Ch 46: Antianginal Agents
A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration?
"I can take up to three tablets at five-minute intervals." Explanation:Clients may take up to three doses of sublingual nitroglycerin at five-minute intervals to relieve anginal chest pain. They should take as few doses as necessary to relieve pain. Administration should begin at the first sign of pain.
What indicates that a client understands how to use sublingual nitroglycerin?
"I should feel a fizzing or burning sensation." Explanation:A fizzing or burning sensation indicates that the tablet is potent. The client should place the tablet under his tongue and away from any lesions or abrasions. If needed, the client can take a sip of water to moisten the mucous membranes so that the tablet will dissolve quickly. After placing the tablet under the tongue, the client should close his mouth and wait until the table has dissolved.
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." Explanation: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.
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." Explanation:The nurse needs to provide additional teaching about where to store nitroglycerin tablets. Nitroglycerin tabs are stored at room temperature, and storing it in a pants pocket will increase the temperature close to body temperature making the drug less effective. The client should keep the medication stored in the original container. Document the date and time when the bottle is opened and remove the cotton. Once opened, it is potent for no longer than 3 to 6 months. The client should feel a tingling sensation under the tongue if it is potent. Ensuring that the mouth is moist is important in providing an optimal environment for absorption. The client should sit or lie down before taking a nitroglycerin because the medication may cause a significant drop in blood pressure.
A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement?
"I will take a pill every 15 minutes until the pain subsides." Explanation:When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension.
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." Explanation:The client with stable or unstable angina will be prescribed sublingual nitroglycerin to relieve chest pain symptoms. The client may take up to three tablets of sublingual nitroglycerin 5 minutes apart. If the chest pain is unrelieved, the client needs to seek emergency medical 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." Explanation:Application of nitroglycerin ointment requires using the dose-measuring application papers supplied with ointment. It is necessary to squeeze the ointment onto a measuring scale printed on paper. The ointment should be applied onto a nonhairy area of the skin, and distal extremities should be avoided. The area of application should not be massaged. All these practices would affect the absorption of the medication.
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." Explanation:Nitrates and phosphodiesterase enzyme type 5 inhibitors like sildenafil decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension. None of the remaining options are accurate statements regarding sildenafil.
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." Explanation:Nitroglycerin should not be used in clients with head trauma because it increases blood flow through the vessels and may increase pressure within the brain. Nitroglycerin affects all vessels of the body.
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." Explanation:Nitroglycerin should not be used in clients with head trauma because it increases blood flow through the vessels and may increase pressure within the brain. Nitroglycerin affects all vessels of the body.
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." Explanation:Fizzing indicates potency, not irritation or deterioration.
A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client?
"The heart muscle isn't getting enough oxygen." Explanation:The body's response to a lack of oxygen in the heart muscle is pain, which is called angina. The narrowing of arteries due to fatty deposits is called atherosclerosis. Although left ventricular enlargement may occur with coronary artery disease, it is not the underlying mechanism involved with angina. Damage to the heart muscle in response to ischemia is called a myocardial infarction.
The nurse is caring for a male client with a history of hypertension and Prinzmetal angina who is currently taking amlodipine 10 mg orally every day, and minoxidil 25 mg orally twice a day. The client stated that he is concerned about a recent enlargement of his breasts. What is the best therapeutic response to the client's concern?
"The increase in breast size is an adverse effect of minoxidil, and I will notify your primary care provider so other options may be explored." Explanation:The best therapeutic response is factual and involves action to help the client. Telling a client to not worry and that the breasts are hardly noticeable is nontherapeutic and patronizing. It is incorrect to tell the client he must stay on the prescribed meds because there are other drugs in the same categories available that do not lead to gynecomastia. Telling the client that he needs to lose weight to help his blood pressure and decrease the breast size is blaming the client for the situation.
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." 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.
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 Explanation:When given sublingually, nitroglycerin is absorbed directly into the systemic circulation and acts within 1 to 3 minutes. If the medication has not produced an effect in 5 minutes, it should be repeated. The nitroglycerine tablets have an onset of action of 1 to 3 minutes, not 5 to 60 minutes.
A client is using nitroglycerin in translingual spray form. The nurse would inform the client that the drug would begin working within which time frame?
1- 3 minutes Explanation:Nitroglycerin translingual spray begins to act in approximately 1-3 minutes.
A patient is receiving transdermal nitroglycerin. The nurse understands that the drug would begin to act within which time frame after application?
30 to 60 minutes Explanation:Transdermal nitroglycerin has an onset of action of 30 to 60 minutes.
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 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.
A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain?
Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. Explanation:The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the client's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the client to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the health care provider if the pain has subsided by the third tablet. If the pain has not subsided, the client is considered to be having an acute MI, and it would be urgent to call the provider. Nitroglycerin does not come in oral form; therefore, it would not be swallowed.
The nurse is providing education to a client who has been prescribed nitroglycerin transdermal spray. What instruction should the nurse provide the client concerning how to administer the spray?
Administer the spray as soon as chest pain develops. Explanation:Administration transdermal spray is essential as soon as chest pain develops. It is unnecessary and inappropriate to delay administration. The client can administer as many as three doses.
A client reports substernal chest pain that radiates to the neck. The pain lasts 5 minutes and then subsides with relaxation. What is the most likely cause of the chest pain?
Angina pectoris Explanation:Classic angina pain related to angina pectoris is substernal chest pain that can radiate to the jaw. Chest pain that lasts longer than 5 minutes is not associated with angina but is associated with myocardial infarction. Hypertension is usually a condition in which the client is pain free. Intermittent claudication is not associated with chest pain.
Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?
Blood pressure Explanation:Atenolol and other beta-blockers have an antihypertensive effect, making the monitoring of blood pressure a priority. They are unlikely to affect temperature, LOC, or oxygen saturation levels.
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?
Bronchospasm Explanation:Clients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client will not experience hyperglycemia, pleural effusion, or pneumonia as a result of this medication.
A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe?
Bronchospasm Explanation:When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung.
When caring for a patient with angina, the nurse instructs the patient to place the nitroglycerin tablet between the cheek and the gums. Which route of administration is the nurse referring to?
Buccal Explanation:The nurse is referring to the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the patient to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the patient to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, transdermal, and translingual routes mentioned. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the front or back of the chest. In translingual nitroglycerin, the spray is directed under or onto the tongue.
The 47-year-old client is experiencing chest pain and has taken three sublingual nitroglycerin tablets, but the pain remains. What should the client do next?
Call 911. Explanation:Nitroglycerin should be administered every five minutes, times three doses. If the pain persists, 911 or the emergency system should be activated. The client should not take additional medication. It is not safe to be transported by private car having chest pain.
What would contraindicate the use of nitrates?
Cerebral hemorrhage Explanation:Nitrates would be contraindicated in clients with cerebral hemorrhage because the relaxation of the cerebral vessels could cause intracranial bleeding. Cardiac tamponade, hypotension, and hepatic disease require cautious use of nitrates.
Which would be important to do when administering nitroglycerin transbuccally?
Check the inside of the cheeks for ulcers or breakdown. Explanation:Abrasions or ulcerations could interfere with the drug absorption. Sublingual tablets are placed under the tongue. Transbuccal tablets dissolve between the gums and cheek pocket. Amyl nitrate is supplied as a capsule that is broken and waved under the nose.
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 Explanation: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. Explanation:People taking beta-blockers do not develop tolerance during therapy as occurs with the organic nitrates. Both nitrates and beta-blockers can be safely taken in a home setting but are not available over the counter. Beta-blockers decrease heart rate and blood pressure.
Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose?
Current blood pressure Explanation:For a client 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 client'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?
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.
A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina?
Decreased oxygenation to the myocardium Explanation:Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries.
When describing the action of ranolazine, which would be most appropriate?
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.
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 Explanation:Bisoprolol reduces the workload of the heart and decreases myocardial oxygen demand by decreasing heart rate and the force of myocardial contractions. It does not prolong the QT interval or shorten the time required for repolarization.
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 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.
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 Explanation:Nitrates act by relaxing the smooth muscle of the blood vessels (arteries and veins) and increasing the amount of blood through the vessel. They also decrease the workload of the heart.
A nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which sign or symptom would the nurse attribute to being a common adverse effect of this medication?
Dizziness Explanation:The most common adverse effects from ranolazine are dizziness, headache, constipation (not diarrhea), and nausea. Bradycardia is not an identified adverse effect of ranolazine therapy. Perspiring skin that is cold to the touch is a manifestation usually associated with a nitroglycerin overdose.
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 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.
The nurse should monitor for what in a client receiving a calcium channel blocker? (Select all that apply.)
Dyspnea Peripheral edema Crackles Explanation:A client receiving a calcium channel blocker should be monitored for signs of heart failure (dyspnea, weight gain, peripheral edema, crackles, rales, and jugular vein distention). The provider should be notified immediately if any of these signs develop.
The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack?
Every 5 minutes Explanation:Sublingual nitroglycerin should be taken every 5 minutes up to a maximum number of 3 tablets in 15 minutes. The client should seek medical care if pain is not relieved after the 3 doses.
A client is using transdermal nitroglycerin. The nurse would instruct the client to apply a new patch at which frequency?
Every day Explanation:Transdermal nitroglycerin is applied once daily. The patch has a duration of 24 hours. Isosorbide dinitrate can be used before an activity that may cause chest pain. Sublingual, translingual spray, or buccal nitroglycerin is used with episodes of acute angina.
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 Explanation:Glucose and blood pressure control can reduce the microvascular changes associated with diabetes mellitus. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease.
The client is taking a calcium-channel blocker. What adverse effects might the client experience?
Headache and dizziness Explanation:Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.
A client with diabetes is prescribed propranolol. For what should the client be assessed?
Hypoglycemia Explanation:Beta-blockers should be used with caution in clients with diabetes mellitus because they conceal signs of hypoglycemia. Beta-blockers do not produce hypercholesterolemia, hypermagnesemia, or hypocalcemia.
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for:
Hypotension Explanation:When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.
The nurse knows that nitroglycerin can be administered in what ways? (Select all that apply.)
IV Transmucosal Transdermal Nitroglycerin is administered in transdermal, and IV preparations. Nitroglycerin is not administered intrathecally.
The health care provider prescribes calcium channel blockers for a client who is diagnosed with angina pectoris. What is the action of calcium channel blockers?
Improve blood supply to the myocardium 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.
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?
Intravenous Explanation:Isosorbide dinitrate is available as an oral agent, sublingual tablet, and chewable tablet. It cannot be given intravenously.
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 Explanation: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.
A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker?
Isosorbide Explanation:Isosorbide is a nitrate. Metoprolol is a beta blocker. Nadolol is a beta blocker. Propranolol is a beta blocker.
Which would a nurse identify as a nitrate?
Isosorbide Explanation:Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers.
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 All nitroglycerin dosages forms are indicated for the prevention of angina pectoris.
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. Explanation:Although the nitroglycerin patch does not act as quickly as the sublingual version of the drug, it is effective for a longer period of time (12 or more hours).
After teaching a group of students about drugs used as antianginal agents, the instructor determines that the teaching was successful when the students identify which as a beta-blocker antianginal agent?
Nadolol Explanation:Nadolol is a beta-blocker used as an antianginal agent. Amlodipine and verapamil are calcium channel blocker antianginal agents. Ranolazine is classified as a piperazine acetamide.
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 Explanation:Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isospin, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.
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. Explanation:Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose.
A male client 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 client's current status?
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.
A male client 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 client's current status?
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 most likely administer which medication?
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.
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. 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.
A client, age 55 years, is started on calcium channel blockers for anginal attacks. The nurse would assess the client for which reaction? Select all that apply.
Peripheral edema Jugular vein distention Breathing difficulty The nurse should assess for signs of heart failure (HF) in clients receiving calcium channel blockers. These include dyspnea, peripheral edema, weight gain, jugular vein distention, and abnormal lung sounds. There is weight gain and not loss of weight in CHF. When calcium channel blockers are administered, they cause a decrease and not an increase in the pulse rate.
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 Explanation: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 reporting 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 Explanation: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.
Which electrocardiogram change should prompt the nurse to question the use of ranolazine for the treatment of a client diagnosed with chronic angina?
QT prolongation Explanation:Ranolazine is contraindicated in clients with preexisting QT prolongation. It is not contraindicated with a normal ST segment, inverted P wave, or shortened QRS.
The nurse is aware that the use of ranolazine is contraindicated in clients who have what condition?
QT-interval prolongation Explanation:Ranolazine is contraindicated in clients who have a condition called QT-interval prolongation.
The client has been diagnosed with coronary artery disease. The nurse teaches the client to avoid which activity?
Shoveling snow Explanation:Shoveling snow increases the workload of the heart and causes decreased oxygenation of the heart muscle. A client with coronary artery disease could experience angina or even death. Washing dishes, gardening and shopping are less strenuous and are acceptable activities.
The nurse would avoid administering nitrates to clients using which medication?
Sildenafil Explanation:Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs.
After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.)
Sildenafil Tadalafil Vardenafil 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.
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 Nitrates are available in the following dosage forms: sublingual, translingual spray, transdermal, and parenteral. Respiratory medications such as bronchodilators and corticosteroids are given in inhalation form. Suppositories to reduce fever and relieve constipation are given rectally.
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. 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
Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin?
The woman will be more susceptible to hypotension than a younger patient. Explanation:Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age.
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 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 with a history of angina, calls the clinic and reports chest pain. The patient states "I'm scared that I am going to die and I've been pacing up and down my driveway." After calming the patient, the initial instruction by the nurse to best manage the situation would be to:
have the patient go into the house and sit or lie down. Explanation:The nurse should instruct the patient to sit or lie down before taking nitroglycerin to prevent dizziness or fainting. The nurse should then inform the patient to place the tablet under the tongue and that the patient can take another tablet in 5 minutes and again in 10 minutes if the pain has not subsided. However, if the pain still has not subsided, the patient should call 911 because the patient may be experiencing a myocardial infarction. The nurse may stay on the phone with the patient while the patient is taking the medication if the patient is overly anxious. The nurse may ask the patient after the medication administration to check the patient's pulse to help determine the patient's level of anxiety and cardiac function.
When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?
inhibiting the influx of calcium through slow channels. Explanation: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 nurse is interviewing a client with a history of diabetes mellitus, obesity, and a recent myocardial infarction. What relevant assessment data should the nurse discuss with the client associated with coronary artery disease (CAD)? Select all that apply.
nicotine use typical A1C results cholesterol consumption experience of angina pain Explanation:Increased cholesterol consumption, nicotine use, poor glucose control, and the presence of episodes of angina pain are all relevant to the diagnosis of coronary artery disease. While an appropriate assessment topic, insomnia is not directly associated with CAD.
The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports:
no episodes of angina since ointment was initiated. 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.
The nurse is performing a history for a black client that is concerned about developing coronary artery disease since it "runs in the family." What risk factor, that is modifiable, does the nurse identify when taking the history?
obese 40% over total body weight Explanation:The client is able to modify the risk factor of obesity with healthy lifestyle changes. The risk factors that are non-modifiable or cannot be changed are the ethnicity of the client, history of family coronary artery disease, or age.
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 Explanation:Oral trauma would be expected to affect sublingual nitroglycerin circulation. Changing the route to transdermal will provide an effective route unaffected by the accident's trauma. Discontinuing the nitroglycerin will only endanger the client; increasing the sublingual dose does not change the potential for uneven absorption due to tissue trauma.
While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it:
should be replaced every six months. Explanation:Sublingual nitroglycerin tablets should be replaced every 6 months because they become ineffective over time.
