CH 36 ANTIANGINAL AND VASODILATING DRUGS

A client arrives at the urgent care center complaining of chest pain and is diagnosed with angina pectoris. Which of the following would the nurse expect to be prescribed? A) Nicardipine B) Hydralazine C) Minoxidil D) Nimodipine

Ans: A Feedback: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an antianginal drug. Hydralazine and minoxidil are vasodilators primarily used to treat hypertension. Nimodipine is a calcium channel blocker used to treat subarachnoid hemorrhage.

A client is prescribed nitrate therapy as treatment for angina. On a follow-up visit to the clinic, the client tells the nurse that he gets dizzy and weak when he takes the medication. The nurse would identify which nursing diagnosis as most likely? A) Risk for Injury B) Risk for Infection C) Deficient Fluid Volume D) Acute Pain

Ans: A Feedback: The client is at risk for injury because of his complaints of dizziness and weakness. There is no indication that the client is experiencing an infection or has a fluid volume deficit. Complaints of pain would lead to a nursing diagnosis of Acute Pain.

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse would anticipate which of the following? A) Decreased effectiveness of the anticoagulant B) Increased effectiveness of the diuretic C) Increased absorption of the anticoagulant D) Increased absorption of the diuretic

Ans: A Feedback: The nurse should monitor for decreased effectiveness of warfarin as an effect of the interaction between the anticoagulant and the diuretic. The nurse need not monitor for the increased effectiveness of the diuretic, the increased absorption of the anticoagulant, or the increased absorption of the diuretic in the client.

A client with thrombotic stroke is administered ticlopidine. The nurse would assess the client for which of the following? A) Dyspepsia B) Dyspnea C) Hematoma D) Bradycardia

Ans: A Feedback: The nurse should monitor for dyspepsia in the client who has been administered ticlopidine. Hematoma is an adverse reaction to heparin. Dyspnea is an adverse reaction to protamine sulfate and treprostinil. Bradycardia is an adverse reaction to protamine sulfate.

A client in a health care facility is receiving the thrombolytic drug reteplase. Which nursing diagnosis would be most likely? A) Anxiety B) Constipation C) Disturbed Sensory Perception D) Ineffective Tissue Perfusion

Ans: A Feedback: The nursing diagnoses for a client receiving the thrombolytic drug reteplase should include Anxiety. Constipation, disturbed sensory perception, and ineffective tissue perfusion would be unlikely for the client receiving reteplase.

When describing anticoagulants to a client, which of the following would the nurse expect to include? Select all that apply. A) Anticoagulants prevent formation of a thrombus. B) Anticoagulants prevent extension of a thrombus. C) Anticoagulants dissolve existing thrombi. D) Anticoagulants thin the blood. E) Anticoagulants can reverse the damage caused by a thrombus.

Ans: A, B Feedback: Anticoagulants can prevent the formation and extension of a thrombus but have no direct effect on an existing thrombus and do not reverse any of the damage from that thrombus. Although clients often refer to anticoagulants as blood thinners, they do not actually thin the blood.

A client is receiving streptokinase. The nurse understands that which of the following would occur? Select all that apply. A) Breakdown of existing thrombi B) Reopening of occluded blood vessels C) Prevention of tissue necrosis D) Decreased risk of internal bleeding E) Prevention of formation of a thrombus

Ans: A, B, C Feedback: Streptokinase is a thrombolytic drug. Thrombolytic drugs break down existing thrombi, reopen blood vessels after occlusion, and prevent tissue necrosis.

A client is receiving a heparin infusion. The nurse should check the needle site for the heparin infusion for signs of which of the following? Select all that apply. A) Inflammation B) Pain C) Tenderness D) Clot formation E) Itching

Ans: A, B, C Feedback: The nurse inspects the needle site for signs of inflammation, pain, and tenderness along the pathway of the vein. If these occur the infusion is discontinued and restarted in another vein.

The nurse instructs a client receiving warfarin about the importance of consistent intake of dietary vitamin K to decrease fluctuations in PT/INR. The nurse determines that the client understands the instructions when he identifies which foods as containing vitamin K? Select all that apply. A) Broccoli B) Cauliflower C) Fish D) Yogurt E) Chicken

Ans: A, B, C, D Feedback: Foods high in vitamin K include leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt.

A client is being discharged on warfarin therapy. Which of the following would the nurse include in the teaching plan for the client? Select all that apply. A) Be consistent with your intake of foods containing vitamin K. B) Do not change brands of warfarin without consulting the physician. C) Take the drug at the same time every evening. D) Do not take or stop taking other medications except on the advice of the physician. E) Inform the dentist of therapy with warfarin prior to any treatment or procedure.

Ans: A, B, C, D, E Feedback: Instructions would include being consistent with intake of foods containing vitamin K, not changing brands of the drug, taking the drug at the same time each evening, not taking or stopping other medications, and informing the dentist about the use of warfarin.

A client taking warfarin asks the nurse about using herbal remedies. Which of the following would the nurse instruct the client to avoid? Select all that apply. A) Chamomile B) St. John's wort C) Ginkgo biloba D) Ginger E) Ginseng

Ans: A, B, C, D, E Feedback: Warfarin, a drug with a narrow therapeutic index, has the potential to interact with many herbal remedies. For example, warfarin should not be combined with any of the following substances, because they may have additive or synergistic activity and increase the risk for bleeding: celery, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo biloba, ginseng, green tea, onion, passionflower, red clover, St. John's wort, and turmeric.

Prior to administering an antianginal drug, the nurse should assess which of the following? Select all that apply. A) Pain B) Physical appearance C) Lung sounds D) Heart sounds E) Vital signs

Ans: A, B, C, E Feedback: Before administering an antianginal agent, the nurse would assess the client's pain, history of medication allergies and disease processes, physical appearance, and lungs for adventitious sounds and obtain a baseline electrocardiogram and vital signs.

Which assessment would the nurse obtain before administering an anticoagulant to a client with DVT? Select all that apply. A) Test for a positive Homans' sign. B) Examine extremity for skin temperature. C) Assess pain. D) Assess blood pressure. E) Check for pedal pulse.

Ans: A, B, C, E Feedback: Preadministration assessment for a client with a DVT should include checking for a pedal pulse, examining the extremity for color and skin temperature, assessing for pain, and checking for a positive Homans' sign.

A client is being discharged from the hospital with a prescription for clopidogrel. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Skin rash B) Bleeding C) Heart palpitations D) Nausea E) Constipation

Ans: A, B, C, E Feedback: The most common adverse reactions associated with clopidogrel are skin rash, dizziness, bleeding, palpitations, and constipation.

When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply. A) Onset of action is almost immediate. B) Maximum effect occurs within 10 minutes. C) It is preferably given intramuscularly. D) Clotting time returns to normal within 4 hours. E) It causes fewer adverse reactions than the oral form.

Ans: A, B, D Feedback: Parenteral heparin results in an almost immediate onset of action with a maximum effect within 10 minutes, but clotting returns to normal within 4 hours unless subsequent doses are given. It is preferably given subcutaneously or intravenously.

A nurse is preparing to administer nitroglycerin intravenously. Which of the following would be important for the nurse to keep in mind? Select all that apply. A) Using glass bottles B) Using non-polyvinyl chloride (PVC) infusion sets C) Administering the drug as an IV bolus D) Diluting the drug with normal saline E) Using a gravity flow rate of infusion

Ans: A, B, D Feedback: When administering IV nitroglycerin, the nurse should dilute it with normal saline or 5% dextrose in water, administer the drug by continuous infusion using an infusion pump for accuracy, and use glass IV bottles and non-PVC infusion sets. The dose is regulated based on client response.

Which of the following does the nurse need to include as part of the physical assessment of a client with anginal pain? Select all that apply. A) Blood pressure B) Apical pulse C) Oxygen saturation D) Radial pulse E) Respiratory rate

Ans: A, B, D, E Feedback: The nurse's physical assessment of a client with angina should include blood pressure, respiratory rate, and apical and radial pulses. The physical assessment may also include weight, inspection of the extremities for edema, and auscultation of the lungs, depending on the type of heart failure.

A nurse is teaching a client who is prescribed nitrate therapy about adverse reactions. When discussing headaches associated with nitrates, which of the following would the nurse include? Select all that apply. A) Headaches should decrease with continued therapy. B) Headaches may be relieved with the use of aspirin or acetaminophen. C) Headaches should be avoided by altering the dosage schedule. D) Headaches are a serious adverse reaction and should be reported immediately. E) Headaches may be a marker of the drug's effectiveness.

Ans: A, B, E Feedback: Headaches are a common adverse reaction of nitrates but should decrease with continued therapy. Headaches 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 nurse instructs a client who is taking oral nitrates to store the drug in which manner? Select all that apply. A) In its original container B) With the container lid tightly sealed C) With other medications in the container D) In a plastic pill box so doses are not missed E) Away from light exposure

Ans: A, B, E Feedback: 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.

When discussing the use of antianginal drugs for the treatment of cardiac disease, a nurse would expect to include which of the following? Select all that apply. A) Relief of pain of acute anginal attacks B) Reduction in serum triglyceride levels C) Prevention of anginal attacks D) Elevation of high-density lipoproteins (HDLs) E) Treatment of chronic stable angina pectoris

Ans: A, C, E Feedback: Antianginal drugs are used to relieve the pain of acute anginal attacks, prevent anginal attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDLs or triglycerides.

After teaching a group of nursing students about heparins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a low-molecular-weight heparin (LMWH)? Select all that apply. A) Dalteparin B) Streptokinase C) Enoxaparin D) Warfarin E) Tinzaparin

Ans: A, C, E Feedback: Dalteparin, enoxaparin, and tinzaparin are all examples of LMWHs. Streptokinase is a thrombolytic; warfarin is an oral anticoagulant.

0.

Ans: A, C, E Feedback: The nurse should withhold the drug and contact the physician if any of the following occur: the PT exceeds

A client is prescribed verapamil as treatment for his angina. Which of the following would the nurse include in the teaching plan for this client? Select all that apply. A) Caplets may be opened and sprinkled on food. B) Drug should be administered without regard to meals. C) Tablet coverings can be expelled in the stool. D) Caplets should be swallowed whole. E) Drug should be administered with a meal.

Ans: A, C, E Feedback: Verapamil frequently causes GI upset and should be administered with a meal. Caplets may be opened and sprinkled on food or mixed in liquids for clients who have difficulty swallowing. Sometimes the tablet coverings are expelled in the stool.

The nurse assesses for which of the following in a client receiving a calcium channel blocker? Select all that apply. A) Crackles B) Bradycardia C) Wheezing D) Dyspnea E) Peripheral edema

Ans: A, D, E Feedback: A client receiving a calcium channel blocker should be monitored for signs of heart failure (dyspnea, weight gain, peripheral edema, abnormal lung sounds such as crackles or rales, and jugular vein distention). The physician should be notified immediately if any of these signs develop.

When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply. A) Leukemia B) Hypotension C) Atrial fibrillation D) GI ulcers E) Tuberculosis

Ans: A, D, E Feedback: Anticoagulants are contraindicated in clients with known sensitivity to the drug, active bleeding, hemorrhagic disease, tuberculosis, leukemia, uncontrolled hypertension, GI ulcers, recent eye or CNS surgery, aneurysms, and severe renal and hepatic disease and during pregnancy and lactation.

When applying nitroglycerin ointment, which of the following would be appropriate? Select all that apply. A) Wear plastic disposable gloves. B) Apply entire tube of ointment to client's skin. C) Use the same application site each time ointment is applied. D) Cleanse the area of skin before application. E) Use the upper arms and legs for application.

Ans: A, D, E Feedback: The nurse should wear plastic gloves while administering ointment and use application paper to measure and apply ointment to the client's chest, abdomen, or upper arms and legs. The application site should be rotated and cleansed with each application.

A nurse reviews a client's medication history for drugs that might interact with the client's prescribed nitrate therapy. Which of the following if administered with nitrates would the nurse identify as causing severe hypotension and possible cardiovascular collapse? Select all that apply. A) Alcohol B) Beta-2 agonists C) HMG-CoA reductase inhibitors D) Angiotensin-converting enzyme inhibitors E) Phosphodiesterase inhibitors

Ans: A, E Feedback: Alcohol and phosphodiesterase inhibitors when administered with nitrates can cause severe hypotension and possible cardiovascular collapse.

A client is prescribed verapamil. The nurse would alert the client to the possibility of which of the following as most common? Select all that apply. A) Constipation B) Tachycardia C) Tachypnea D) Hypotension E) Headache

Ans: A, E Feedback: The most common adverse reactions associated with verapamil are constipation and headache. Hypotension is associated with nitrate therapy. Tachycardia and tachypnea are not associated with verapamil.

A nurse is conducting an in-service presentation about hemostasis. The nurse determines that the teaching was successful when the class identifies a thrombus as which of the following? A) Damage to a blood vessel B) Formation of a blood clot C) Cessation of bleeding D) Coagulation cascade

Ans: B Feedback: A thrombus refers to the formation of a blood clot, sometimes from damage, in a vessel that impedes blood flow. Cessation of bleeding refers to hemostasis. The coagulation cascade is the series of events that occur in the formation of a blood clot to stop bleeding.

A client receiving amlodipine for angina is complaining of dizziness. Which of the following interventions should the nurse implement to help alleviate the condition? A) Apply a cold cloth over the forehead. B) Instruct the client to lie down. C) Instruct the client to drink more water. D) Reduce the dosage of amlodipine.

Ans: B Feedback: Dizziness is a common central nervous system adverse effect seen with calcium channel blocker use. The nurse should instruct the client to lie down until the dizziness passes. Applying a cold cloth over the forehead will not relieve the dizziness. The dosage should not be reduced or altered unless instructed by the health care provider. Increasing the fluid consumption will also not help in alleviating dizziness.

A client is experiencing an overdosage of heparin. The nurse would expect to administer which of the following? A) Vitamin K1 B) Protamine C) Ticlopidine D) Tenecteplase

Ans: B Feedback: Heparin overdosage is treated with protamine. Vitamin K1 is used to treat overdoses of warfarin. Ticlopidine, an antiplatelet drug, and tenecteplase, a thrombolytic, would have no effect on counteracting the effects of warfarin.

A nurse is caring for a client receiving the anticoagulant drug warfarin. Which assessment would be most appropriate before administering the drug? A) Observe for signs of thrombus formation. B) Assess prothrombin time (PT) and INR. C) Assess for signs of bleeding. D) Monitor for hypersensitivity reaction.

Ans: B Feedback: The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the client. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in clients who are administered warfarin.

In which of the following situations would a nurse withhold the antianginal medication and contact the physician? Select all that apply. A) Heart rate above 50 bpm B) Heart rate below 50 bpm C) Systolic blood pressure below 90 mm Hg D) Diastolic blood pressure below 90 mm Hg E) Respiratory rate below 20 breaths per minute

Ans: B, C Feedback: A nurse would withhold the antianginal medication and contact the physician if a client's heart rate was below 50 bpm or systolic blood pressure drops below 90 mm Hg.

Protamine is used to treat overdose of which of the following medications? Select all that apply. A) Clopidogrel (Plavix) B) Heparin C) Enoxaparin (Lovenox) D) Alteplase (Activase) E) Warfarin (Coumadin)

Ans: B, C Feedback: Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs).

Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply. A) Urinalysis B) Platelet count C) Blood count D) Stool analysis E) Ultrasound

Ans: B, C, D Feedback: A complete blood count, platelet count, and stool analysis for occult blood may be ordered periodically throughout anticoagulant therapy.

After reviewing information about antianginal drugs, a student demonstrates understanding by identifying which of the following as indicated for the prevention of angina pectoris? Select all that apply. A) Diltiazem B) Isosorbide mononitrate C) Topical nitroglycerin D) Oral nitroglycerin E) Amlodipine

Ans: B, C, D Feedback: All nitrates are indicated for the prevention of angina pectoris. Diltiazem and amlodipine are used to treat chronic stable angina.

A client has a nursing diagnosis of Acute Pain related to angina. When teaching a client about antianginal drugs, the nurse would explain which of the following about pain relief? Select all that apply. A) Pain will only occur during prolonged exercise. B) Pain may be less intense. C) Pain may not be completely relieved. D) Pain may be less frequent. E) Pain will worsen with continued use.

Ans: B, C, D Feedback: 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.

When a nurse is obtaining a history from a client regarding anginal pain, which of the following should be included? Select all that apply. A) Duration of the pain B) Events that relieve anginal pain C) Events that trigger anginal pain D) Description of the pain E) Whether the pain radiates

Ans: B, C, D, E Feedback: A client history regarding anginal pain should include a description of the pain, whether the pain radiates and to where it radiates, what events appear to trigger the pain, and what events appear to relieve the pain.

The nurse instructs a client suffering from frequent anginal attacks to keep a record of each attack. Which of the following would the nurse instruct the client to record? Select all that apply. A) Blood pressure B) Date of attack C) Time of attack D) Drug used to relieve the acute pain E) Dose of drug used to relieve the acute pain

Ans: B, C, D, E Feedback: Clients should keep a record of the frequency of acute anginal attacks including date of attack, time of attack, and drug and dose used to relieve the acute pain. The client should bring this record to each physician visit.

A client is receiving treatment for angina with a vasodilator. The nurse instructs the client to notify his primary health care provider about which of the following? Select all that apply. A) Weight loss of 2 lb in a week B) Swelling of the extremities C) Episodes of dyspnea D) Heart rate increased by about 10 bpm E) Fainting

Ans: B, C, E Feedback: The primary health care provider should be notified if the client experiences a heart rate of 20 bpm or more above the normal rate; rapid weight gain of 5 lb or more; unusual swelling of the extremities, face, or abdomen; dyspnea; angina; severe indigestion; or fainting.

After teaching a client about how to use translingual nitroglycerin spray, the nurse determines that the teaching was successful when the client states which of the following? Select all that apply. A) "I need to shake the canister before use." B) "I will place one to two metered doses under my tongue at the start of an attack." C) "I'm not to use this form to prevent an attack." D) "I should not exceed three metered doses in 15 minutes." E) "I can spray the drug onto or under the tongue."

Ans: B, D, E Feedback: Nitroglycerin translingual spray can be used prophylactically 5 to 10 minutes prior to engaging in activities that precipitate an anginal attack. The client should not shake the canister before use. At the onset of an anginal attack, the client should spray one or two metered doses onto or under the tongue and not exceed three metered doses within 15 minutes. The client should clean the canister as directed on the package.

When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply. A) Holding the needle at a 45-degree angle B) Pinching a fold of skin C) Aspirating before injecting the drug D) Applying firm pressure after injection E) Changing sites for each dose

Ans: B, D, E Feedback: When administering a subcutaneous dose of heparin, the nurse picks a site that has not been use previously, pinches a fold of skin, holds the needle at a 90-degree angle, does not aspirate before injecting, and then applies firm pressure to the area after injection.

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) Sublingual B) Transdermal C) Buccal D) Translingual

Ans: C Feedback: The nurse is referring to 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 mentioned. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the front or back of the chest. In the translingual route, the spray is directed under or onto the tongue.

A nurse is caring for a client prescribed warfarin. The nurse would instruct the client that which of the following foods are high in vitamin K? A) Dairy products B) Root vegetables C) Green leafy vegetables D) Fruits and cereals

Ans: C Feedback: The nurse should inform the client that green leafy vegetables are high in vitamin K. Increased amounts of vitamin K could decrease the PT/INR and increase the risk of clot formation. Dairy products, root vegetables, fruits, and cereals are generally low in vitamin K. A diet that is very low in vitamin K may prolong the PT/INR and increase the risk of hemorrhage. The key to vitamin K management for clients receiving warfarin is maintaining a consistent daily intake of vitamin K. To avoid large fluctuations in vitamin K intake, clients receiving warfarin should be aware of the vitamin K content of food.

A client is being discharged after being treated with nitroglycerin for angina. Which of the following instructions should the nurse include in the teaching plan for the client? A) Store the nitroglycerin capsules in a plastic container. B) Place the nitroglycerin capsules along with other tablets. C) Recap the container tightly after taking out the capsules. D) Do not store nitroglycerin in a dark container.

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

Ans: C Feedback: The nurse should instruct the client 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 client to apply a thin layer of the ointment on the skin using an applicator. The nurse must instruct the client 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.

A female client is receiving an anticoagulant to prevent the formation and extension of blood clots. What instruction should the nurse include in the teaching plan for the client? A) Avoid caffeinated drinks. B) Take the drug on an empty stomach. C) Use a reliable contraceptive. D) Take the drug with a glass of milk.

Ans: C Feedback: The nurse should instruct the female client to use a reliable contraceptive to prevent pregnancy. The nurse need not instruct the client to avoid caffeinated drinks, take the drug on an empty stomach, or take the drug with a glass of milk.

A nurse is conducting a seminar on thrombosis. What information would the nurse include about the cause of arterial thrombosis? A) Decreased blood flow B) Injury to the vessel wall C) Arrhythmias D) Altered blood coagulation

Ans: C Feedback: The nurse should mention that arterial thrombosis is caused by atherosclerosis and arrhythmias. Decreased blood flow, injury to the vessel wall, and altered blood flow are causes of venous thrombosis.

When instructing the client on how to use the prescribed nitroglycerin ointment, the nurse would tell the client to use which of the following to determine the amount? A) A teaspoon B) Length of a finger C) Paper applicator D) The size of the previous dose

Ans: C Feedback: The topical ointment is supplied with a paper applicator to determine the amount of drug to be used. No other method is appropriate. CH 37 ANTICOAGULANT AND THROMBOLYTIC DRUGS

A nurse is caring for a client who is prescribed transdermal nitroglycerin for angina. The nurse instructs the client to apply the patch for how long? A) 4 to 6 hours B) 6 to 8 hours C) 10 to 12 hours D) 12 to 14 hours

Ans: C Feedback: The transdermal nitroglycerin patch should be applied every day for 10 to 12 hours. If the patch is applied for a shorter time, the therapeutic dosage may not be delivered. Applying the patch for a longer time will result in the development of tolerance to the antianginal effects. Applying the patch in the morning and leaving it on for 10 to 12 hours, followed by a patch-free period of 10 to 12 hours, delays the development of tolerance.

A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply. A) Heparin B) Warfarin C) Abciximab D) Anagrelide E) Dipyridamole

Ans: C, D, E Feedback: Abciximab, anagrelide, and dipyridamole are antiplatelet agents. Heparin and warfarin are anticoagulants.

A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply. A) Bruising B) Blood in the stool C) Subtherapeutic INR D) Supratherapeutic INR E) Calf pain and warmth

Ans: C, E Feedback: Coadministration of warfarin and oral contraceptives can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

After teaching a group of nursing students about antianginal drugs, the instructor determines that the teaching was successful when the students identify which of the following as a calcium channel blocker? A) Minoxidil B) Hydralazine C) Isosorbide D) Nifedipine

Ans: D Feedback: Nifedipine is a calcium channel blocker used to treat angina. Minoxidil and hydralazine are peripheral vasodilators. Isosorbide is a nitrate.

A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse would expect to administer this drug cautiously if the client's history reveals which of the following? A) Intermittent claudication B) Pulmonary emboli C) Myocardial infarction D) Pancytopenia

Ans: D Feedback: The nurse should administer cilostazol with caution to clients with pancytopenia. Anticoagulants are used for the prevention and treatment of pulmonary emboli, the adjuvant treatment of myocardial infarction, and the treatment of intermittent claudication.

A client is receiving heparin by continuous IV infusion. Which of the following would be most appropriate for the nurse to do? A) Perform a complete blood count. B) Perform baseline PT/INR. C) Perform APTT test 4 to 6 hours after injection. D) Perform blood coagulation tests every 4 hours.

Ans: D Feedback: The nurse should perform blood coagulation tests every 4 hours for the client receiving heparin by continuous IV infusion. A blood count test or the baseline PT/INR test is not the right intervention for this client. When administering heparin by the subcutaneous route, an APTT test is performed 4 to 6 hours after the injection.

A nurse is caring for a client with angina who is receiving diltiazem. In which of the following conditions should the nurse withhold the drug and notify the health care provider? A) Client's systolic pressure is 110 mm Hg. B) Client exhibits significant weight loss. C) Client experiences lightheadedness. D) Client's pulse rate is 45 beats per minute.

Ans: D Feedback: 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.