CH 28 Drugs for Coronary Heart Disease (E3)
The nurse is teaching the client about coronary artery disease (CAD). Which statement by the client indicates that he or she has understood the teaching? A) "I will avoid exercise because it will precipitate my angina." B) "As long as I take my medicines, I will not need to decrease my fat intake." C) "My high blood pressure has no effect on my episodes of chest pain." D) "High fat in the diet and smoking can cause my episodes of chest pain."
D
A nurse is taking a medication history from a client who has angina is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? SELECT ALL THAT APPLY. A) Digoxin B) Simvastatin C) Verapamil D) Amlodipine E) Nitroglycerin transdermal patch
A, B, C
A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks. "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain? Which of the following responses should the nurse make? A) "Take two more sublingual tablets at the same time. B) "Call the emergency response team. C) "Take a sustained-release nitroglycerin capsule." D) "Wait another 5 minutes then take a second sublingual tablet.
B
An older adult client, diagnosed with angina pectoris, has been prescribed nifedipine. After administering a dose of the drug at 08:00, the nurse should anticipate maximum effect at what time? A) between 08:30 and 09:00 B) 09:00 to 10:00 C) between 12:00 and 14:00 D) 11:30 to 12:30
B
Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment? A) level of consciousness (LOC) B) blood pressure (BP) C) oxygen saturation levels (SaO2) D) oral temperature
B
What medication will most likely be prescribed for a client whose chest pain is not relieved with sublingual organic nitrate? A) intravenous morphine sulfate B) intravenous nitroglycerin C) oral nonsteroidal anti-inflammatory agents D) fentanyl topical patch
B
What principle should guide the nurse's follow-up assessment after administering an oral dose of 30 mg of long-lasting nifedipine? A) Nifedipine has the potential to induce prodysrhythmic effects. B) Nifedipine does not affect heart rate, so assessment after administration is not normally necessary. C) The client's heart rate will be at its lowest approximately 45 minutes to 1 hour after oral administration of nifedipine. D) The client's blood pressure, heart rate, and oxygen saturation level should be assessed 30 minutes after administration of nifedipine.
B
A 63-year-old woman continues to complain of chest pain, although her cardiac catheterization showed no significant cardiac disease. She notes that the chest pain occurs at the same time each night and typically during the cold weather. What kind of angina is the patient likely experiencing? A) stable angina B) unstable angina C) variant angina D) acute coronary syndromes
C
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? A) Nitroglycerin will raise the client's blood pressure. B) Nitroglycerin will cause decreased cerebral edema. C) Nitroglycerin will increase intracranial pressure. D) Nitroglycerin will decrease blood glucose.
C
Concurrent use of nitrates in any form or route of administration with phosphodiesterase enzyme inhibitors produces which of the following? A) enhanced erectile potential B) significant tachycardia C) severe hypotensive effects D) mild bronchodilation
C
The health care provider prescribes nitroglycerin 2% ointment, 1.5-inch dose every 4 hours. To accurately apply the ointment, the patient should be instructed to do which of the following? A) rub the ointment into the skin to enhance absorption B) leave previous ointment on for 4 hours after applying a new dose C) rotate application sites to decrease skin irritation D) place the ointment on a distal part of the lower body to increase absorption
C
What should the client be taught regarding the advantage of the nitroglycerin patch? A) It is only administered one time per week. B) It requires rotation of application site. C) It has a longer duration of action. D) It has a faster action than the tablets.
C
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? A) myocardial infarction B) intermittent claudication C) hypertension D) angina pectoris
D
A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect? A) relief of fatigue B) increased oxygen saturation levels C) mild to moderate drowsiness D) decreased heart rate
D
A nurse is caring for a client who is prescribed isosorbid mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications shouId the nurse expect to administer? A) Furosemide B) Captopril C) Ranolazine D) Metoprolol
D
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? A) subcutaneous injection B) oral sustained-release tablet C) nebulized inhalation D) transmucosal spray
D
When teaching the client to safely administer nitroglycerin ointment, the nurse should convey which instruction? A) "The backs of your hands and the tops of your feet are ideal sites for applying the ointment." B) "Make sure you squeeze the ointment on to a paper measuring scale before applying it." C) "Massage the ointment into your skin for 10 to 15 seconds after applying it." D) "Don't apply the ointment unless you're experiencing chest pain at the time."
B
Which of the following classes of medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A) nitrates B) beta-adrenergic blockers C) adenosine diphosphate receptor antagonists D) calcium channel blockers
B
Which assessment findings would prompt the nurse to withhold a scheduled dose of oral atenolol? SELECT ALL THAT APPLY. A) heart rate of 68 beats per minute B) blood pressure of 88/49 mm Hg C) heart rate of 54 beats per minute D) blood pressure of 141/92 mm Hg E) oxygen saturation of 90% on room air
B, C
A 57-year-old man taking metoprolol presents to the cardiac clinic following a myocardial infarction. He reports that he continues to smoke. Smoking may contribute to what effect on beta-adrenergic blocking activity? A) reduce the efficacy B) potentiate an increase in intracranial pressure C) precipitate ventricular fibrillation D) increase the incidence of adverse effects
A
A 59-year-old client with a long history of heavy alcohol use and angina was diagnosed with liver cirrhosis several months ago. When considering the use of nifedipine, what consideration should the nurse be aware of? A) The client is likely to experience an increased effect of the medication. B) This client will require a higher dose than a client without this medical history. C) Nifedipine is contraindicated because it is highly hepatotoxic. D) The client's increased albumin levels will negate the therapeutic effect.
A
A 72-year-old woman with angina pectoris, who is being discontinued from beta-adrenergic blockers, asks the nurse, "Why can't I just stop taking the drug today if it's not working anyway?" The nurse instructs the patient that failure to taper the drug slowly may lead to which of the following? A) worsening of her angina symptoms B) significant bronchoconstriction C) development of heart failure D) drug fever
A
A client is experiencing chest pain and self-administers nitroglycerin sublingually. When should the client expect to notice relief of the chest pain? A) 1 to 3 minutes B) 5 to 10 minutes C) 15 to 20 minutes D) 30 to 60 minutes
A
A client with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem? A) bronchospasm B) hyperglycemia C) pleural effusion D) pneumonia
A
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? A) "Nitroglycerin and sildenafil cause a severe decrease in blood pressure." B) "Nitroglycerin and sildenafil can lead to prostate cancer." C) "Nitroglycerin decreases the effect of sildenafil for erectile dysfunction." D) "Nitroglycerin and sildenafil will diminish the effectiveness of chest pain relief."
A
A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instruction? A) "Remove the prior dose before applying a new dose. B) "Rub the ointment directly into your skin until it is no longer visible. C) "Cover the applied ointment with a clean gauze pad." D) "Apply the ointment to the same skin area each time.
A
A nurse is teaching a client who has prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A) Remove the patch each evening. B) Cut each patch in half if angina attacks are under control. C) Take off the nitroglycerin patch for 30 min if a headache occurs. D) Apply a new patch every 48 hr.
A
A patient taking nitroglycerin for angina reports developing a headache after taking more than one tablet. The nurse should inform him of which of the following? A) Headache is a common side effect due to the vasodilating effects of the medication. B) A headache indicates that a person is allergic to the nitroglycerin. C) The experience of headache means that the levels of nitroglycerin are toxic. D) The experience of headache likely means that the tablets have passed their expiration date.
A
The nurse should administer bisoprolol with an understanding that it achieves a therapeutic effect in what way? A) decreasing heart rate B) increasing the force of myocardial contractions C) prolonging the QT interval D) shortening the time required for repolarization
A
When teaching clients about the effect of nicotine on the cardiovascular system, the nurse should include what information? A) It increases catecholamines that increase heart rate. B) It diminishes the blood's ability to clot. C) It increases myocardial contractility of the heart. D) It increases high-density lipoproteins.
A
The nurse is educating a patient taking sublingual nitroglycerin 0.4 mg for anginal pain. Which of the following statements indicate that the patient understands the instructions? SELECT ALL THAT APPLY. A) "I should take one nitroglycerin tablet every 5 minutes for pain, up to a total of three tablets, as needed." B) "I should expect that the nitroglycerin will cause a stinging sensation when placed under my tongue." C) "I should store my nitroglycerin in the original dark bottle to protect the tablets from light." D) "I should replace my nitroglycerin tablets every month whether the bottle has been opened or not." E) "I should seek help for my anginal symptoms if I do not get relief with three sublingual tablets."
A, B, C
When will the nurse know that the client has maximal tolerance of isosorbide dinitrate? A) when nausea develops B) when halos are seen around lights C) when a headache develops D) when the heart rate increases to 100
C
Which of the following are expected outcomes for a patient on the 2nd day of hospitalization after revascularization following an ST-segment elevation myocardial infarction? SELECT ALL THAT APPLY. A) The patient reports only minimal chest pain and diaphoresis with activity. B) Electrocardiogram (ECG) monitors shows sinus tachycardia with only occasional premature ventricular contractions. C) There is absence of bleeding complications. D) 12-Lead ECG shows a decrease of the ST-segment elevations by 50% of the initial height.
C, D
In caring for a patient with chronic angina who has been prescribed the new drug, ranolazine, the nurse is correct in counseling which of the following about this drug? A) may be crushed if necessary B) must not be taken with beta-adrenergic blockers C) must not be taken with meals D) should not be taken with grapefruit juice
D
The nurse removes a patient's transdermal nitroglycerin disk at bedtime as ordered to minimize nitrate tolerance. The patient awakens during the night and complains of anginal symptoms. The nurse's action is to do which of the following? A) notify the health care provider B) apply a new transdermal disk C) obtain further history of complaints D) administer a short-acting nitrate as ordered
D
Which electrocardiogram change should prompt the nurse to question the use of ranolazine for the treatment of a client diagnosed with chronic angina? A) normal ST segment B) inverted P wave C) shortened QRS D) QT prolongation
D
