Prep U's - Chapter 28 - Drug Therapy for Coronary Artery Disease

The client is taking a calcium-channel blocker. What adverse effects might the client experience? A. Headaches and dizziness. B. Palpitations and tingling of extremities. C. Fever and bronchospam. D. Hypertension and tachycardia.

Answer: A Rationale: Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.

A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond? A. "You may experience headaches as an adverse reaction to nitroglycerin." B. "Do not take any more nitroglycerin. It is increasing your blood pressure." C. "If you lie down when taking nitroglycerin, you will not experience a headache." D. "Nitroglycerin is dropping your blood pressure and that is causing the headache."

Answer: A Rationale: An adverse reaction of nitroglycerin includes headaches. The client should not reduce or stop taking the medication. Lying down will not prevent headaches associated with taking nitroglycerin.

A male client asks the nurse why the health care provider has added combined aspirin, antilipemic, and antihypertensives to his medication regimen when he feels fine and hasn't experienced an anginal episode in a year. The nurse explains that this combination of drugs is given for what reason? A. Prevents progression of myocardial ischemia to MI. B. Prevents episodic hypertensive crisis and subsequent CVA. C. Prevents cerebral edema and subsequent CVA. D. Reduces afterload that fosters an MI.

Answer: A Rationale: Aspirin, antilipemic, and antihypertensives are used in conjunction with antianginal drugs to prevent progression of myocardial ischemia to MI.

An asthmatic client on a beta blocker should be observed for which adverse reaction? A. Bronchospasm B. Pneumonia C. Hypoglycemia D. Pleural effusion

Answer: A Rationale: Bronchospasm can occur with beta blockade. The patient would not have to be observed for hypoglycemia, pleural effusion, or pneumonia.

The nurse would avoid administering nitrates to clients using which medication? A. Sildenafil B. Atorvastatin C. Albuterol D. Lisinopril

Answer: A Rationale: Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs.

The 47-year-old client is experiencing chest pain and has taken three sublingual nitroglycerin tablets, but the pain remains. What should the client do next? A. Call 911. B. Notify his healthcare provider. C. Have someone take him to the emergency department. D. Take another nitroglycerin and call 911.

Answer: A Rationale: Nitroglycerin should be administered every five minutes, times three doses. If the pain persists, 911 or the emergency system should be activated. The client should not take additional medication. It is not safe to be transported by private car having chest pain.

A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route? A. Oral B. Intravenous C. Sublingual D. Transdermal

Answer: A Rationale: Propranolol is used orally as treatment for angina.

The nurse is performing a history for a black client that is concerned about developing coronary artery disease since it "runs in the family." What risk factor, that is modifiable, does the nurse identify when taking the history? A. obese 40% over total body weight. B. father had a myocardial infarction at 48. C. client ethnicity. D. age of 62.

Answer: A Rationale: The client is able to modify the risk factor of obesity with healthy lifestyle changes. The risk factors that are non-modifiable or cannot be changed are the ethnicity of the client, history of family coronary artery disease, or age.

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? A. Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. B. Ask the client to lie back and try to relax. C. Call the health care provider. D. Have the client swallow a tablet every 5 minutes for 15 minutes.

Answer: A Rationale: The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the client's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the client to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the health care provider if the pain has subsided by the third tablet. If the pain has not subsided, the client is considered to be having an acute MI, and it would be urgent to call the provider. Nitroglycerin does not come in oral form; therefore, it would not be swallowed.

A patient is being discharged after being treated with nitroglycerin for an acute anginal attack. Which of the following instructions should the nurse provide the patient regarding the administration of nitroglycerin ointment? A. Use an applicator for applying the ointment. B. Apply a thick layer of the ointment. C. Rub the ointment onto the skin. D. Apply on the same site during every application.

Answer: A Rationale: The nurse should instruct the patient to use an applicator for applying the nitroglycerin ointment. The ointment should not come in contact with the skin of the person applying it, as it gets easily absorbed. The nurse should instruct the patient to apply a thin layer of the ointment on the skin using an applicator. The nurse must instruct the patient not to rub the ointment while applying as it delivers large amounts of the drug into the system. The nurse should not apply the ointment on the same site during every application. The application site should be rotated to prevent inflammation of the area.

The nurse is teaching a client and caregiver the proper technique for administering the prescribed nitroglycerin ointment. Which method should the nurse point out is the best way to determine the amount of ointment to apply? A. Paper applicator. B. A teaspoon. C. A ruler. D. Length of a finger.

Answer: A Rationale: The topical ointment is supplied with a paper applicator with markings to indicate dosage to determine the amount of drug to be used. No other method is appropriate.

The nurse cautions a client receiving nitrate therapy about avoiding the use of alcohol to prevent which reaction? A. Severe hypotension. B. Hypertensive emergency. C. Myocardial infarction. D. Acute anginal attack.

Answer: A Rationale: The use of alcohol with nitrates can result in severe hypotension and cardiovascular collapse may occur. Acute angina attack and myocardial infarction are seen with heart disease and emboli.

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? A. "I will take a pill every 15 minutes until the pain subsides." B. "I may get a headache after I take this medication." C. "Before I take my medication, I will lie down." D. "I will keep my medication in the original container."

Answer: A Rationale: When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension.

Angina pectoris is a clinical syndrome characterized by episodes of chest pain. What other characteristics describe angina pectoris? Select all that apply. A. It occurs when there is a deficit in myocardial oxygen supply. B. It is most often caused by atherosclerotic plaque in the coronary arteries. C. It occurs when there is an excess in myocardial oxygen supply. D. There are three types of angina: classic, variant, and unstable.

Answer: A, B, D Rationale: Angina pectoris is a clinical syndrome characterized by episodes of chest pain. It occurs when there is a deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand. There are three main types of angina: classic, variant, and unstable. Angina is most often caused by atherosclerotic plaque in the coronary arteries but may also be caused by coronary vasospasm.

The nurse determines a client has a nursing diagnosis of acute pain related to angina. When teaching the client about antianginal drugs, the nurse would point out which information about the pain? Select all that apply. A. May be less frequent. B. May not be completely relieved. C. Will only occur during prolonged exercise. D. Will worsen with continued use. E. May be less intense.

Answer: A, B, E Rationale: Although some clients experience complete angina pain relief, it may not be completely relieved in all clients. In some clients, pain may be less intense or less frequent or may only occur during prolonged exercise. If the pain worsens with continued use, it is a medical emergency and the client should present to the closest emergency department for treatment as it could be an indication of a myocardial infarction.

Several forms of nitroglycerin have been developed to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. What characteristics of nitrate therapy can contribute to the ineffectiveness of the medication when prescribed via the oral route? Select all that apply. A. Delayed pain relief. B. Slow onset of action. C. Large doses reaching systemic circulation. D. Short duration of action. E. Rapid metabolism by the liver.

Answer: A, B, E Rationale: Oral dosage forms are rapidly metabolized in the liver and relatively small proportions of doses reach the systemic circulation. In addition, oral doses act slowly and do not help relieve acute chest pain. The duration of action is 4 to 8 hours.

Which of the following is true with headaches associated with nitrates? Select all that apply: A. Headaches may be a mark of the drug's effectiveness. B. Headaches should be avoided by altering the dosage schedule. C. Headaches should decrease with continued therapy. D. Headaches may be relieved with the use of aspirin or acetaminophen. E. Headaches are a serious adverse reaction and should be reported immediately.

Answer: A, C, D Rationale: Headaches are a common adverse reaction of nitrates but should decrease with continued therapy. Headache should be reported if they become severe or persist. Headaches may be a marker of the nitrate's effectiveness, and clients should not alter the dosing schedule to avoid headaches. Headaches may be treated with acetaminophen or aspirin.

A client is prescribed oral nitrate for occasional anginal pain. The nurse should point out that nitrates must be stored in which manner(s)? Select all that apply. A. In its original container. B. With other medications in the container. C. With the container lid tightly sealed. D. Away from light exposure. E. In a plastic pill box so doses are not missed.

Answer: A, C, D Rationale: The proper storage of oral nitroglycerin includes keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, keeping the drug away from light, and always replacing the container tightly and as soon as the drug is removed.

Antianginal drugs are most often used to manage what conditions? (Select all that apply.) A. Severe angina. B. Severe hypertension. C. Serious cardiac arrhythmias. D. Severe postural hypotension. E. Serious heart failure.

Answer: A, C, E Rationale: Antianginal drugs have multiple cardiovascular effects and may be used alone or in combination with other cardiovascular drugs in clients with critical illness. They are probably used most often to manage severe angina, severe hypertension, or serious cardiac arrhythmias. They are not indicated for treatment of serious heart failure.

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. A. Slow the conduction velocity of the cardiac impulse. B. Increase the amount of blood flowing through the vessel. C. Dilate coronary arteries and arterioles. D. Relax the smooth muscle layer of blood vessels. E. Depress myocardial contractility.

Answer: A, C, E Rationale: Calcium channel blockers slow the conduction velocity of the cardiac impulse, depress myocardial contractility, and dilate coronary arteries and arterioles. Vasodilators relax smooth muscle and allow more blood to flow through the vessel.

The nurse should instruct the client to take what action if nitroglycerin tablets taken sublingually are not effective in eliminating chest pain? A. Lie down after taking an aspirin. B. Go to the emergency department. C. Take more tablets until pain subsides, to a maximum of six tablets. D. Call the primary health care provider.

Answer: B Rationale: A sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses. If pain persists, the client should go to the emergency department. The client should not waste time by calling the primary health care provider or lying down. It would be unsafe to take more tablets.

The client is taking a calcium-channel blocker. What adverse effects might the client experience? A. Fever and bronchospasm. B. Headache and dizziness. C. Palpitations and tingling of extremities. D. Hypertension and tachycardia.

Answer: B Rationale: Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.

A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond? A. "Do not take any more nitroglycerin. It is increasing your blood pressure." B. "You may experience headaches as an adverse reaction to nitroglycerin." C. "Nitroglycerin is dropping your blood pressure and that is causing the headache." D. "If you lie down when taking nitroglycerin, you will not experience a headache."

Answer: B Rationale: An adverse reaction of nitroglycerin includes headaches. The client should not reduce or stop taking the medication. Lying down will not prevent headaches associated with taking nitroglycerin.

A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? A. Decreased musculature of the myocardium related to plaque. B. Decreased oxygenation to the myocardium. C. A reduction in plaque secondary to atherosclerosis. D. Hypertension of the myocardium.

Answer: B Rationale: Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries.

The nurse is assessing a client taking a beta blocker as treatment for angina. Which statement by the client indicates to the nurse that the client is experiencing an adverse effect of the medication? A. "I have not changed by diet." B. "I feel so down about my life." C. "My heart doesn't race anymore." D. "I sleep through the night better."

Answer: B Rationale: Beta blockers are used to block the stimulatory effects of the sympathetic nervous system. This decreases the excitability of the heart, decreases cardiac output, decreases cardiac oxygen consumption, and lowers blood pressure. Even though the dose to prevent angina is lower than doses to treat hypertension, adverse effects can still occur. One adverse effect is emotional depression. The statement about feeling down about life indicates an adverse effect. Statements about diet, sleep, and heart rate do not indicate adverse effects of the medication.

The nurse is caring for a client who has been diagnosed with angina and has been prescribed nitroglycerin. What teaching about the client's lifestyle should the nurse provide? A. "You need to make sure that you are able to get at least 6 hours of sleep each night." B. "It is best for your health to eliminate or reduce your intake of alcoholic beverages." C. "It's important not to take nitroglycerin unless you're actually experiencing chest pain." D. 'Since you are taking this medication, you need to avoid drinking grapefruit juice."

Answer: B Rationale: Clients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. Clients should ideally take nitroglycerin before the onset of chest pain. There is no particular need for adequate sleep, beyond the general benefits of this practice. Grapefruit juice does not interfere with the metabolism of nitroglycerin.

Prior to the administration of nitroglycerin, the nurse would assess which of the following? A. EKG B. Blood pressure. C. Breath sounds. D. Pulse.

Answer: B Rationale: It is important to assess the client's blood pressure prior to administering nitroglycerin because it can cause hypotension. Pulse, breath sounds, and EKG are not a priority before administration.

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? A. Amlodipine B. Nadolol C. Ranolazine D. Verapamil

Answer: B Rationale: Nadolol is a beta-blocker used as an antianginal agent. Amlodipine and verapamil are calcium channel blocker antianginal agents. Ranolazine is classified as a piperazine acetamide.

A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina? A. Papaverine B. Nicardipine C. Isospin D. Cilostazol

Answer: B Rationale: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isospin, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect? A. binding extracellular sodium ions with chloride ions. B. inhibiting the influx of calcium through slow channels. C. preventing the outflow of intracellular potassium. D. potentiating the effect of B-type natriuretic peptide.

Answer: B Rationale: Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. None of the other options accurately describes the action of nifedipine.

The 47-year-old client is experiencing chest pain and has taken three sublingual nitroglycerin tablets, but the pain remains. What should the client do next? A. Take another nitroglycerin and call 911. B. Call 911. C. Notify his health care provider. D. Have someone take him to the emergency department.

Answer: B Rationale: Nitroglycerin should be administered every five minutes, times three doses. If the pain persists, 911 or the emergency system should be activated. The client should not take additional medication. It is not safe to be transported by private car having chest pain.

A client with chronic angina is prescribed ranolazine, a piperazine acetamide agent. Which information would the nurse include when teaching the client about this medication? A. "Notify your health care provider if you develop dizziness." B. "Avoid grapefruit juice when taking this medication." C. "Do not take a dose of the medication if diarrhea occurs." D. "Seek medical attention if you become nauseated."

Answer: B Rationale: Ranolazine is a drug to treat chronic angina. It may inhibit late sodium influx but does prolong the QT interval without decreasing the heart rate or blood pressure. This medication will react to the chemicals in grapefruit juice. Because of this, the client should be instructed to avoid grapefruit juice while taking this medication. Dizziness and nausea are common adverse effects and do not need to be reported to the health care provider. Diarrhea is not an adverse effect of the medication; however, the client should be instructed to take the medication as prescribed and not to skip any doses.

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? A. Milk products. B. Alcoholic beverages. C. Synthetic fabrics. D. Exercise

Answer: B Rationale: Since both alcohol and nitrate antianginal drugs dilate blood vessels, concomitant use of the two can cause an excessive drop in blood pressure. Exercise, milk products and synthetic fabrics have no effects on nitrates.

A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client? A. "The arteries are narrowed due to fatty deposits." B. "The heart muscle isn't getting enough oxygen." C. "The heart muscle has become damaged due to blocked blood flow." D. "The heart muscle has grown larger to compensate."

Answer: B Rationale: The body's response to a lack of oxygen in the heart muscle is pain, which is called angina. The narrowing of arteries due to fatty deposits is called atherosclerosis. Although left ventricular enlargement may occur with coronary artery disease, it is not the underlying mechanism involved with angina. Damage to the heart muscle in response to ischemia is called a myocardial infarction.

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? A. "The headache is actually a result of your angina, not the nitroglycerin." B. "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache." C. "I'll contact your health care provider. This may mean that nitroglycerin is not the right drug for you." D. "If you can take your nitroglycerin on a full stomach, it might reduce the frequency and severity of your headaches."

Answer: B Rationale: The most common adverse effect of nitroglycerin is a severe headache, which is typically treated with acetaminophen. Taking the drug on a full stomach is ineffective, and headaches do not contraindicate the use of the drug.

When caring for a client with angina, the nurse instructs the client to place the nitroglycerin tablet between the cheek and the gums. Which form of nitroglycerin is the nurse administering? A. Translingual B. Buccal C. Transdermal D. Sublingual

Answer: B Rationale: The nurse is administering the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the client to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the client to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, transdermal, and translingual routes. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the skin. In the translingual route, a spray is directed under or onto the tongue.

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? A. Risk for Fluid Volume Deficit related to adverse effects of drug therapy. B. Acute Pain, Headache, related to adverse effects of drug therapy. C. Confusion, Acute, related to adverse effects of drug therapy. D. Incontinence, Functional, related to adverse effects of drug therapy.

Answer: B Rationale: The vasodilation associated with the use of nitroglycerin can cause severe headaches. The drug does not typically cause urinary incontinence, fluid volume deficit, or confusion.

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? A. "I will take the nitroglycerin whenever I eat, to help with the absorption of the medication." B. "I will use the nitroglycerin if I experience chest pain." C. "I will take the nitroglycerin once a week to improve my ability to exercise." D. "I will take the nitroglycerin twice a day."

Answer: B Rationale: Therapeutic uses of nitroglycerin vary by the route of administration. Given sublingually or by transmucosal or translingual spray, nitroglycerin is used to treat acute angina.

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? A. chronic depression. B. orthostatic hypotension. C. gastroesophageal reflux disease (GERD). D. Raynaud's syndrome.

Answer: B Rationale: Underlying hypotension can be exacerbated by nitroglycerin, creating a risk for syncope or falls. GERD, depression, and Raynaud's syndrome do not complicate the use of nitrates for angina.

A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: A. Hypertension B. Hypotension C. Hyperkalemia D. Hypokalemia

Answer: B Rationale: When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.

Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) A. Decrease serum triglyceride. B. Relieve the pain of acute anginal attacks. C. Treatment chronic stable angina pectoris. D. Prevent angina attacks. E. Increase high-density lipoproteins (HDL).

Answer: B, C, D Rationale: Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.

The nurse knows that nitroglycerin can be administered in what ways? (Select all that apply.) A. Intrathecally B. Transdermal C. Transmucosal D. IV

Answer: B, C, D Rationale: Nitroglycerin is administered in transdermal, and IV preparations. Nitroglycerin is not administered intrathecally.

What should the nurse tell the client about storage of oral nitroglycerin products? (Select all that apply.) A. Store oral nitroglycerin and other medications in the container. B. Store oral nitroglycerin away from light exposure. C. Store oral nitroglycerin in a plastic pill box so doses are not missed. D. Store oral nitroglycerin in the original container. E. Store oral nitroglycerin with the container lid tightly sealed.

Answer: B, D, E Rationale: The proper storage of oral nitroglycerin includes keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, and always replacing the container tightly and as soon as the drug is removed.

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? A. Sedation B. Hypokalemia C. Hypotension D. Renal insufficiency

Answer: C Rationale: Adverse effects of nitroglycerin include hypotension, dizziness, lightheadedness, palpitations, and headache. Adverse reactions of nitroglycerine do not include hypokalemia, renal insufficiency or sedation.

A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The primary health care provider adds nifedipine to the client's regimen. The nurse should observe the client for what adverse effect? A. renal insufficiency B. hypokalemia C. hypotension D. hypoglycemia

Answer: C Rationale: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect, so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

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? A. Susceptibility of the client to intracranial pressure. B. Susceptibility of the client to renal insufficiency. C. Current blood pressure. D. Current respiratory rate.

Answer: C Rationale: For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy.

Which would a nurse identify as a nitrate? A. Amlodipine B. Nicardipine C. Isosorbide D. Metoprolol

Answer: C Rationale: Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers.

A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina? A. Isospin B. Papaverine C. Nicardipine D. Cilostazol

Answer: C Rationale: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isospin, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.

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? A. Every 2 minutes. B. Every 10 minutes. C. Every 5 minutes. D. Every 15 minutes.

Answer: C Rationale: Sublingual nitroglycerin should be taken every 5 minutes up to a maximum number of 3 tablets in 15 minutes. The client should seek medical care if pain is not relieved after the 3 doses.

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: A. has an indefinite shelf life. B. should be replaced annually. C. should be replaced every six months. D. should be replaced monthly.

Answer: C Rationale: Sublingual nitroglycerin tablets should be replaced every 6 months because they become ineffective over time.

The nurse is caring for a client diagnosed with angina who is taking a calcium-channel blocker. What adverse effects would the nurse caution this client about? A. hypertension and tachycardia. B. nausea and diarrhea. C. headache and dizziness. D. itching and rash.

Answer: C Rationale: The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.

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? A. Withhold medication until blood pressure increases. B. Administer the medication. C. Notify the health care provider. D. Ask the client how he feels.

Answer: C Rationale: The client is having angina and it must be addressed. If the blood pressure is less than 90 systolic, the nurse should not administer the medication and call the provider immediately.

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? A. "I will take one tablet and lay down for an hour." B. "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief,, I will contact my health care provider." C. "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief, I will seek emergency care immediately." D. "I will take three tables every 5 minutes until the chest pain subsides."

Answer: C Rationale: The client with stable or unstable angina will be prescribed sublingual nitroglycerin to relieve chest pain symptoms. The client may take up to three tablets of sublingual nitroglycerin 5 minutes apart. If the chest pain is unrelieved, the client needs to seek emergency medical care immediately.

The nurse is preparing to teach discharge instructions to a client with angina. Which instruction should the nurse prioritize giving the client when teaching about the prescribed oral nitroglycerin? A. Do not store nitroglycerin in a dark container. B. Store the nitroglycerin capsules in a plastic container. C. Recap the container tightly after taking out the capsules. D. Place the nitroglycerin capsules along with other tablets.

Answer: C Rationale: The nurse should instruct the client to recap the container tightly after taking out the nitroglycerin capsule. This is to ensure that the potency of nitroglycerin is not lost on exposure to air. Nitroglycerin should be stored in a dark container and protected from direct light exposure. The nurse should instruct the client to never store nitroglycerin under bright sunlight or in a plastic container. Nitroglycerin deteriorates when stored in plastic containers and on exposure to air and light. The nurse should instruct the client not to store nitroglycerin along with other drugs, as it loses its potency.

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? A. "Before I take my medication, I will lie down." B. "I will keep my medication in the original container." C. "I will take a pill every 15 minutes until the pain subsides." D. "I may get a headache after I take this medication."

Answer: C Rationale: When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension.

The nurse is preparing to administer an antianginal medication. The nurse should question administering the medication and contact the health care provider first if which assessment(s) is noted? Select all that apply. A. Heart rate above 50 bpm. B. Diastolic blood pressure below 90 mm Hg. C. Heart rate below 50 bpm. D. Systolic blood pressure below 90 mm Hg. E. Respiratory rate below 20 breaths per minute.

Answer: C, D Rationale: A nurse would withhold the antianginal medication and contact the health care provider if a client's heart rate was below 50 bpm or systolic blood pressure drops below 90 mm Hg. It should be safe to administer the antianginal if the heart rate is above 50 bpm, diastolic blood pressure is below 90 mm Hg, or respiratory rate is below 20 breaths per minute.

When describing angina to a group of clients, what would be most accurate? A. Spasm of the blood vessels. B. Chest pain that occurs with exercise. C. Damage to the heart muscle. D. Pain due to lack of oxygen in the heart muscle.

Answer: D Rationale: Angina is most accurately described as the body's response to a lack of oxygen in the heart muscle. It commonly is manifested as chest pain, but it can occur at rest or with activity. Angina does not necessarily indicate damage to the heart muscle. Ischemia leads to damage. Prinzmetal angina is a type of angina that is due to vessel spasm.

The nurse is assessing a client taking a beta blocker as treatment for angina. Which statement by the client indicates to the nurse that the client is experiencing an adverse effect of the medication? A. "My heart doesn't race anymore." B. "I sleep through the night better." C. "I have not changed by diet." D. "I feel so down about my life."

Answer: D Rationale: Beta blockers are used to block the stimulatory effects of the sympathetic nervous system. This decreases the excitability of the heart, decreases cardiac output, decreases cardiac oxygen consumption, and lowers blood pressure. Even though the dose to prevent angina is lower than doses to treat hypertension, adverse effects can still occur. One adverse effect is emotional depression. The statement about feeling down about life indicates an adverse effect. Statements about diet, sleep, and heart rate do not indicate adverse effects of the medication.

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? A. "I should take three tablets as soon as I start to feel chest pain." B. "I should only take the medication if the pain becomes severe." C. "I should take as many tablets as I need to make the pain go away." D. "I can take up to three tablets at five-minute intervals."

Answer: D Rationale: Clients may take up to three doses of sublingual nitroglycerin at five-minute intervals to relieve anginal chest pain. They should take as few doses as necessary to relieve pain. Administration should begin at the first sign of pain.

A client diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The client has received the first two doses of the medication and reports dizziness. What is the nurse's best action? A. Withhold the next scheduled dose and implement falls precautions. B. Report this finding to the client's primary health care provider. C. Reassure the client that this is an expected adverse effect. D. Assess the client's blood pressure.

Answer: D Rationale: If a client reports dizziness after beginning treatment with a calcium channel blocker, hypotension is a likely cause. The nurse should obtain objective data by assessing the client's blood pressure before taking further action. The nurse should not independently withhold the drug. The nurse should assess the client before providing reassurance. There may be no need to report this to the provider if it is transient.

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? A. "The head trauma is the priority at this point." B. "It is important that the nitroglycerin be restarted immediately to increase blood flow to the heart." C. "Nitroglycerin is contraindicated in head trauma as it diverts blood away from the brain and sends to the heart." D. "Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage."

Answer: D Rationale: Nitroglycerin should not be used in clients with head trauma because it increases blood flow through the vessels and may increase pressure within the brain. Nitroglycerin affects all vessels of the body.

After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: A. Chest pain that occurs with coronary artery disease. B. Chest pain that occurs at rest. C. Chest pain that occurs due to vasospasm. D. Chest pain that is relieved by rest.

Answer: D Rationale: Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.

The health care provider prescribes a small dose of antianginal medication to a client newly diagnosed with coronary artery disease. Small doses are given initially to minimize: A. myocardial enervation. B. oxygenation to the myocardium. C. angina. D. adverse effects.

Answer: D Rationale: Starting with relatively small doses of antianginal drugs and increasing them at appropriate intervals as necessary should achieve optimal benefit and minimal adverse effects.

A client arrives at the urgent care center reporting 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? A. Cardiogenic shock B. Sick sinus syndrome C. Atrioventricular (AV) block D. Prinzmetal angina

Answer: D Rationale: The nurse should identify Prinzmetal angina as the condition for which amlodipine is indicated. Prinzmetal angina is a vasospastic angina for which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome, and AV block are the conditions for which amlodipine is contraindicated.

A nurse is assessing a client with angina who has received diltiazem. Which finding should the nurse prioritize and notify the health care provider for further instructions? A. Lightheadedness. B. Systolic pressure is 110 mm Hg. C. Significant weight loss. D. Pulse rate is 45 beats per minute.

Answer: D Rationale: The nurse should withhold the drug and notify the health care provider when the client's pulse rate is 45 beats per minute. When calcium channel blockers are administered, there may be a fall in the pulse rate. When the pulse rate falls below 50 beats per minute, the nurse should notify the health care provider. When the systolic pressure falls below 90 mm Hg, the nurse should notify the primary health care provider. Weight gain, and not weight loss, occurs with the use of calcium channel blockers. The nurse should report weight gain. Lightheadedness is a common central nervous system adverse reaction occurring after taking the drug, and the nurse should instruct the client to lie down until the symptoms pass.

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports: A. that he gets a headache each time the ointment is applied. B. minimal episodes of angina. C. dizziness after each application. D. no episodes of angina since ointment was initiated.

Answer: D Rationale: Topical nitroglycerin is used to manage angina. The treatment is effective if the client reports no episodes of angina. Headache and dizziness are adverse effects of the medication.

A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: A. Hypertension B. Hypokalemia C. Hyperkalemia D. Hypotension

Answer: D Rationale: When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.

The nurse cautions the client taking nitroglycerin to avoid the use of which vitamin? A. Vitamin E B. Vitamin D C. Vitamin B D. Vitamin A

Answer: A Rationale: Vitamin E increases the effects of nitroglycerin.

A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route? A. Transdermal B. Sublingual C. Intravenous D. Oral

Answer: D Rationale: Propranolol is used orally as treatment for angina.