PHARM201 CH36

A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond?

"You may experience headaches as an adverse reaction to nitroglycerin."

A client is to take diltiazem (Cardizem) 360 mg/d PO in four divided doses. How many mg will the client take per dose?

90 mg

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain?

Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided.

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 as soon as chest pain develops.

Beta-blockers have what advantage over nitrates in the management of angina?

Clients do not develop tolerance to beta-blockers.

A client should be instructed to take sublingual NTG how often if he experiences chest pain?

Every 5 minutes times 3

What principle should guide the nurse's follow-up assessment after administering an oral dose of 30 mg of long-lasting nifedipine?

Nifedipine does not affect heart rate, so assessment after administration is not normally necessary.

Nitrate efficacy in lowering systolic blood pressure contraindicates when what contraindication exists? Select all that apply.

phosphodiesterase enzyme type 5 inhibitor cerebral hemorrhage severe anemia

What characteristic of nitrate therapy can contribute to the ineffectiveness of the medication when prescribed via the sublingual administration route? Select all that apply.

slow onset of action delayed pain relief

A client, diagnosed with erectile dysfunction, is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated?

"Nitroglycerin and sildenafil cause a severe decrease in blood pressure."

A client was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse?

"Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage."

A client may administer a maximum of how many doses of sublingual nitroglycerin in a 15-minute period?

3

The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack?

Every 5 minutes

A 61-year-old client with a history of diabetes mellitus, obesity, and a recent myocardial infarction should be questioned concerning what relevant assessment data associated with coronary artery disease (CAD)? Select all that apply.

nicotine use typical A1C results cholesterol consumption experience of angina pain

A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client?

"The heart muscle isn't getting enough oxygen."

A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin (Nitrostat). The health care provider orders nifedipine (Adalat) added to the regimen. The nurse should observe for which adverse effect?

Hypotension

A client has been diagnosed with angina and prescribed nitroglycerin. What aspect of the client's health history should prompt the nurse to monitor the client particularly closely after administration of the drug?

Orthostatic hypotension

The nurse is caring for a client diagnosed with coronary artery disease and a history of angina receiving the medication nitroglycerin ointment 2%, 2 inches every 8 hours. The nurse should perform which assessment(s) for safe administration of the nitroglycerin? Select all that apply.

Remove previous nitroglycerin ointment and applicator paper and fold in half before disposing in trash. Do not massage area of nitroglycerin ointment, and secure the applicator paper with tape with date, time, initials. Wear gloves when removing old application and applying new application to prevent the development of headache.

Angina pectoris occurs when the myocardial demand for oxygen exceeds that which can be supplied.

True

A health care provider has ordered 40 mg of isosorbide dinitrate for a client who reports chest pain. The nurse administers the medication after confirming the absence of what condition?

anemia

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.

An older adult client, diagnosed with angina pectoris, has has been prescribed nifedipine. After administering a dose of the drug at 08:00, the nurse should anticipate maximum effect at what time?

09:00 to 10:00

The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?

Nitrostat

A male client is having angina. As the nurse prepares to administer sublingual nitroglycerin, it is noted that the client's blood pressure is 82/54. What is the best action of the nurse?

Notify the health care provider.

Nitroglycerin has several uses in medicine. Which client is most likely to benefit from the administration of nitroglycerin?

A client with chronic constipation who has developed anal fissures

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

After administering a nitrate, the nurse would be alert for which reactions? Select all that apply.

Headache Hypotension Flushing

The client is taking a calcium-channel blocker. What adverse effects might the client experience?

Headache and dizziness

The nurse is caring for a client who is taking a calcium-channel blocker. What adverse effects would the nurse caution this client about?

Headache and dizziness

Clients who are taking nifedipine should be monitored for which of the following adverse effects?

Peripheral edema

People receiving nifedipine (Adalat) should be assessed for which adverse effects?

Peripheral edema

When teaching a client how to use a transdermal nitroglycerin patch, which instructions would be most important for the nurse to include? Select all that apply.

Remove the old patch before applying the new patch. Leave patch in place for 10 to 12 hours. Apply patch to a dry, hair free area.

A client with chronic alcoholism has been admitted to the health care center for acute angina management and is started on nitrates. The nurse emphasizes the need for the client to avoid alcohol use to prevent which reaction?

Severe hypotension

The nurse cautions a client receiving nitrate therapy about avoiding the use of alcohol to prevent which reaction?

Severe hypotension

The nurse would avoid administering nitrates to clients using which medication?

Sildenafil

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.

The client has been prescribed nitroglycerin. What would the nurse teach the client about the safe and effective use of nitroglycerin? Select all that apply.

"The tablet should fizzle or burn when placed under the tongue." "Protect the drug from heat and light." "Always replace when past the expiration date."

A client's angina pectoris is being successfully treated on an outclient 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 a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."

A client is to take nifedipine (Adalat) 10 mg PO tid. How many milligrams will the client take per dose?

10 mg

A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided?

"I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."

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 cause a severe decrease in blood pressure."

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?

"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 client with a longstanding diagnosis of angina has been prescribed nitroglycerin and diltiazem. In addition to monitoring the client's heart rate, the nurse should prioritize what assessment?

Blood pressure

The client is taking a calcium channel blocker. Which assessment findings would the nurse expect?

Bradycardia

A client has been admitted to a health care facility for chest pain. Initial diagnosis indicates constrictive pericarditis, for which nitrate therapy is contraindicated. The nurse understands that nitrates are also contraindicated for which condition? Select all that apply.

Cerebral hemorrhage Severe anemia Closed-angle glaucoma

The nurse should administer bisoprolol with an understanding that it achieves a therapeutic effect in what way?

decreasing heart rate

A nurse explains to a client that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for which?

nitrate tolerance.

An older adult client whose medical history includes angina experiences a sudden onset of chest pain. This client would most likely administer a dose of nitroglycerin by what route?

transmucosal spray

A client was given a new prescription for a transdermal nitroglycerin patch. What client education should the nurse provide regarding this medication?

"Put your patch on a part of your skin that doesn't have too much hair on it."

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's angina may necessitate the use of a calcium channel blocker.

Which statement by a 54-year-old client indicates an understanding of how to take sublingual nitroglycerin?

"I can take up to 3 tablets at 5-minute intervals."

After teaching a group of nursing students about antianginal agents, the instructor determines that the teaching was successful when the students identify which mechanisms of calcium channel blockers? Select all that apply.

Slow the conduction velocity of the cardiac impulse. Depress myocardial contractility. Dilate coronary arteries and arterioles

A nurse is preparing to administer a prescribed nitrate to a client with angina. The nurse understands that nitrates are available in which dosage forms? Select all that apply.

Sublingual Transdermal Parenteral

Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?

blood pressure (BP)

A nurse is creating a plan of care for a 68-year-old client with a recent diagnosis of unstable angina and new prescription for nitroglycerin. Which nursing diagnoses should the nurse prioritize in the planning of this client's care?

Acute Pain, Headache, related to adverse effects of drug therapy

A male client is admitted to the emergency department (ED) with chest pain. The client is diagnosed with angina pectoris. He is being discharged with an order for nitroglycerin SL PRN. What action should the nurse take when the client reports chest pain?

Administer a tablet under the client's tongue and repeat the action in 5 and 10 minutes if the pain has not subsided.

The nurse should instruct the client to take what action if nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?

Go to the emergency department

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

Organic nitrates are widely used to decrease cardiac workload, effectively decreasing angina. Nitrate efficacy in lowering systolic blood pressure contraindicates its use with which of the following? (Select all that apply.)

Phosphodiesterase enzyme type 5 inhibitor Cerebral hemorrhage

A client arrives at the urgent care center complaining of chest pain. After diagnosis, the health care provider prescribes amlodipine for the client's condition. The nurse understands that this drug is indicated for which condition?

Prinzmetal angina

The nurse is administering sublingual nitroglycerin to a client. Prior to administering the medication, the nurse informs the client that immediately after administration, the client may experience:

T=throbbing headache or dizziness.

The nurse is caring for a client with hypertension currently receiving a nitroglycerin intravenously at 20 mcg/minute via the right forearm via 20-gauge angiocath. The client has an ordered antibiotic for intravenous piggyback (IVPB) to be administered. Which is the <b>best</b> action for the nurse to take?

Use another IV site, or insert a new IV angiocath at another location and infuse the IVPB at that site.

A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

decreased heart rate

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports:

no episodes of angina since ointment was initiated.

The client is started on a transdermal nitroglycerin patch system. The nurse teaches the client that the system relieves pain by which action?

Dilates arteries and veins

When describing the possible adverse effects associated with nitroglycerin, what would the nurse include?

Dizziness

A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for:

Hypotension

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?

Hypotension

A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker?

Isosorbide

A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration?

"I can take up to three tablets at five-minute intervals."

Which of the following statements by the client prescribed sublingual nitroglycerin indicates the need for additional education?

"I know the medication is working if I feel a burning sensation in my mouth."

A nurse has an order to apply nitroglycerin topically, twice a day. The nurse's initial action will be to do which?

don a pair of gloves.

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?

inhibiting the influx of calcium through slow channels.

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?

Alcoholic beverages

Which agent would the nurse expect to administer for a client with Prinzmetal's angina?

Amlodipine

A client is prescribed a transdermal nitroglycerin system. The nurse educates the client on which action?

Apply the new transdermal system at the same time daily.

Nitrates should not be used in clients with which of the following? (Choose one)

Closed-angle glaucoma

A nurse understands that nitrates should not be used in clients with which conditions? Select all that apply.

Closed-angle glaucoma Cerebral hemorrhage

A nurse is teaching a 45-year-old client about the sublingual nitroglycerin that the health care provider has prescribed for management of stable angina. Which statement by the client indicates that the client understands the teaching session?

"I will use the nitroglycerin if I experience chest pain."

The client tells the nurse he does not like taking his prescription isosorbide because it makes him feel weak, dizzy, flushed, and he gets a severe headache. What is the nurse's best response?

"With time, these adverse reactions often subside."

A client is admitted to the emergency department with severe chest pain. The emergency department health care provider orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which assessment?

Blood pressure

Prior to the administration of nitroglycerin, the nurse would assess which of the following?

Blood pressure

A client using a nitroglycerin patch should avoid:

alcoholic beverages.

The nurse provides client teaching for a client diagnosed with angina about the prescribed nitroglycerin transdermal patch. Which client statement establishes the need for further teaching?

"I will apply the patch for 24 hours and then remove it, and place another transdermal patch."

A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement?

"I will take a pill every 15 minutes until the pain subsides."

A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets?

Nitroglycerin will increase intracranial pressure.

A male client has sustained a head injury in a motor vehicle accident. He has nitroglycerine tablets for chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerine have on the client's current status?

Nitroglycerine will increase intracranial pressure.

The nurse provides client education on how to use translingual nitroglycerin. The client has an angina attack. The client uses the drug. At which step during the client usage would the nurse intervene?

Shakes the canister gently before using.