Ch 51 Drugs for Angina Pectoris

Nitroglycerin

Nitrate

A nurse has administered sublingual nitroglycerin. Which parameter should the nurse use to determine the effectiveness of sublingual nitroglycerin? A. Relief of anginal pain B. Improved cardiac output C. Deceased BP D. Dilation of superficial blood vessels

A. Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in BP is a reason why IV nitroglycerin may be administered, decreased BP is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the BP and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the drug's effectiveness.

A nurse is caring for a client who is admitted to the hospital with a diagnosis of unstable angina. Sublingual nitroglycerin has been prescribed. What client response indicates that nitroglycerin is effective? A. Pain subsides as a result of arteriole and venous dilation B. Pulse rate increases because the cardiac output has been stimulated C. Sublingual area tingles because sensory nerves are being triggered D. Capacity for activity improves as a response to increased collateral circulation

A. Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain. An increased pulse rate does not indicate effectiveness; it is a side effect of nitroglycerin. The tingling indicates that the medication is fresh; relief of pain is the only indicator of effectiveness. Nitroglycerin does not promote the formation of new blood vessels.

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and an MI. Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? A. "I may experience a headache" B. "Confusion is a common adverse effect" C. "A slow pulse rate is an expected side effect" D. "Increased BP readings may occur initally"

A. The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A nurse is preparing to teach a client to apply a nitroglycerin patch as prophylaxis for angina. Which instruction should the nurse include in the teaching plan? A. Apply the patch on a distal extremity. B. Remove a previous patch before applying the next one. C. Massage the area gently after applying the patch to the skin. D. Apply a warm compress to the site before attaching the patch.

B. Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose. Ideally, a patch should be removed after 12 to 14 hours to avoid the development of tolerance. The patch should be rotated among hair-free and scar-free sites; acceptable sits include chest, upper abdomen, proximal anterior thigh, or upper arm. The patch should be gently pressed against the skin to ensure adherence; it should not be massaged. Applying a warm compress to the site before attaching the patch is unnecessary and can result in an excessive absorption of the medication.

A client who had an MI receives a prescription for a nitroglycerin patch. What does the nurse identify as the purpose of the nitroglycerin patch? A. Decreased HR lowers cardiac output B. Increased cardiac output increased oxygen demand C. Decreased cardiac preload reduces cardiac workload D. Peripheral venous and arterial constriction increases peripheral resistance

C. Nitroglycerin reduces cardiac workload by decreasing the preload of the heart by its vasodilating effect. It decreases blood pressure, not HR (which may increase to compensate for the decreased BP). It decreases, not increases, oxygen demand. Nitroglycerin dilates, not constricts, peripheral veins and arteries.

Sublingual nitroglycerin tablets are prescribed to control periodic episodes of chest pain in the client with stable angina. Which instruction should the nurse include when teaching the client about sublingual nitroglycerin? A. Once the tablet is dissolved, spit out the saliva. B. Take tablets 3 min apart up to a max of 5 tablets. C. Common side effects include headache and low BP. D. Once opened, the tablets should be refrigerated to prevent deterioration.

C. The primary side effects of nitroglycerin are headache and hypotension. It is not necessary to spit out saliva into which nitroglycerin has dissolved. For pain that is not relieved, additional tablets may be taken every 5 minutes up to a total of 3 tablets. It should be stored at room temperature.

A client takes isosorbide dinitrate daily. The client states, "I would like to start taking sildenafil for ED." The nurse explains that taking both of these medications concurrently may result in which complication? A. Constipation B. Protracted vomiting C. Respiratory distress D. Severe hypotension

D. Concurrent use of sildenafil and a nitrate, which causes vasodilation, may result in severe, potentially fatal hypotension. Protracted vomiting and respiratory distress are not adverse effects associated with concurrent use of sildenafil and a nitrate. Sildenafil may cause diarrhea; adding a nitrate will not cause constipation.