Chapter 23 Antianginal drugs - Sherpath EAQ

A patient diagnosed with angina is being discharged home with sublingual nitroglycerin. Which statement by the patient indicates an understanding of when to take the medication? - "As soon as I start having chest pain, I will take the nitroglycerin." - "When I have chest pain, I will call my doctor before I take the nitroglycerin." - "If the pain is not relieved after resting for 15 minutes, I will take the nitroglycerin." - "I will take the nitroglycerin if the pain is not relieved after taking a nap."

"As soon as I start having chest pain, I will take the nitroglycerin." The patient with angina needs to understand that sublingual nitroglycerin should be taken with the first sign of chest pain. If the chest pain is not relieved within 5 minutes of the initial dose, the dose should be repeated for a maximum of 3 doses. An emergency medical service should be contacted to transport the patient to the nearest emergency department.

Which instruction does the nurse provide to the patient for correct application of nitroglycerin ointment? - "Apply a line on the applicator paper in the amount prescribed." - "Apply the ointment to the skin and cover with the applicator paper." - "Using gloves, massage the ointment into the skin of your upper torso." - "Use gloved fingers to spread the ointment evenly over a 3-inch area on your lower torso."

- "Apply a line on the applicator paper in the amount prescribed." The ointment is applied onto the applicator paper in a line in the amount prescribed, such as "1 inch." The paper can then be rubbed together to spread out the ointment, and it is applied on a nonhairy portion of the upper torso. The nurse would wear gloves when applying the ointment to prevent absorption of the drug into the skin. The ointment is measured as one thin line on the nitroglycerin applicator and is gently spread over the paper and applied to, but not rubbed into, the skin. The medication would not be rubbed in.

Which patient instruction will help prevent tolerance to nitrate therapy? - "Apply the nitroglycerin patch every other day." - "Use the nitroglycerin patch for acute episodes of angina only." - "Use sublingual nitroglycerin if your systolic blood pressure is 140 mm Hg." - "Apply the nitroglycerin patch in the morning and remove it for 8 hours at night."

- "Apply the nitroglycerin patch in the morning and remove it for 8 hours at night." Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. The patch is removed for 8 to 12 hours every night, and a new patch is applied in the morning. Applying the patch every other day will not have therapeutic effects. Sublingual nitroglycerin is administered for treating acute episodes of angina. Sublingual nitroglycerin is more effective for chest pain.

Which information would the nurse provide to the patient about the cause of chest pain related to coronary artery disease? - "It is related to overstimulated pain receptors." - "Decreased oxygen causes anaerobic metabolism, resulting in pain." - "When the heart works hard to pump, the muscle strain causes pain." - "Increased blood flow to the heart engorges arteries and causes pain."

- "Decreased oxygen causes anaerobic metabolism, resulting in pain." Chest pain is caused by a lack of oxygen to the heart muscle. It is not related to overstimulated receptors or engorged arteries. Muscle strain is not the cause of pain.

Which information about interactions would be included in the discharge teaching plan for a patient who is receiving nifedipine? - "Avoid milk products while taking nifedipine." - "Nifedipine cannot be taken with any other cardiac medications." - "Grapefruit and grapefruit juice can cause nifedipine toxicity and should be avoided." - "Spinach can interact with the medication and needs to be eliminated from the diet."

- "Grapefruit and grapefruit juice can cause nifedipine toxicity and should be avoided."

Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? - "I should keep my nitroglycerin in a cool, dry place." - "I should change positions slowly to avoid getting dizzy." - "I can take up to five tablets at 3-minute intervals for chest pain if necessary." - "If I get a headache, I should keep taking nitroglycerin and use acetaminophen for pain relief."

- "I can take up to five tablets at 3-minute intervals for chest pain if necessary." Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.

Which assessment finding indicates that a patient is having a therapeutic response to a beta blocker administered for angina? - Decreased heart rate - Absence of chest pain - Decreased blood glucose - Blood pressure less than 130/90 mm Hg

- Absence of chest pain Beta blockers are administered to patients with angina to prevent chest pain. Although beta blockers may cause fluctuations in blood glucose levels and heart rate, this is not the therapeutic outcome desired for a patient with angina. A blood pressure less than 130/90 mm Hg is not the therapeutic response for a patient who has angina.

Which response by the patient indicates the need for further education when discussing safe administration of nifedipine? - "I should avoid taking this medication with grapefruit juice." - "I should change positions slowly while taking this medication." - "I should avoid eating high-fiber foods while taking this medication." - "I should anticipate experiencing dizziness while taking this medication."

- "I should avoid eating high-fiber foods while taking this medication." Nifedipine therapy may cause constipation; therefore, the nurse would instruct the patient to include fiber-rich foods in the diet rather than avoiding fiber. Nifedipine, a calcium channel blocker, interacts with grapefruit juice, causing an increased risk for drug toxicity, so the patient is correct in avoiding this food. The patient should change positions slowly because nifedipine may cause dizziness.

Which patient statement indicates a correct understanding of the safe administration of nitroglycerin? - "I should place the tablet under my tongue." - "I may have blurred vision during the first week of therapy." - "I can take up to five tablets if my chest pain is not relieved." - "I should take hot showers daily during the course of therapy."

- "I should place the tablet under my tongue." Nitroglycerin is a medication that is often prescribed for the treatment of angina. The medication is administered sublingually to have a quick effect and prevent the first-pass effect. The statement by the patient indicating that the tablet is placed under the tongue indicates a correct understanding of the information presented. Blurred vision may be experienced each time nitroglycerin is taken, not just during the first week of therapy. The patient can take up to three nitroglycerin tablets, spaced 5 minutes apart, to treat the angina. If the patient is still experiencing angina after three doses, emergency medical care should be sought. Hot showers should be avoided because this will exacerbate vasodilation and increase the chance of orthostatic hypotension and syncope.

Which statement made by the patient about nitroglycerin indicates effective learning? - "I will keep the nitroglycerin stored in the original container." - "I will refill my prescription once a year to maintain potency." - "I will take a nitroglycerin tablet 2 hours before I engage in physical activity." - "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone."

- "I will keep the nitroglycerin stored in the original container." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. The prescription should be refilled or replaced every 3 to 6 months to maintain potency. Nitroglycerin is used just before engaging in activity that is known to cause chest pain or every 5 minutes for pain relief.

Which statement indicates that the patient understands teaching about the purpose of nitrate therapy for their angina? - "Nitrates dilate blood vessels." - "Nitrates have no adverse effects." - "Nitrates increase blood pressure." - "Nitrates slow conduction in the heart."

- "Nitrates dilate blood vessels." Nitrates dilate blood vessels and increase blood flow to the heart muscle. Nitrates have several potentially adverse effects. They do not increase blood pressure or slow conduction in the heart.

Which information would the nurse include in the response to a patient with type 1 diabetes mellitus who asks why beta blockers are contraindicated? Select all that apply. One, some, or all responses may be correct. - "This medication will interact with your insulin therapy." - "This medication will predispose you to other health problems." - "This medication may cause your blood glucose to go very low." - "This medication may cause your blood glucose to go very high." - "This medication may make it more difficult for you to tell when you are having episodes of hypoglycemia."

- "This medication may cause your blood glucose to go very low." - "This medication may cause your blood glucose to go very high." - "This medication may make it more difficult for you to tell when you are having episodes of hypoglycemia." Beta blockers can cause both hypoglycemia and hyperglycemia in patients with diabetes mellitus and should be avoided if possible. They may also block the normal response to hypoglycemia, such as tachycardia, and make it more difficult for the patient to notice the symptoms. The medication would not interact with insulin or predispose the patient to other health problems.

Which amount of time represents the duration of action of sublingual nitroglycerin? - 3 to 5 minutes - 0.5 to 1 hour - 4 to 6 hours - 10 to 12 hours

- 0.5 to 1 hour The duration of action of sublingual nitroglycerin is 0.5 to 1 hour. The duration of action of intravenous nitroglycerin is 3 to 5 minutes. The duration of action of an immediate-release nitroglycerin tablet is 4 to 6 hours. For patients wearing a transdermal nitroglycerin patch, steady-state plasma concentrations start about 2 hours after application and last for the duration of wearing the patch, which is typically for 10 to 12 hours.

Which patient would nifedipine be contraindicated in? Select all that apply. One, some, or all responses may be correct. - A 42-year-old male with an allergy to dihydropyridines - A 36-year-old female with hypotension - A 70-year-old male in second-degree atrioventricular block with a pacemaker - A 72-year-old female in third-degree atrioventricular block - A 64-year-old male with angina and hypertension

- A 42-year-old male with an allergy to dihydropyridines - A 36-year-old female with hypotension - A 72-year-old female in third-degree atrioventricular block Calcium channel blockers such as nifedipine are contraindicated in patients who have a known allergy to this drug. Nifedipine is a dihydropyridine class of calcium channel blocker, and the patient has an allergy to that class. Hypotension is another contraindication. Nifedipine is also contraindicated in patients who have second- or third-degree atrioventricular (AV) block and do not have pacemakers. The patient with an AV block and pacemaker may take nifedipine. Calcium channel blockers are indicated for treatment of angina and hypertension.

Which patient is a candidate for nitroglycerin therapy? - A patient with chest pain who has a history of anemia - A patient with angina who shows indications of hypotension - A patient with severe head injury who reports chest pain - A patient with coronary heart disease who reports chest pain

- A patient with coronary heart disease who reports chest pain A patient with coronary heart disease who reports chest pain will benefit from nitroglycerin therapy because it vasodilates to increase oxygen to the heart muscle, thus decreasing pain. The other patients have conditions that are contraindicated with the use of nitrates. Nitrates will compromise the already-reduced tissue oxygenation in patients with anemia. Patients with hypotension will have increased hypotension with nitrates. The vasodilatory effects of nitrates may worsen hypotension and head injury in a patient.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? - Absence of dizziness - Absence of chest pain - Patient feeling stronger - Decreased swelling in the ankles and feet

- Absence of chest pain The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina because afterload is decreased. Dizziness may be a side effect of the medication. Calcium channel blockers may cause fatigue, not a feeling of increased strength. Diuretics, not calcium channel blockers, are used to decrease edema in the ankles and feet.

Which action would the nurse take for a patient who is receiving nitroglycerin therapy and reports a headache? - Administer aspirin. - Hold the nitroglycerin. - Administer acetaminophen. - Call the health care provider.

- Administer acetaminophen. Acetaminophen is administered to a patient with a headache caused by nitroglycerin therapy. Aspirin decreases platelet adhesion and may lead to bleeding or interfere with other anticoagulants in patients with cardiac disease. The medication should not be held. This is a common side effect, and the health care provider does not need to be called.

Which item will the nurse instruct a patient with angina taking atenolol to avoid when providing discharge teaching? Select all that apply. One, some, or all responses may be correct. - Alcohol - Hot tubs - Saunas - Cold weather - Cold showers

- Alcohol - Hot tubs - Saunas The patient must avoid alcohol, hot tubs, saunas, hot showers, hot weather, and hot environments. All of these will exacerbate vasodilation and increase the occurrence of orthostatic hypotension. This puts the patient at risk for dizziness, syncope, and falls. Cold weather and cold showers would not lead to those effects.

Which assessment finding is a contraindication to a patient being prescribed a nonselective beta blocker? - Asthma - Weight loss - Elevated cholesterol - History of alcohol abuse

- Asthma Beta blockers need to be used cautiously in patients who have a history of asthma because these drugs induce bronchoconstriction and cause airway resistance, which may lead to dyspnea and wheezing. Weight loss and elevated cholesterol are not contraindications to using beta blockers. Beta blockers can interact with alcohol and cause such adverse effects as hypotension. However, a history of alcohol abuse is not a concern if the patient no longer engages in such behavior.

Which condition is the primary cause of ischemic heart disease? - Clotting - Atherosclerosis - Angina pectoris - Myocardial infarction

- Atherosclerosis Atherosclerosis is a disease of the coronary arteries that involves fatty plaque deposits in the arterial walls. This disease process causes ischemic heart disease. Clotting, angina pectoris, and myocardial infarction can be consequences of ischemic heart disease but not the cause of the pathology.

Which class of drugs is prescribed for a patient who experiences exertional angina? - Beta blockers - Nitrate antianginal drugs - Calcium channel blockers - Nitroglycerin transdermal patch

- Beta blockers The beta blockers are more effective in the treatment of exertional angina because they decrease heart rate and blood pressure that have risen because of exercise. This helps decrease myocardial oxygen demand. Nitrates are more effective for chronic stable angina. Calcium channel blockers are more effective in reducing afterload and workload of the heart. The nitroglycerin transdermal patch has an onset of action of 30 to 60 minutes and cannot provide prompt relief.

Which classes of drug is used in the treatment of angina pectoris? Select all that apply. One, some, or all responses may be correct. - Diuretics - Beta blockers - Antihistamines - Nitrates and nitrites - Calcium channel blockers

- Beta blockers - Nitrates and nitrites - Calcium channel blockers Beta blockers are effective after a myocardial infarction to minimize the negative effects of catecholamines. Nitrates and nitrites minimize the frequency of angina attacks by dilating all blood vessels. Calcium channel blockers help decrease afterload and reduce the workload of the heart. Diuretics are not prescribed for the treatment of angina pectoris but to increase the patient's fluid output. Antihistamines are used to reduce the physiologic and pharmacologic effects of histamine and are not used to treat angina.

Which medication should be used cautiously in a patient who has been prescribed nitrate therapy? Select all that apply. One, some, or all responses may be correct. - Diuretics - Beta blockers - Phenothiazines - Calcium channel blockers - Phosphodiesterase 5 (PDE5) inhibitors

- Beta blockers - Phenothiazines - Calcium channel blockers - Phosphodiesterase 5 (PDE5) inhibitors Nitrates interact with beta blockers, phenothiazines, and calcium channel blockers and may worsen hypotension in a patient taking one of these. Nitrates have also been known to cause death in patients as a result of an interaction with erectile dysfunction drugs (PDE5). Diuretics do not interact with nitrates.

Which nursing assessment is required before administering isosorbide mononitrate? - Blood pressure - Serum electrolytes - Level of consciousness - Blood urea nitrogen and creatinine

- Blood pressure Isosorbide mononitrate is a vasodilator and thus can cause hypotension; assessment of blood pressure is important before administering it. Electrolytes, level of consciousness, and blood urea nitrogen and creatinine do not need to be assessed before the administration of isosorbide mononitrate.

Which patient assessment finding requires immediate nursing intervention for a patient who received a dose of sublingual nitroglycerin and is lying in the supine position? - Reports of dizziness - Blood pressure of 80/45 mm Hg - Blood pressure of 140/90 mm Hg - Heart rate increase from 80 to 90 beats/min

- Blood pressure of 80/45 mm Hg A systolic blood pressure of 90 mm Hg or less indicates hypotension; nitroglycerin results in a fall in blood pressure of about 10 mm Hg. As a result, the patient may experience syncope. Dizziness resulting from hypotension can be prevented by asking the patient to change positions slowly or rest for 30 minutes. For the patient in a supine position, the nitrate dose can increase the heart rate up to 10 beats/min. However, it does not last more than 30 minutes.

Which condition is a contraindication for metoprolol? - Bradycardia - Myocardial infarction - Hypertension - Cardiac dysrhythmias

- Bradycardia Beta-blockers are contraindicated for patients with bradycardia due to their effects on heart rate and myocardial contractility. Beta-blockers are indicated for treatment of myocardial infarction, hypertension, and cardiac dysrhythmias.

Which assessment finding would alert the nurse to a possible interaction between amiodarone and a calcium channel blocker taken daily? - Tachycardia - Bradycardia - Constipation - Atrioventricular block

- Bradycardia The interaction of amiodarone and calcium channel blockers may result in bradycardia and decreased cardiac output. The interaction of amiodarone and calcium channel blockers causes bradycardia, not tachycardia. Constipation is a side effect of calcium channel blockers and not a drug interaction. The interaction of calcium channel blockers and beta blockers may cause bradycardia and atrioventricular block.

Which action would the nurse take when amlodipine 10 mg intravenously once a day has been prescribed for a patient with angina? - Give medication as prescribed - Call the provider for clarification of the prescription - Check the patient's blood pressure - Monitor for nausea and constipation

- Call the provider for clarification of the prescription Amlodipine is only administered by mouth. The nurse should call the provider and clarify the prescription to make sure the drug is given by the correct route. The medication should not be given intravenously. Although the patient's blood pressure should be checked before and during administration of the drug, the patient has hypertension, meaning that the blood pressure has already been checked. An adverse effect of amlodipine is constipation and nausea, but the patient has not started the medication yet.

Which action would the nurse take for a patient who has a rash where topical nitroglycerin was applied? - Stop the medication. - Assess the patient's diet. - Administer an antihistamine. - Change the area of administration.

- Change the area of administration. The patient is exhibiting contact dermatitis. The nurse would change the site of administration and evaluate the skin. Changing the area of administration to a less sensitive skin area may diminish or stop the reaction. This is not caused by the patient's diet. Antihistamines are not administered for localized contact dermatitis. If it continues, another intervention is needed.

Which assessment may indicate a myocardial infarction in a patient who is taking nitroglycerin for angina? - The patient has hypotension. - The patient has a headache after taking nitroglycerin. - The patient reports feeling dizzy when trying to move. - Chest pain is unrelieved after three doses of sublingual nitroglycerin.

- Chest pain is unrelieved after three doses of sublingual nitroglycerin. If chest pain is not relieved after taking nitroglycerin, it may indicate a myocardial infarction. The primary health care provider needs to be notified immediately. Hypotension may occur with nitroglycerin, but it does not indicate that a myocardial infarction is occurring. Headache is a common side effect of nitroglycerin therapy. It diminishes soon after the therapy is started. Dizziness is result of vasodilation and possibly hypotension.

Which assessment finding requires immediate nursing intervention for a patient who is receiving an intravenous (IV) nitroglycerin infusion? - Flushing - Continued chest pain - Heart rate of 90 beats/min - Blood pressure of 110/90 mm Hg

- Continued chest pain If a patient continues to have chest pain while on IV nitroglycerin, this is a serious finding. This would prompt the nurse to intervene. Headache and flushing are common side effects of nitroglycerin. A heart rate of 90 beats/min is still within normal range. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin.

Which action would the nurse take for a patient who reports dizziness while receiving intravenous nitroglycerin and has a blood pressure of 85/40 mm Hg? - Assess the patient's lung sounds. - Decrease the intravenous nitroglycerin. - Stop the nitroglycerin infusion for 1 hour and then restart. - Continue the infusion and recheck the patient's vital signs in 15 minutes.

- Decrease the intravenous nitroglycerin. Nitroglycerin is a vasodilator and causes a decrease in blood pressure. Because it is short acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored while changing the rate of the intravenous nitroglycerin infusion. There is no reason to assess lung sounds because this medication does not directly affect the lungs. Stopping the infusion may precipitate a myocardial infarction. The infusion should not be continued at the current rate because the patient's blood pressure is too low.

Which condition is a contraindication to the administration of a beta blocker for the treatment of angina? - Diabetes mellitus - Peptic ulcer disease - Parkinson's disease - Myocardial infarction (MI)

- Diabetes mellitus Beta blockers may mask the symptoms of hypoglycemia, such as tachycardia, and therefore are not first-line therapy for patients with diabetes mellitus. Beta-blocker therapy is not contraindicated in patients with peptic ulcer, Parkinson's disease, or MI.

A patient with angina is prescribed ranolazine. Which assessment finding will the nurse report to the primary health care provider? - Migraine - Elevated liver enzymes - History of ischemic heart disease - Blood pressure of 130/90 mm Hg

- Elevated liver enzymes Ranolazine is used in patients who fail to benefit from other antianginal therapies. It is important to assess hepatic function in the patient to determine whether the drug is metabolized properly. Migraine or headache does not affect the use of ranolazine. Ranolazine is an antianginal drug and is effective in patients with ischemic heart disease. A normal blood pressure is not a concern; however, the drug is expected to lower the blood pressure.

Which beverage is contraindicated when a patient is taking nifedipine? - Tea - Milk - Mango juice - Grapefruit juice

- Grapefruit juce Grapefruit juice can reduce the metabolism of calcium channel blockers, especially nifedipine. Tea, milk, and mango juice do not cause an interaction when ingested with calcium channel blockers.

Which action would the nurse take for a patient who reports flushing and headache after receiving sublingual nitroglycerin? - Administer aspirin. - Have the patient sit and rest. - Administer an antihistamine. - Call the health care provider. Confident

- Have the patient sit and rest. Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use. The nurse would instruct the patient to sit and rest. For patients with cardiac disease, administering therapeutic acetaminophen for a headache is preferred over therapeutic aspirin. An antihistamine will not help. The health care provider does not have to be called for this side effect.

The nurse is providing teaching to a patient regarding the difference between side effects of nitroglycerin that can be managed and adverse effects, which may necessitate discontinuation of the drug. Which conditions are considered side effects of nitroglycerin? - Headache - Swelling - Blurred Vision - Hypotension - Confusion - Tachycardia

- Headache Headache is a side effect of nitroglycerin. This can be managed and typically decreases with continued use of the medication. - Hypotension Hypotension is a side effect of nitroglycerin. This can be managed and typically decreases with continued use of the medication. -Tachycardia Reflex tachycardia is a side effect of nitroglycerin. This can be managed and typically decreases with continued use of the drug.

Which cue is a common adverse effect of oral nitroglycerin? - Bradycardia - Hypertension - Headache - Skin inflammation

- Headache Headache is the most common undesirable effect of nitrates, including nitroglycerin. These drugs may cause tachycardia and hypotension due to the effects of vasodilation, not bradycardia and hypertension. Skin inflammation or dermatitis is seen as an adverse effect in topical forms of nitrate, not in oral forms.

For which adverse effect would the nurse assess the patient after administering nitrates? Select all that apply. One, some, or all responses may be correct. - Cough - Headache - Tachycardia - Contact dermatitis - Postural hypotension

- Headache - Tachycardia - Postural hypotension Tachycardia and postural hypotension occur if the nitrate-induced vasodilation occurs rapidly. Cough is not an adverse effect of nitrates. Headache is a common adverse effect of nitrate vasodilation. Contact dermatitis may result from various topical nitrate dosages, but it is not considered an adverse effect.

Which nursing assessment is a priority before administering diltiazem for a patient with Prinzmetal angina who also takes atenolol for hypertension? - Heart rate - Pain level - Blood glucose - Urinary output

- Heart rate Diltiazem is a calcium channel blocker (CCB) used for treating Prinzmetal angina. Atenolol is a beta blocker used for hypertension. When these two medications are coadministered, bradycardia can occur; therefore, the nurse would assess the patient's heart rate before administering these medications. Although assessing pain is important, it is not required before administering these two medications together. A nurse would not need to specifically monitor urine output when administering these two medications concurrently. Although beta blockers can alter blood glucose levels, assessment of blood glucose is generally only necessary in patients who have diabetes mellitus and should not affect patients who do not have predisposing conditions.

Which assessment would the nurse obtain before administering sublingual nitroglycerin for chest pain? Select all that apply. One, some, or all responses may be correct. - Heart rate - Blood glucose - Blood pressure - Medical history - Height and weight

- Heart rate - Blood pressure - Medical history The nurse would assess the patient's heart rate and blood pressure before administering sublingual nitroglycerin and ask the patient to sit or lie down. Medical history including any medications taken for erectile dysfunction are important to avoid adverse effects. Glucose is not affected by sublingual nitroglycerin. A measurement of height and weight need to be completed, but not during an emergency problem such as chest pain. The goal is to increase oxygen to the heart via vasodilation.

Which condition is an indication for nitroglycerin? Select all that apply. One, some, or all responses may be correct. - Hypertension - Dysrhythmias - Variant angina - Unstable angina - Myocardial infarction

- Hypertension - Variant angina - Unstable angina - Myocardial infarction Treatment of angina pectoris is the main indication for nitroglycerin. This drug causes vasodilation, leading to decreased preload, myocardial workload, and oxygen consumption. Nitroglycerin is indicated for the treatment of vasospastic angina, for unstable angina, and in the treatment of an acute myocardial infarction to dilate coronary arteries. Long-acting preparations of nitroglycerin are also used for the control of hypertension. Nitroglycerin is not utilized to treat dysrhythmias because it does not affect heart rate or rhythm directly.

Which condition in the patient's history is a contraindication for a new calcium channel blocker prescription? - Hypotension - Hypokalemia - Dysrhythmias - Increased intracranial pressure

- Hypotension Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension. They are not contraindicated for the patient with a history of hypokalemia, dysrhythmias, or increased intracranial pressure.

Which statement is true regarding ranolazine? - It is a first-line drug indicated for angina. - It may be taken with verapamil. - It may decrease digoxin levels. - Its mechanism of action is unknown.

- Its mechanism of action is unknown. Ranolazine's mechanism of action is unknown. The drug is reserved for patients who have failed to benefit from other antianginal drug therapy. It may cause significant drug interactions with verapamil. Ranolazine may increase digoxin levels.

Which medication is contraindicated for a patient experiencing chest pain during sleep who also has a history of type 1 diabetes mellitus and iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct. - Aspirin - Diltiazem - Metoprolol - Nitroglycerin - Isosorbide dinitrate

- Metoprolol - Nitroglycerin - Isosorbide dinitrate Chest pain that occurs at rest is indicative of Prinzmetal angina, which is often treated with a calcium channel blocker, such as diltiazem. Metoprolol is contraindicated in patients with diabetes because it causes a risk of hypoglycemia. Nitroglycerin preparations, such as isosorbide dinitrate, are contraindicated with anemia because of the risk of exacerbation of symptoms. Aspirin is often taken due to its antiplatelet action and is not contraindicated in this patient.

Which medication would the nurse expect to administer to relieve angina for a patient with a history of heart failure and atrioventricular block? - Atenolol - Diltiazem - Amlodipine - Nitroglycerin

- Nitroglycerin The nurse administers sublingual nitroglycerin for angina in a patient with heart failure. Atenolol, diltiazem, and amlodipine are indicated in the treatment of angina; however, these medications are used for maintenance therapy. Atenolol is contraindicated for patients with systolic heart failure, and amlodipine and diltiazem are contraindicated with atrioventricular block.

The nurse has ensured that a patient is in a sitting position and conducted a thorough assessment before administering a nitrate drug for angina. Which cue will the nurse continue to monitor? Select all that apply. One, some, or all responses may be correct. - Pain level - Blood pressure - Pulse rate - Temperature - Dizziness

- Pain level - Blood pressure - Pulse rate - Dizziness The nurse will conduct a chest pain assessment using a pain scale before, during, and after drug therapy. The nurse will monitor the patient's blood pressure and pulse rate and assess for headache, dizziness, and lightheadedness. Temperature does not have to be monitored with nitrate drug therapy.

Which assessment finding indicates that nitroglycerin administration has been effective for a patient with angina? - Heart rate of 70 beats/min - Blood pressure of 120/80 mm Hg - Patient stating that pain is 0 out of 10 - Electrocardiogram (ECG) without evidence of ST changes

- Patient stating that pain is 0 out of 10 The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. Vasodilation should increase blood flow to the heart muscle and relieve the pain caused by lack of oxygen. A normal heart rate of 70 beats/minute and a normal blood pressure of 120/80 mm Hg do not indicate a therapeutic response to nitroglycerin, but they do indicate that the patient is stable. An ECG without ST changes confirms that the patient is not currently having ischemia; however, angina pain can occur without immediate changes in the ECG.

Which assessment data would the nurse collect for a patient who is receiving intravenous nitroglycerin? Select all that apply. One, some, or all responses may be correct. - Visual acuity - Presence of chest pain - Serum nitroglycerin levels - Continuous blood pressure - Hourly electrocardiograms

- Presence of chest pain - Continuous blood pressure Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain must be monitored as well as blood pressure. Visual acuity is not an indicator of therapeutic effect, and it is not used to assess for side effects. Nitroglycerin levels are not checked. The electrocardiogram is used during chest pain episodes, not hourly.

Which assessment is a priority when caring for a patient who reports chest pain and is prescribed metoprolol and verapamil? - Cardiac enzymes every 8 hours - Electrocardiogram (ECG) daily - Lung sounds after medication is administered - Pulse before administration of medications

- Pulse before administration of medications Verapamil is a calcium channel blocker (CCB). When a CCB is prescribed with a beta blocker, such as metoprolol, the interaction can cause hypotension and bradycardia. The nurse would assess the pulse rate before administering medications and hold the dose when appropriate. Enzymes are assessed with chest pain when a myocardial infarction is suspected. Assessing the ECG daily is not necessary. Lung sounds should be assessed after administering beta blockers in patients with predisposing respiratory problems because beta blockers may cause bronchial constriction at higher doses. Assessment of pulse, however, is a priority because these two medications combined can have a profound effect on heart rate and blood pressure. Priorities of care are carried out first, and in this instance, assessment of heart rate must be done before administering the medication.

Which intervention is essential when a patient is receiving intravenous nitroglycerin? Select all that apply. One, some, or all responses may be correct. - Insert a Foley catheter. - Regulate the infusion via a pump. - Monitor blood pressure continuously. - Calculate the prescribed drip rate carefully. - Administer a diuretic to decrease fluid load.

- Regulate the infusion via a pump. - Monitor blood pressure continuously. - Calculate the prescribed drip rate carefully. The nitroglycerin drip must be regulated on an infusion pump. The patient's blood pressure should be monitored continuously. The drip rate should be carefully calculated. The patient does not need to have a Foley catheter inserted, and a diuretic medication is not essential when the patient is on nitroglycerin therapy.

Which assessment finding in a patient receiving nitrate therapy requires immediate nursing intervention? - Headache - Severe anemia - Anginal episode - Ischemic heart disease

- Severe anemia If a patient with severe anemia is administered nitrates, the vasodilatory effects of the nitrates can worsen the anemia. Headache is a side effect of nitrates therapy. Nitrates will minimize the frequency of angina episodes in a patient with ischemic heart disease.

Which medication in the patient's history would be a contraindication to the administration of isosorbide mononitrate? - Aspirin - Levothyroxine - Sildenafil - Verapamil

- Sildenafil Sildenafil can cause severe hypotension when administered with a nitrate, such as isosorbide mononitrate; therefore, these medications should not be prescribed concurrently. The nurse would hold the medication and call the health care provider. Aspirin, levothyroxine, and verapamil are not contraindicated with the administration of a nitrate preparation.

Which intervention would the nurse perform for a patient who is receiving intravenous nitroglycerin and has a blood pressure of 92/60 mm Hg? - Slow the infusion. - Stop the medication. - Tell the patient to change positions slowly. - Monitor the patient's electrocardiogram (ECG).

- Slow the infusion. The capacity of nitroglycerin to dilate arterioles is directly related to the dose; as the dosage increases, the chance of vasodilation increases. The medication dose may need to be decreased to increase the blood pressure to within normal range. The medication should not be stopped because the patient would then have pain. The patient changes positions slowly and ECG is monitored to prevent transient hypotension.

Which nitroglycerin preparation would the nurse administer to a patient with a history of angina who reports a sudden onset of chest pain? - Isosorbide dinitrate - Isosorbide mononitrate - Sublingual nitroglycerin - Nitroglycerin transdermal patch

- Sublingual nitroglycerin Sublingual nitroglycerin has an onset that is almost immediate. This preparation is given to patients with chest pain to vasodilate and increase oxygen supply to the heart muscle. Isosorbide dinitrate, isosorbide mononitrate, and transdermal nitroglycerin have a longer onset of action and a longer duration of action.

Which intervention is recommended for a patient with angina who is going to engage in a known stressful behavior? - Take a sublingual nitroglycerin prophylactically. - Take an extra dose of long-acting nitroglycerin. - Take a nonsteroidal anti-inflammatory medication before the activity. - Take a bronchodilator before the activity.

- Take a sublingual nitroglycerin prophylactically. Sublingual nitroglycerin is prescribed prophylactically for patients in whom any physical activity may cause an unexpected angina episode. A long-acting nitroglycerin preparation would not provide immediate relief at the time of the stressful behavior. A nonsteroidal anti-inflammatory medication would not produce the vasodilation needed to increase blood flow to the heart muscle. A bronchodilator would not assist in alleviating symptoms of angina.

Which intervention helps to decrease the incidence of drug tolerance to nitrates? - Taking the medication every other day - Taking the medication with breakfast daily - Taking a week off from medication therapy - Taking the medication three times daily with a 12-hour interval between the last and first dose

- Taking the medication three times daily with a 12-hour interval between the last and first dose Patients who are on nitrate therapy on a long-term basis are at risk for tolerance to the drug's effects. Taking the medication three times daily with an 8- to 12-hour interval between the last and first dose helps to decrease the incidence of tolerance. The patient should not take the medication every other day or take a week off from medication therapy because this could lead to an increased incidence of angina pain. There is no reason to take the medication with breakfast.

Which event is likely to increase orthostatic hypotension in a patient who is using nitroglycerin therapy for angina? - The patient stops the medication. - The patient takes a hot shower after a walk. - The patient takes a bronchodilator for asthma. - The patient drinks 2 to 3 liters of fluid per day.

- The patient takes a hot shower after a walk. A hot shower or hot temperature increases orthostatic hypotension in a patient who is on nitroglycerin therapy, as a result of vasodilation. The other situations will not worsen hypotension, but they may cause other problems. If the drug is stopped suddenly, angina may result. Drinking fluid should help to decrease hypotension. A bronchodilator does not increase the risk of hypotension and could actually cause hypertension.

Which documentation would be correct for skin inflammation noted on a patient taking nitroglycerin ointment for angina? - The reaction is a contact dermatitis. - The reaction is normal in the initial doses. - The patient doesn't complain of any pain. - The allergy is caused by drug-food interaction.

- The reaction is a contact dermatitis. The skin inflammation is caused by the dosage delivery system and not by the drug. It may not be an allergic reaction to the drug but rather a contact dermatitis. Hence, the nurse need not discontinue the dose. Skin inflammation is not normal in the initial doses; hence, the nurse needs to assess the reaction carefully. Rashes and inflammation are an indication of skin reactions, not pain. The nurse would understand that the allergic reaction is not caused by food-drug interaction but is a contact dermatitis.

Which indication would the nurse include in the teaching plan for a patient who has been prescribed a calcium channel blocker (CCB)? - To prolong the QT interval - To reduce elevations in heart rate - To decrease the workload of the heart - To treat acute myocardial infarction (MI)

- To decrease the workload of the heart CCBs decrease afterload and reduce the workload of the heart by decreasing muscle contraction and promoting muscle relaxation. CCBs do not prolong the QT interval. CCBs are contraindicated in patients with acute MI. Some CCBs decrease elevations in heart rate; however, this is not the primary indication for their use.

Which patient condition will benefit from the administration of a nitrate? - Unstable angina - Angina and hypotension - Chest pain with a history of severe anemia - Severe head injury with report of chest pain

- Unstable angina A patient with unstable angina will benefit from nitroglycerin therapy because it decreases the intensity of angina pain. The vasodilatory effects of nitrates can worsen hypotension and head injury in a patient. Nitrates will compromise the already-reduced tissue oxygenation in patients with anemia due to hypotension.

Which form of nitroglycerin is likely to have a large first-pass effect? - Oral - Sublingual - Intravenous - Transdermal

- oral Oral nitroglycerin travels first to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from the circulation. This is known as a large first-pass effect. Sublingual, intravenous, and transdermal preparations do not pass through the liver. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly because the area under the tongue is highly vascular. Intravenous nitroglycerin is quickly absorbed in the blood, and it has an onset of action of 1 to 2 minutes. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris because it allows for the continuous slow delivery of nitroglycerin.

The nurse monitors blood pressure while administering nitroglycerin intravenously knowing that the medication has which therapeutic action? - Lowering HR - Dilating vessels - Increasing BP - Increasing preload

Dilating vessels Nitroglycerin acts directly on vascular smooth muscle, which relaxes and dilates the vessels. Vessel dilation results in lower blood pressure. If the blood pressure becomes too low, the dose may need to be decreased.

A patient with a history of angina and peripheral vascular disease inquires about taking sildenafil for erectile dysfunction while on extended-release oral nitroglycerin. Which educational information would the nurse provide? - Because both drugs help dilate vessels, it is safe to take together. - Both drugs can be taken together, but the effects of sildenafil may take longer to achieve. - Drugs for erectile dysfunction should not be taken with nitroglycerin. - Avanafil, not sildenafil, is safe to take with nitroglycerin.

Drugs for erectile dysfunction should not be taken with nitroglycerin. Drugs for erectile dysfunction, such as sildenafil, can increase the blood pressure-lowering effects of nitroglycerin and should not be taken together. If the two classes of drugs are taken together, severe hypotension could develop.

Which route of administration for nitroglycerin is most common? - Topical - Sublingual - Oral - IV

Sublingual Sublingual is the most common route of administration due to its quick onset of action.

A patient asks why a nitroglycerin patch cannot be worn for 24 hours. Which response by the nurse is appropriate? - Rashes are more likely with 24-hour use of a nitroglycerin patch. - Dizziness will occur more frequently with 24-hour use of a nitroglycerin patch. - Headaches will become more frequent and present with increased intensity with 24-hour use of a nitroglycerin patch. - Tolerance to the nitroglycerin can develop with 24-hour use of a nitroglycerin patch.

Tolerance to the nitroglycerin can develop with 24-hour use of a nitroglycerin patch. Tolerance to nitroglycerin can develop with 24-hour use of a nitroglycerin patch. A drug-free or patch-free period prevents the development of tolerance to nitroglycerin.

Which route of administration for nitroglycerin is associated with development of tolerance if a drug-free interval is not established? - Sublingual - Transdermal - Oral - IV

Transdermal Tolerance to nitroglycerin can develop with transdermal nitroglycerin if left on continuously. Having a drug-free interval on a daily basis is important to minimize the development of tolerance.

A nurse is preparing to administer nitroglycerin ointment. Which action by the nurse is most important when handling nitroglycerin? - Wash hands before handling nitroglycerin. - Wear a gown to protect clothing from medication spills. - Wear gloves when handling nitroglycerin. - Wear a surgical mask when handling nitroglycerin.

Wear gloves when handling nitroglycerin. Nitroglycerin can be absorbed very quickly through the skin and can cause systemic vasodilation. Nurses would wear gloves when handling nitroglycerin to prevent systemic effects.

How long after administering nitroglycerin intravenously (IV) would the nurse expect the patient's chest pain to be relieved? - Within seconds - After 3 minutes - Within 30 minutes - After 60 minutes

Within seconds Onset of action for nitroglycerin IV should be in seconds (immediate) upon administration.