Chapter 46-- antianginal agents
What indicates that a client understands how to use sublingual nitroglycerin? "I can chew the tablet once it starts dissolving." "I need to avoid taking any sips of water before using the drug." "I should put the pill between my tongue and cheek." "I should feel a fizzing or burning sensation."
"I should feel a fizzing or burning sensation."
A client diagnosed with a cardiac conduction disorder tells the nurse, "They keep telling me that my P cells are the problem; but I don't know what a P cell is." How should the nurse respond to best educate this client? "A 'P cell' is vital to your heart's ability to automatically beat." "They are simple cells that produce the electrical charge your heart needs to pump blood."
"They are simple cells that produce the electrical charge your heart needs to pump blood."
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant? "Anticoagulants thin the blood so clots can't get as big." "This medication will keep unnecessary clots from forming in my blood."
"This medication will keep unnecessary clots from forming in my blood."
True or False: Beta blockers decrease myocardial oxygen demand by increasing the heart rate and decreasing cardiac contraction.
False
Fluid moves into the arterial end of a capillary due to:
Hydrostatic pressure
A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?
Implement interventions to lower blood pressure.
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 Inverted P Wave Short ST segment
QT prolongation
A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension?
Stage 2
A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this client's angina? The client will likely have a trial of antiplatelet drugs before being prescribed nitrates. The client's angina may necessitate the use of a calcium channel blocker. The client may need low molecular weight heparin
The client's angina may necessitate the use of a calcium channel blocker.
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? 5 10 15 20
5
What statement should underlie the nurse's response when asked if ACE inhibitor therapy can be continued during pregnancy?
ACE inhibitors are contraindicated during pregnancy because they are teratogenic.
The client is experiencing chest pain. What should be assessed just prior to the administration of antianginal medication? Select all that apply. Location, quality of pain Blood pressure Skin color GI upset Weight
Location, quality of pain Blood pressure Skin color
After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply? Myocardium hypertrophy Increased risk for hepatic damage
Myocardium hypertrophy
The nurse has completed administering an oral dose of 30 mg of long-lasting nifedipine. What principle should guide the nurse's follow-up assessment? The client's heart rate will be at its lowest approximately 45 minutes to 1 hour after oral administration of nifedipine. Nifedipine has the potential to induce prodysrhythmic effects. The client's blood pressure, heart rate, and oxygen saturation level should be assessed 30 minutes after administration of nifedipine. Nifedipine does not affect heart rate, so assessment after administration is not normally necessary.
Nifedipine does not affect heart rate, so assessment after administration is not normally necessary.
Which statement correctly distinguishes between the therapeutic effects of sublingual isosorbide and sublingual nitroglycerin? Sublingual isosorbide has a lesser sustained effect than sublingual nitroglycerin. Sublingual isosorbide has a faster onset and a shorter duration of action than sublingual nitroglycerin. Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Sublingual isosorbide is not as effective as sublingual nitroglycerin.
Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin.
The chest pain and pressure a client experiences during an anginal attack is caused by which of the following?
decreased oxygen supply to the heart
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 one tablet and lay down for an hour." "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider." "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." "I will take three tables every 5 minutes until the chest pain subsides."
"I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider."
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's a normal report we hear." "That means that the drug is still potent and working."
"That means that the drug is still potent and working."
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 5 to 10 minutes 1 to 20 minutes
1 to 3 minutes
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? Call the ER doctor Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. Begin CPR
Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided.
The physician is considering prescribing a beta blocker for a patient who is experiencing angina. For which condition should the patient be assessed before the physician orders the medication? Asthma Chronic obstructive pulmonary disease (COPD) Diabetes All the above
All the above
The client is taking a calcium channel blocker. Which assessment findings would the nurse expect? Bradycardia Tachycardia Palpitations Vomitting
Bradycardia
Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment? Oxygen saturation levels Level of consciousness (LOC) Oral temperature Blood pressure
Blood pressure
When considering vital signs, which assessment is focused on the functioning of the body's resistance system
Blood pressure
The 47-year-old client is experiencing chest pain and has taken three sublingual nitrogylcerin tablets, but the pain remains. What should the client do next? Call 911 Go to the emergency room Take another tablet
Call 911
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? Perspiring skin that is cold to the touch Diarrhea Dizziness Bradycardia
Dizziness
When describing the possible adverse effects associated with nitroglycerin, what would the nurse include? Constipation Dizziness Fever
Dizziness
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hypokalemia Hypotension Hyponatremia
Hypotension
When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?
Ineffective Tissue Perfusion
After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse? AV node SA node bundle of His Purkinje fibers
SA Node
The nurse is teaching the client about coronary artery disease (CAD). Which statement by the client indicates that he or she has understood the teaching? "My high blood pressure has no effect on my episodes of chest pain." "I will avoid exercise because it will precipitate my angina." "High fat in the diet and smoking can cause my episodes of chest pain." "As long as I take my medicines, I will not need to decrease my fat intake."
"High fat in the diet and smoking can cause my episodes of chest pain."
When a client is prescribed nitroglycerin transdermal spray, what instructions should the nurse provide the client concerning how to administer the spray? Administer the spray if the angina pain is unrelieved by 30 minutes of rest. Administer the spray after administering oxygen by nasal prongs. Administer the spray as soon as chest pain develops. Administer the spray after consulting with the care provider or a nurse.
Administer the spray as soon as chest pain develops.
In which situation would blood be most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up
The client has been prescribed a nitroglycerin patch for anginal pain. The nurse is teaching the client about safe and proper use of the nitroglycerin patch. What should the nurse caution the client to avoid? synthetic fabric alcoholic beverages milk products
alcoholic beverages
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? Intermittent claudication Angina pectoris Myocardial infarction Hypertension
angina pectoris
How does captopril contribute to a reduction of a client's blood pressure?
blocking the conversion of angiotensin I to angiotensin II
Pathologic changes in the structure of the capillary and venular endothelium can result in the accumulation of fluid in interstitial space. What term refers to this accumulation?
edema
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: constipation xerostomia depression falls
falls.
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will: hold the dose and contact the provider administer the scheduled dose and contact the provider administer double the dose and monitor the patient
hold the dose and contact the provider
When prescribed for angina, how does oral nifedipine achieve a therapeutic effect? binding extracellular sodium ions with chloride ions inhibiting the influx of calcium through slow channels. potentiating the effect of B-type natriuretic peptide preventing the outflow of intracellular potassium
inhibiting the influx of calcium through slow channels.
When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery supplies the:
left ventricle
The nurse is caring for a male client with a history of hypertension and Prinzmetal's 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 <b>best</b> therapeutic response to the client's concern? "Don't worry, this is an expected side effect of minoxidil, and it is hardly noticeable, and your blood pressure is stable with the meds." "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."
"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."
A nurse is explaining to a client the physiology of the heart with reference to the cardiac valves. Which statement by the client about the function of the cardiac valves demonstrates the correct understanding of the nurse's explanation? Contraction of ventricles Allow blood to flow in one direction only Receiving center for blood
Allow blood to flow in one direction only
After teaching a group of students about nitrates, the instructor determines that the teaching was successful when the students identify what as a contraindication? Cerebral hemorrhage Hypotension Liver dysfunction Hypovolemia
Cerebral hemorrhage Explanation: Nitrates would be contraindicated in patients with cerebral hemorrhage because the relaxation of the cerebral vessels could cause intracranial bleeding. Nitrates should be used cautiously in patients with hypotension, which could be exacerbated by the drug. Nitrates should be used cautiously in patients with liver dysfunction, which could alter the drug's metabolism. Nitrates should be used cautiously in patients with hypovolemia, which could be exacerbated by the drug therapy.bral hemorrhage
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 occurs at rest Chest pain that is relieved by rest Chest pain that occurs due to vasospasm Chest pain that occurs with coronary artery disease
Chest pain that is relieved by rest
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? Susceptibility of the client to intracranial pressure Susceptibility of the client to renal insufficiency Current blood pressure Current respiratory rate
Current blood pressure
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? Increasing the force of myocardial contractions Decreasing heart rate Prolonging the QT interval Shortening the time required for repolarization
Decreasing heart rate
Which assessment finding would prompt the nurse to withhold a scheduled dose of oral atenolol? Select all that apply. blood pressure of 88/49 mm Hg heart rate of 54 beats per minute oxygen saturation of 90% on room air
blood pressure of 88/49 mm Hg heart rate of 54 beats per minute
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 hyperglycemia pleural effusion pneumonia
bronchospasm
Calcium channel blockers are used in
chronic stable angina
A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil (Viagra)? "Nitroglycerine and Viagra will diminish the effectiveness of chest pain relief." "Nitroglycerine and Viagra cause a severe decrease in blood pressure."
"Nitroglycerine and Viagra cause a severe decrease in blood pressure."
The pharmacology instructor is discussing clopidogrel (Plavix). According to the instructor, this drug is frequently used for: prophylaxis of deep venous thrombosis in clients having hip replacement surgery. reduction of myocardial infarction in clients with atherosclerosis.
reduction of myocardial infarction in clients with atherosclerosis.
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 Increased oxygen consumption Increased blood pressure Increased heart rate
Decreased cardiac output
A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? Decreased oxygenation to the myocardium A reduction in plaque secondary to atherosclerosis Hypertension of the myocardium Decreased musculature of the myocardium related to plaque
Decreased oxygenation to the myocardium
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 Increasing conduction to the atrioventricular node, thereby increasing cardiac output Increasing blood pressure, which increases the amount of blood returned to the heart Increasing cardiac output, thereby increasing the oxygen supplied to the heart
Decreasing the heart rate, allowing for longer filling time and increased blood to the heart
Which would a nurse identify as a nitrate? Nicardipine Isosorbide Metoprolol Amlodipine
Isosorbide
Blood returning to the heart arrives at the right ventricle by way of the: tricuspid valve vena cava The pulmonary vein
vena cava
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 rotate where the patch is on my body from my arm to my thigh to my butt I will apply the patch for 24 hours and then remove it, and place another transdermal patch. I will wash the area the patch was on with soap and water and then dry
"I will apply the patch for 24 hours and then remove it, and place another transdermal patch."
After explaining an electrocardiogram to a patient, which statement indicates that the patient understands this test? "It will help to identify how my heart is working mechanically." "It will show how impulses are moving through my heart."
"It will show how impulses are moving through my heart."
When teaching the client to safely administer nitroglycerin ointment, the nurse should convey which instruction? "Don't apply the ointment unless you're experiencing chest pain at the time." "Massage the ointment into your skin for 10 to 15 seconds after applying it." "The backs of your hands and the tops of your feet are ideal sites for applying the ointment." "Make sure you squeeze the ointment on to a paper measuring scale before applying it."
"Make sure you squeeze the ointment on to a paper measuring scale before applying it."
A current patient, an overweight, 61-year-old man with a history of diabetes mellitus, is status post-MI 1 month and has returned for his cardiology follow-up. Included with his dietary changes, the cardiologist recommended which nonpharmacological lifestyle changes to reduce microvascular changes? Glucose control Increased cholesterol consumption Increased nicotine use Maintaining weight
Glucose control
A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client? Renal insufficiency Hypotension Sedation Hypokalemia
Hypotension
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 morphine sulfate Intravenous nitroglycerine Oral nonsteroidal anti-inflammatory agents Fentanyl topical patch
Intravenous nitroglycerine
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 is easier for the patient to use It has a longer duration of action than sublingual tablets. It only needs to be applied weekly
It has a longer duration of action than sublingual tablets.
Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which statement is true regarding the use of ranolazine for the treatment of this patient's angina? Ranolazine confers protection from myocardial infarction but does not relieve symptoms of angina. Mr. Penny will need to be taught to monitor his blood pressure and heart rate. Amlodipine will now be contraindicated in the treatment of Mr. Penny's angina. Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.
Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.
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? Ranolazine Verapamil Nadolol Amlodipine
Nadolol
Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) Increase high-density lipoproteins (HDL). Treatment chronic stable angina pectoris. Decrease serum triglyceride. Prevent angina attacks. Relieve the pain of acute anginal attacks.
Prevent angina attacks. Relieve the pain of acute anginal attacks. Treatment chronic stable angina pectoris.
After teaching a group of students about anticoagulants, the instructor determines that the teaching was successful when the students identify which agents as interacting with warfarin that increase the risk of bleeding? (Select all that apply.) Barbiturates Salicylates Metronidazole Ranitidine Cefoxitin
Salicylates Ranitidine Metronidazole Cefoxitin (Salicylates, ranitidine, metronidazole, and cefoxitin interact with warfarin, resulting in the increased risk of bleeding. Barbiturates and carbamazepine interact with warfarin resulting in a decreased anticoagulant effect)
The nurse would avoid administering nitrates to clients using which medication? Lisinopril Simvastatin Sildenafil Albuterol
Sildenafil
The nurse is reviewing a patient's ECG and notes that the ECG is normal, but the rate is 110 beats/minute. The nurse would identify this as: Paroxysmal atrial tachycardia Sinus tachycardia Atrial flutter
Sinus tachycardia
The nurse is caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within: five to ten minutes. one to three minutes. ten to fifteen minutes
one to three minutes.
What should the nurse tell the client about storage of oral nitroglycerin products? (Select all that apply.) Store oral nitroglycerin away from light exposure. Store oral nitroglycerin in a pill box so that daily doses are not missed Store oral nitroglycerin in the original container. Store oral nitroglycerin with other medicines Store oral nitroglycerin with the container lid tightly sealed.
Store oral nitroglycerin away from light exposure. Store oral nitroglycerin in the original container. Store oral nitroglycerin with the container lid tightly sealed.
True or False: Warfarin typically takes 3 days to achieve its onset of action.
True
An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client's blood pressure be classified? stage 1 hypertension isolated systolic hypertension
isolated systolic hypertension
The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports: minimal episodes of angina. no episodes of angina since ointment was initiated. dizziness after each application. that he gets a headache each time the ointment is applied.
no episodes of angina since ointment was initiated.
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: has an indefinite shelf life. should be replaced annually. should be replaced every six months. should be replaced monthly.
should be replaced every six months.
A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil (Viagra)? "Nitroglycerine decreases the effect of Viagra for erectile dysfunction." "Nitroglycerine and Viagra cause a severe decrease in blood pressure
"Nitroglycerine and Viagra cause a severe decrease in blood pressure
The client is experiencing an acute onset of angina. The nurse would most likely administer which medication? Nitrostat Procardia Nitro-Dur Norvasc
Nitrostat
A client's angina pectoris is being successfully treated on an outpatient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication? "This is actually a result of your angina, not the nitroglycerin." "I'll contact you care provider. This may mean that nitroglycerin is not the right drug for you." "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache." "If you can take your nitroglycerin on a full stomach, it might reduce the frequency and severity of your headaches."
"This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."
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 A greater incidence of hyperglycemic episodes Decreased effectiveness of the antianginal drug Decreased effectiveness of the antihypertensive
A greater incidence of adverse drug effects
A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?
Potassium
When describing nitrates, which explanation of mechanisms would the nurse expect to include? Select all that apply. Nitrates relax the smooth muscle layer of blood vessels. Nitrates depress myocardial contractility. Nitrates slow the conduction velocity of the cardiac impulse. Nitrates increase the amount of blood flowing through the vessel. Nitrates increase the lumen of the artery or arteriole.
Nitrates relax the smooth muscle layer of blood vessels. Nitrates increase the lumen of the artery or arteriole. Nitrates increase the amount of blood flowing through the vessel.
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 raise the client's blood pressure. Nitroglycerin will decrease blood glucose. Nitroglycerin will increase intracranial pressure. Nitroglycerin will cause decreased cerebral edema.
Nitroglycerin will increase intracranial pressure.
A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route? Sublingual Oral IV IM
Oral
