NCLEX Style Practice Questions: Nitroglycerin Management

Nitroglycerin precautions

Monitor BP for hypotension

Nitroglycerin Names

Nitrolingual, Nitrostat, Nitrobid, Tridil

Sublingual nitroglycerin is given to a client who experiences chest pain. Which symptom can occur with nitroglycerin? A. tachycardia B. tinnitus C. diarrhea D. Diplopia

A

itroglycerin is ordered for an elderly pt who is having an episode of chest pain. Which is a correct statement regarding the use of nitroglycerin spray instead of nitroglycerin tablets in this age group? A. there is increased absorption in the older client with the spray B. older clients attempt to chew the tablet C. tablets dissolve slower in this population D. the spray lasts longer in the system

A

A 62 y/o male pt has nitroglycerin (Nitrostat) added to his med regimen. Which statement made by this pt indicates that further education is needed? A. I will take this med if I have an episode of chest pain B. I will wait at least 1 hour after I take my sildanefil (Viagra) before using Nitrostat C. I can take up to 3 tablets every 5 minutes if my angina occurs D. I know that I must put this tablet under my tongue for it to work

B

a pt receives a nitroglycerin drip. Which is the true statement regarding the use of this med in IV therapy? A. vented tubing is needed to administer this med B. a glass bottle and vented tubing are needed to administer this med C. admixture must be done under a laminar flow hood with proper handling techniques D. this med cannot be given through small diameter catheters in elderly pts

B

A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.) a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. d. Call the health care provider after taking 5 tablets if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? a. Assess the client's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Stop the nitroglycerin infusion for 1 hour, and then restart. d. Recheck the client's vital signs in 15 minutes but continue the infusion.

b. Decrease the intravenous nitroglycerin by 10 mcg/min.

The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry it in your pocket." d. "It's best to lock them in the glove compartment to keep them away from heat and light."

b. "It's best to keep it in its original container away from heat and light."

What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) a. Continuous oxygen saturation b. Continuous blood pressures c. Hourly ECGs d. Presence of chest pain e. Serum nitroglycerin levels f. Visual acuity

b. Continuous blood pressures d. Presence of chest pain

What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? a. Apply the nitroglycerin patch every other day. b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. d. Use the nitroglycerin patch for acute episodes of angina only.

c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.

Nitroglycerin Interactions

caution w/pts who use vasodilators, alcohol, Ca2+ blockers, beta blockers, & phenothiazines (antipsychotics= end-zine). Don't give with Viagra or cardiogenic shock

Nitroglycerin Indications

chest pain (cardiac origin) acute pulmonary edema Given for myocardial ischemia

Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? a. "This medication works faster than sublingual nitroglycerin works." b. "This medication is the strongest of any nitroglycerin preparation available." c. "This medication should be used only when you are experiencing chest pain." d. "This medication will work for 24 hours and you will need to change the patch daily."

d. "This medication will work for 24 hours and you will need to change the patch daily."

Nitroglycerin classification:

direct-acting vasodilator; nitrate; antianginal

Nitroglycerin side effects

headache, hypotension, bradycardia, rebound HTN/tachycardia, palpitations, facial flushing, sublingual burning, dizziness, weakness, faintness, nasal congestion, GI bleeding, edema

Nitroglycerin Action

relaxes smooth => venous dilation, reduces preload/afterload, dilates coronary arteries => increased perfusion to heart.

8. A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin? (Select all that apply.) a. Have client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. d. Call the health care provider after taking 5 tablets if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

A B E

A nurse teaching a pt on correct self administration of sublingual nitroglycerin (Nitrostat) tablets realizes the pt requires further teaching when they state: A. I will call an ambulance while administering the 3rd tablet B. I will not drive while taking nitroglycerin tablets C. I will keep my tablets in a clear bottle D. I will not take nitroglycerin with erectile dysfunction medication

AC

3. The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? 4. A) a. Blood pressure 110/90 mm Hg 5. B) b. Flushing 6. C) c. Headache 7. D) d. Chest pain

ANSWER: D The client should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

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

ANSWER: D. Clients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.

2. A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A) a. Blood pressure 120/80 mm Hg B) b. Heart rate 70 beats per minute C) c. ECG without evidence of ST changes D) d. Client stating that pain is 0 out of 10

ANSWER: D. The client taking nitroglycerin should expect the therapeutic effect of absence of chest pain.

What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? A) a. "This medication works faster than sublingual nitroglycerin works." B) b. "This medication is the strongest of any nitroglycerin preparation available." C) c. "This medication should be used only when you are experiencing chest pain." D) d. "This medication will work for 24 hours and you will need to change the patch daily."

ANSWER: D. The transdermal patch has a duration of action of 24 hours. Sublingual nitroglycerin is more rapid acting than the transdermal patch. There are other preparations that may be considered stronger because they are higher in dosage. Sublingual and IV preparations are preferred during episodes of chest pain.

Nitroglycerin administration

Administer no more than 3 nitroglycerin tablets, 5 minutes apart. If the pain has not gone away after taking one tablet, take another and call 911. Then may take a 3rd one 5 minutes later. Acts directly on the smooth muscle of the blood vessels causing relaxation and dilation. Decreased cardiac preload and afterload with reducing myocardial oxygen demand. Onset is 1 to 3 minutes. Direct-acting vasodilators promote an increase in blood flow to the brain and kidneys. Direct-acting vasodilators are used in the client with moderate to severe hypotension/ used during acute hypertensive emergencies.

1. A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? A. "Apply the patch to a non-hairy area of the upper torso or arm." B. "Apple the patch to the same site each day." C. If you have a headache, remove the patch for 4 hours then reapply." D. If you have chest pain, apply a second patch next to the first patch."

Answer: A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain

What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) A) a. Continuous oxygen saturation B) b. Continuous blood pressures C) c. Hourly ECGs D) d. Presence of chest pain E) e. Serum nitroglycerin levels F) f. Visual acuity

B, D. Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.

What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? A) a. Use the fingers to spread the ointment evenly over a 3-inch area. B) b. Apply the ointment to a nonhairy part of the upper torso. C) c. Massage the ointment into the skin. D) d. Cover the application paper with ointment before use.

B. Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.

The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A) a. "You can protect it from heat by placing the bottle in an ice chest." B) b. "It's best to keep it in its original container away from heat and light." C) c. "You can put a few tablets in a resealable bag and carry it in your pocket." D) d. "It's best to lock them in the glove compartment to keep them away from heat and light."

B. Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.

What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? A) a. Apply the nitroglycerin patch every other day. B) b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. C) c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. D) d. Use the nitroglycerin patch for acute episodes of angina only.

C. Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A) a. Assess the client's lung sounds. B) b. Decrease the intravenous nitroglycerin by 10 mcg/min. C) c. Stop the nitroglycerin infusion for 1 hour, and then restart. D) d. Recheck the client's vital signs in 15 minutes but continue the infusion.

B. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The client should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Nitroglycerin contraindications

BP < 100, pts who have taken erectile dysfx meds in last 48 hrs, S/S of head trauma (increased intracranial pressure), cerebral hemorrhage, & poor systemic perfusion

A nurse with adequate knowledge about the administration of IV nitroglycerin will recognize that which of the following statements is correct? A. the intravenous form is given by bolus injection B. because the IV forms are short-lived, the dosing must be every 2 hours C. IV nitroglycerin must be protected form exposure to light through use of special tubing D. IV nitroglycerin can be given via gravity drip infusions

C

A pt has a new prescription from transdermal nitroglycerin patches. The nurse teaches the pt that these patches are most appropriately used for which of the following? A. to relieve exertional angina B. to prevent palpatations C. to prevent the occurrence of angina D. to reduce the severity of anginal episodes

C

the pt states, "I always put my nitroglycerine patch in the same place so I do not forget to take it off." Which of the following is the best response by the nurse? A. change the patch every 24 hours B. massage into the skin if ointment comes in contact with your hands C. rotate the NTG patch to a different hairless area each day D. after removing the patch, scrub the are vigorously with soap and water

C

which of the following is NOT a nursing intervention relevant to administration of nitroglycerin? A. inform the pt there may be a burning sensation under their tongue upon ingestion B. inform the pt that this med must be kept in its original bottle C. inform the pt that a headache is the most common side effect associated with this drug

C

a 68 y/o male is experiencing severe hypotension after receiving IV nitroglycerin. What is the most probable cause for this reaction? A. pt is having a MI B. the pt has a high potassium level C. the pt routinely exercises, but has not be active in over a week D. the pt failed to report that he is on Viagra

D

Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? A) a. "I will take up to five doses every 3 minutes for chest pain." B) b. "I can chew the tablet for the quickest effect." C) c. "I will keep the tablets locked in a safe place until I need them." D) d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

D. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.