106 Ch 24 Practice Test + EAQ

The nurse is teaching a patient about the correct use of nitroglycerin paste. Which statement by the patient indicates a need for further teaching?

"I will choose a convenient site for application and use it consistently." Sites must be rotated to prevent skin irritation. The patient is in need of further instruction based on his incorrect statement. When terminating the use of topical nitroglycerin, the dose and frequency of application should be reduced gradually over 4 to 6 weeks. The best way to avoid tolerance to prophylactic use of transdermal nitroglycerin is to have periodic 8- to 12-hour-nitrate-free periods. Because of the potential for skin irritation, the area where nitroglycerin paste is applied should not be shaved or have alcohol applied to it.

The nurse is teaching a patient about the use of transdermal nitroglycerin. Which statement by the patient indicates a correct understanding of the nurse's instructions?

"If the disk becomes dislodged, I will replace it with a new disk." The disk should be replaced if it falls off or becomes dislodged. Failure to replace the disk may result in the patient not receiving the proper dose of nitroglycerin. The disk should not be applied to skinfolds. The waist is typically in a skinfold area and should be avoided because the drug will not absorb properly and may cause skin irritation from rubbing. Therapeutic effects occur within 30 minutes after attachment of the disk. Shaved areas may become irritated when the disk is applied and may alter drug absorption.

A patient states that he frequently gets a headache when he changes his nitroglycerin patch. Which is the best response by the nurse?

"Nitrate-induced headaches may be treated with acetaminophen." Nitrate-induced headaches range from a mild sensation of fullness in the head to an intense and severe generalized headache. Most patients develop a tolerance within a few weeks of starting therapy. A headache from a nitroglycerin patch is a known adverse effect and is not an indication to stop the medication. A headache from a nitroglycerin patch is not an indication that the medication dosage needs to be increased. There is no need to take a prescription pain medication to relieve a nitrate-induced headache.

Which is an adverse reaction that may occur when sildenafil (Viagra) and nitrates are taken together?

A significant drop in blood pressure Sildenafil potentiates the vasodilatory effects of nitrates, resulting in a significant drop in blood pressure that may be fatal. The combination of sildenafil and nitrates does not cause an increase in blood pressure, does not directly cause an increase in the heart rate, and does not cause coronary artery spasms.

Which term describes a feeling of chest discomfort arising from the heart because of lack of oxygen to heart cells?

Angina pectoris This is the definition of angina pectoris. Ischemic heart disease develops when the supply of oxygen needed by the heart cells is inadequate. Peripheral vascular disease affects the blood vessels of the extremities. Myocardial infarction describes the damage that has occurred in the heart muscle.

A patient taking a calcium ion antagonist asks how the drug works to help his angina. Which is an action of calcium ion antagonists that the nurse should include when answering this question?

Dilate coronary arteries and peripheral blood vessels, thereby increasing myocardial blood flow and decreasing workload Dilation of peripheral vessels reduces the workload of the heart and therefore the myocardium's need for oxygen. Coronary artery dilation improves coronary blood flow and the delivery of oxygen to the heart. Calcium ion antagonists dilate peripheral and coronary blood vessels. Calcium ion antagonists do not constrict peripheral blood vessels, alter the response of the heart to stress, or change the ability of the myocardium to tolerate low levels of oxygen.

Which instructions will the nurse provide when educating a patient with angina on the use of nitroglycerin translingual spray?

Dont use near fire, dont shake container, dont swallow spray Nitroglycerin translingual spray should not be swallowed or inhaled, and should not be shaken because bubbles may form and slow the release of the drug. Nitroglycerin translingual spray is highly flammable and it should not be used anywhere it might ignite. The proper administration of nitroglycerin translingual spray is to spray it onto or under the tongue. The mouth should be closed after each dose to allow for penetration of the drug.

A patient is prescribed ranolazine (Ranexa) for the treatment of chronic stable angina. Which medication currently prescribed for this patient would the nurse report to the healthcare provider?

Erythromycin (E mycin) Ranolazine may prolong the QT interval when taken with erythromycin. Cimetidine, butorphanol, and zidovudine do not interact with ranolazine.

Which statement about nitrates is true?

Nitroglycerin is currently the drug of choice for treating angina pectoris. The nitrates, available in different doses for adjustment to patient needs, are the oldest effective therapy for angina pectoris and still the drug of choice. One of the primary therapeutic goals for nitrate therapy is to relieve anginal pain. Other therapeutic outcomes include reduced frequency and severity of anginal attacks as well as increased tolerance of activities. Nitroglycerin does not prevent myocardial infarction. With continued use of nitrates, tolerance and loss of antianginal response develop, and periodic nitrate-free periods are required. When used with beta blockers or calcium antagonists, nitrates produce greater antianginal and antiischemic effects than when used alone. These agents also help provide prophylaxis against attacks during nitrate-free periods.

Which condition should a patient be assessed for when beginning treatment with the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec)?

Persistent cough Persistent cough can occur from the use of ACE inhibitors such as enalapril. Therefore, it is important to know if a persistent cough is present before the medication is begun. Vertigo, tinnitus, and orthopnea are unrelated to the use of enalapril.

Which action will the nurse implement when applying nitroglycerin ointment to a patient?

Use an applicator to measure the correct dose of ointment. Using an applicator to apply nitroglycerin ointment ensures correct dose measurement. To promote absorption, the site should be covered with a clear plastic wrap. Nitroglycerin patch sites should always be rotated; this helps prevent skin irritation. Massaging nitroglycerin ointment into the skin is not an appropriate method for the use of this medication.

Which principle does the nurse follow when preparing to administer nitroglycerin to a patient intravenously?

Use an infusion pump to administer nitroglycerin. An infusion pump is used to administer nitroglycerin because the dose must be administered precisely and is titrated. IV nitroglycerin should not be mixed with other medications because drug interactions may occur. IV nitroglycerin is administered only with administration sets made specifically for nitroglycerin because most plastic administration sets absorb the bag. IV nitroglycerin is used in the intensive care and cardiac telemetry setting and requires continual monitoring of vital signs. Every 4 hours is not frequent enough.