an angiotensin II receptor blocker that inhibits the binding of angiotensin II to angiotensin I receptors. Amlodipine is a calcium channel blocker that prevents calcium entry into the vascular smooth muscles and myocytes. Nitroglycerin is short-acting nitrate that causes peripheral vasodilation, thereby decreasing preload and afterload.
Which drug is given along with aspirin to patients with unstable angina and NSTEMI? Multiple choice question Heparin Warfarin Clopidogrel Atenolol
Heparin For patients with UA and NSTEMI, aspirin and heparin (UH or LMWH) are recommended. Unfractionated heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin. LMWH binds to antithrombin III, enhancing its effect. It also prevents conversion of fibrinogen to fibrin. Warfarin is used as an alternative for patients who cannot use aspirin or clopidogrel. Atenolol is a beta-adrenergic blocker which may prevent or control coronary vasospasm.
Which type of angina occurs in the absence of significant coronary artery disease (CAD)? Multiple choice question Silent angina Unstable angina Prinzmetal's angina Microvascular angina
Microvascular angina Microvascular angina occurs in the absence of coronary atherosclerosis or vasospasm. It is mainly associated with abnormalities of coronary microcirculation. Silent ischemia mostly occurs in patients with diabetes because diabetic neuropathy affects the nerves that innervate the cardiovascular system. Unstable angina occurs due to the rupture of thickened plaque. Prinzmetal's angina often occurs at rest in response to spasms of a major coronary artery.
A patient reports episodic chest pain lasting 10 minutes that is provoked by exertion and relieved upon resting. The nurse suspects that the cause of the patient's symptoms is what? Multiple choice question Spasm of a major coronary artery Exposure of the thrombogenic surface to plaque Myocardial ischemia due to coronary artery disease Myocardial ischemia secondary to microvascular disease
Myocardial ischemia due to coronary artery disease Pain is provoked upon exertion and relieved upon rest due to an increase in demand for oxygen or a decrease in the supply of oxygen that leads to myocardial ischemia secondary to coronary artery disease. Coronary vasospasm leads to Prinzmetal's angina, which primarily occurs at rest. Unstable angina occurs due to the rupture of thickened plaque, exposing thrombogenic surfaces in blood vessels. Microvascular angina is common in women and results from myocardial ischemia secondary to microvascular disease.
A patient tells the nurse, "Recently, each time I run on a treadmill machine, I get chest pain. The pain, however, goes away when I rest." The nurse anticipates that the patient will receive a prescription for which medication that may be used before the patient exercises? Multiple choice question Atenolol Diltiazem Morphine Nitroglycerin
Nitroglycerin Nitroglycerin (NTG) causes vasodilation, which decreases the blood volume returned to the heart and the resistance of the heart pump, causing a decrease in oxygen demand and consumption. Patients can use NTG prophylactically before starting an activity that is known to cause angina. Diltiazem is used to treat hypertension, not exercise-induced angina. Morphine produces venous dilation, reduces oxygen demand, and decreases pain and respirations. Atenolol is a beta blocker that lowers pulse and blood pressure.
A patient experiences anginal pain. What is an appropriate nursing intervention? Multiple choice question Position the patient upright and supply oxygen. Encourage the patient to perform isometric exercises. Place the patient in recumbent position during the attack. Recommend a salt-rich diet to prevent orthostatic hypotension.
Position the patient upright and supply oxygen. A patient with angina should be placed in an upright position and supplied oxygen to provide comfort and to attain an appropriate amount of oxygen in blood unless contraindicated. A recumbent positioning of the patient may precipitate the attack. Isometric exercises are stressful and may exacerbate the symptoms by increasing the cardiac workload. Salt and saturated fat foods are restricted in the patient to prevent further complications.
Which type of angina occurs as a result of coronary vasospasm? Multiple choice question Nocturnal angina Prinzmetal's angina Microvascular angina Chronic stable angina
Prinzmetal's angina Prinzmetal's angina is chest pain that occurs as a result of coronary vasospasm. Nocturnal angina occurs at night, during sleep. Microvascular angina is a result of myocardial ischemia secondary to microvascular disease, affecting the small, distal branches of coronary arteries. Chronic stable angina is the result of myocardial ischemia caused by an oxygen supply/demand mismatch.
A patient that smokes reports chest pain while at rest. The nurse suspects that the patient is experiencing which condition? Multiple choice question Silent ischemia Angina decubitus Prinzmetal's angina Chronic stable angina
Prinzmetal's angina Prinzmetal's angina often occurs at rest, usually in response to spasms of a major coronary artery due to nicotine, which cause the release of catecholamines such as epinephrine and norepinephrine. When the spasms occur, the patient experiences pain and ST segment elevation. Silent ischemia refers to the ischemia that occurs in the absence of any subjective symptoms. Angina decubitus is chest pain that occurs only when the patient is lying down. Chronic stable angina does not occur at rest and is triggered by physical exertion.
A patient with chronic stable angina is experiencing a prolonged QT interval on the electrocardiogram (ECG) monitor. The nurse reviews the list of drugs prescribed for the patient and should question which medication? Multiple choice question Aspirin Heparin Captopril Ranolazine
Ranolazine Ranolazine is a sodium current inhibitor that further prolongs the QT interval in patients who have QT prolongation. Aspirin and heparin are safe in patients with chronic stable angina and are used to inhibit clot formation in blood vessels. Captopril is an angiotensin II converting inhibitor that reduces the risk of cardiac events by dilating the blood vessels and reducing blood pressure.
The nurse is performing an assessment on a newly admitted patient who presented to the emergency department with reports of chest pain. Which assessment data would indicate that the patient has stable angina? Multiple choice question The patient developed chest pain shortly after going to bed. The patient developed chest pain while sitting and reading a book. The pain developed when the patient was jogging and subsided after the patient rested. The pain starts approximately the same time every day without regard to activity level.
The pain developed when the patient was jogging and subsided after the patient rested. Pain associated with stable angina is precipitated by increased demand of myocardial muscle for oxygen that happens with exercising or other activity and subsides with rest in 5 to 15 minutes. Prinzmetal's angina (variant angina) occurs at rest. Nocturnal angina occurs when patient is supine in bed. Prinzmetal's angina (variant angina) is characterized by pain that occurs at the same time of the day.
What is the reason behind prescribing low-molecular-weight heparin (LMWH) after a stent placement? Multiple choice question To stabilize the stent and prevent dislodgement To prevent thrombosis formation within the stent To prevent an anaphylactic reaction related to the stent anaphylaxis To allow for a smooth vascular surface within the intimal lining that grows over the stent
To prevent thrombosis formation within the stent Stent placement is associated with many risks. Dual antiplatelet drugs are taken to prevent thrombosis formation within the stent. LMWH is not an appropriate treatment for stent displacement or anaphylaxis. LMWH does not help healing in the vessel wall.
Which type of angina increases in frequency, duration, and severity as the time progresses? Multiple choice question Unstable angina Prinzmetal's angina Microvascular angina Chronic stable angina
Unstable angina Unstable angina is a chronic stable angina that increases in frequency, duration, and severity as the time progresses. Prinzmetal's angina occurs primarily at rest and is triggered by smoking and increased levels of substances, such as histamine and epinephrine. Microvascular angina is triggered by activities of daily life and exertion. Chronic stable angina is provoked by exertion and relieved by rest.
The nurse is caring for a patient with chronic stable angina that has a history of a stroke. Which prescription should the nurse question? Multiple choice question Aspirin Vorapaxar Metoprolol Nitroglycerin
Vorapaxar The nurse should be concerned about the prescription for vorapaxar. It must not be used in people who have had a stroke, because the risk for bleeding in the head is too great. Aspirin, nitroglycerin, and metoprolol may be appropriate for treatment of chronic stable angina in a patient who has had a stroke.
Which drug produces an anticoagulant effect by interfering with hepatic synthesis of vitamin K-dependent clotting factors? Multiple choice question Warfarin Prasugrel Argatroban Eptifibatide
Warfarin Warfarin interferes with hepatic synthesis of the vitamin K-dependent clotting factors that result in an anticoagulant effect. Prasugrel causes an antiplatelet effect by inhibiting platelet aggregation. Argatroban acts by directly inhibiting the clotting factor thrombin and results in an anticoagulant effect. Eptifibatide prevents the binding of fibrinogen to platelets, thereby blocking platelet aggregation.
A patient with a history of asthma presents to the emergency department with wheezing, chest pain, and shortness of breath. The nurse reviews the patient's medication profile and identifies that which type of medication may be responsible for the patient's symptoms? Multiple choice question Short-acting nitrate β-adrenergic blocker Calcium channel blocker Angiotensin II receptor blocker
β-adrenergic blocker The patient with a history of asthma should avoid β-adrenergic blockers because their side effects include wheezing from bronchospasm. Short-acting nitrates are the first line treatment for a patient with angina and can be used safely in patients. Calcium channel blockers are used in patients if β-blockers are contraindicated, poorly tolerated, or do not control anginal symptoms. Angiotensin II receptor blockers can be given to the patient safely because they have no harmful effects on the respiratory system.
