CHAPTER 28

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

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

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

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

Clients suffering from frequent anginal attacks should be instructed to keep a record of each attack. What information should the client document in the record? Select all that apply. • Dose of drug use to relieve the acute pain • Time of attack • Blood pressure • Drug used to relieve the acute pain • Date of attack

Date of attack Time of attack Drug used to relieve the acute pain Dose of drug use to relieve the acute pain Explanation: Clients should keep a record of the frequency of acute anginal attacks including date, time of attack, drug and dose used to relieve the acute pain. The client should bring this record to each visit.

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

Decreased oxygenation to the myocardium 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 providing education to a client who has been prescribed sublingual nitroglycerin tablets. What action should the nurse instruct the client to take if the medication is not effective in relieving chest pain? • Call the health care provider • Take more tablets until pain subsides, to a maximum of six tablets • Go to the emergency department • Lie down after taking an aspirin

Go to the emergency department 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 delay treatment by calling the health care provider or lying down. It would be unsafe to take more than three tablets

The nurse is providing education to a client who has been prescribed sublingual nitroglycerin tablets. What action should the nurse instruct the client to take if the medication is not effective in relieving chest pain? • Lie down after taking an aspirin • Take more tablets until pain subsides, to a maximum of six tablets • Call the health care provider • Go to the emergency department

Go to the emergency department 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 delay treatment by calling the health care provider or lying down. It would be unsafe to take more than three tablets.

A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The health care provider adds nifedipine to the client's regimen. The nurse should observe the client for what adverse effects? • Hypotension • Hypoglycemia • Hypokalemia • Renal insufficiency

Hypotension 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.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.

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

Relieve the pain of acute anginal pectoris Prevent angina attacks Treatment chronic stable angina pectoris 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 would avoid administering nitrates to clients using which medication? • Sildenafil • Albuterol • Simvastatin • Lisinopril

Sildenafil 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

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. • Transdermal • Rectal • Sublingual • Parenteral

Transdermal Sublingual Parenteral Nitrates are available in the following dosage forms: sublingual, translingual spray, transdermal, and parenteral. Respiratory medications such as bronchodilators and corticosteroids are given in inhalation form. Suppositories to reduce fever and relieve constipation are given rectally.

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

Treatment chronic stable angina pectoris. Prevent angina attacks. Relieve the pain of acute anginal attacks. 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

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

inhibiting the influx of calcium through slow channels. 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

Prior to the administration of nitroglycerin, the nurse would assess which of the following? • EKG • Blood pressure • Breath sounds • Pulse

• Blood pressure 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

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

• Hypotension When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension

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. • The client indicates a need for daily low-molecular weight heparin therapy • The client will likely have a trial of antiplatelet drugs before being prescribed nitrates. • The client would benefit from a weekly intravenous dose of a beta blocker.

• The client's angina may necessitate the use of a calcium channel blocker. Calcium channel blockers are used in chronic stable angina when the client cannot tolerate beta blockers, or if the symptoms are not adequately controlled while on this therapy. Regularly scheduled beta blockers are not administered intravenously. Low molecular weight heparin is not typically used in the treatment of stable angina, and antiplatelet medications do not need to precede the use of nitrates

A client experiences pain in the chest that radiates to the jaw, occurring when the client is at rest. The nurse would interpret this as: • Prinzmetal angina • Unstable angina • Stable angina • Myocardial infarction

• Unstable angina Unstable angina is chest pain that occurs when the client is at rest. Stable angina is chest pain that occurs with activity and is relieved by rest. Prinzmetal angina is chest pain due to vessel spasm. Myocardial infarction indicates ischemia and subsequent necrosis of the heart muscle

You are teaching a patient about his new prescription for oral propranolol. If the patient asks you how long it will take for the medication to relieve pain, what will you say in response? • "It will start working in about fifteen minutes." • ""It will start working in about a half hour." • "It will start working in about ten minutes." • "It will start working in about a minute."

""It will start working in about a half hour." The onset of action is approximately thirty minutes for oral propranolol and one to two minutes for IV propranolol

You are teaching a patient about his new prescription for oral propranolol. If the patient asks you how long it will take for the medication to relieve pain, what will you say in response? • "It will start working in about a minute." • ""It will start working in about a half hour." • "It will start working in about ten minutes." • "It will start working in about fifteen minutes."

""It will start working in about a half hour." The onset of action is approximately thirty minutes for oral propranolol and one to two minutes for IV propranolol.

A nurse is teaching a 54-year-old client how to take sublingual nitroglycerin. What statement by the client indicates an understanding of the nurse's instructions? • "If I become dizzy after taking the medication, I should stop taking it." • "A headache means a toxic level has been reached." • "I can the drug as I require it because it is not habit-forming." • "I can take up to three tablets at 5-minute intervals."

"I can take up to three tablets at 5-minute intervals." Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation so no more than three tablets should be taken, even though it is not habit-forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate the client should stop taking it.

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

"I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." 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 caring for a client with angina who has been prescribed nitroglycerin. What health teaching about the client's lifestyle should the nurse provide? "It's best to eliminate or reduce your intake of alcoholic beverages." "It's important not to take nitroglycerin unless you're actually experiencing chest pain." "Avoid drinking grapefruit juice because it will interfere with how your body processes nitroglycerin." "Make sure that you're able to get at least 6 hours of sleep each night, if possible."

"It's best to eliminate or reduce your intake of alcoholic beverages." 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.

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

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

The nurse is aware that the use of ranolazine is contraindicated in clients who have what condition? • Sinus tachycardia • QT-interval prolongation • Congestive heart failure • Arterial claudication

• QT-interval prolongation Ranolazine is contraindicated in clients who have a condition called QT-interval prolongation

nitroglycerin and diltiazem. In addition to monitoring the client's heart rate, the nurse should prioritize what assessment? Blood pressure Level of consciousness Respiratory status Daily weights and abdominal girth

Blood pressure Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client's blood pressure carefully. Changes to LOC, respiratory status, and fluid balance are less likely to result from this particular combination.

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

Headache and dizziness Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.

A health care provider has prescribed sublingual nitroglycerin and the nitroglycerin patch for a client. When the nurse explains the medications to the client, what advantage of the patch might the nurse mention? • It is more effective than sublingual tablets in treating acute angina. • It has a longer duration of action than sublingual tablets. • It only has to be administered once a week. • It acts more quickly than sublingual tablets.

It has a longer duration of action than sublingual tablets Although the nitroglycerin patch does not act as quickly as the sublingual version of the drug, it is effective for a longer period of time (12 or more hours)

A health care provider has prescribed sublingual nitroglycerin and the nitroglycerin patch for a client. When the nurse explains the medications to the client, what advantage of the patch might the nurse mention? • It is more effective than sublingual tablets in treating acute angina. • It has a longer duration of action than sublingual tablets. • It only has to be administered once a week. • It acts more quickly than sublingual tablets.

It has a longer duration of action than sublingual tablets. Although the nitroglycerin patch does not act as quickly as the sublingual version of the drug, it is effective for a longer period of time (12 or more hours).

The nurse is caring for a client with angina who has been prescribed nitroglycerin. What health teaching about the client's lifestyle should the nurse provide? • "It's important not to take nitroglycerin unless you're actually experiencing chest pain." • "Avoid drinking grapefruit juice because it will interfere with how your body processes nitroglycerin." • "Make sure that you're able to get at least 6 hours of sleep each night, if possible." • "It's best to eliminate or reduce your intake of alcoholic beverages."

It's best to eliminate or reduce your intake of alcoholic beverages." 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

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? • Reynaud syndrome • Orthostatic hypotension • Gastroesophageal reflux disease (GERD) • Depression and use of a selective serotonin reuptake inhibitor

Orthostatic hypotension Underlying hypotension can be exacerbated by nitroglycerin, creating a risk for syncope or falls. GERD, depression, and Reynaud syndrome do not complicate the use of nitrates for angina.

The nurse is preparing to administer sublingual nitroglycerin to a client for the first time. What effect might the client experience right after administration? • Tinnitus or diplopia. • Throbbing headache or dizziness • Drowsiness or blurred vision • Nervousness or paresthesia

Throbbing headache or dizziness • Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid self-contamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the client usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.

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." • "If you lie down when taking nitroglycerin you will not experience a headache." • "Nitroglycerin is dropping your blood pressure and that is causing the headache." • "Do not take any more nitroglycerin. It is increasing your blood pressure."

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

Clients who are taking nifedipine should be monitored for which of the following adverse effects? • Asthma • Hyperkalemia • Peripheral edema • Tetany

• Peripheral edema Nifedipine is a calcium channel blocker. Of the four choices offered, only peripheral edema is an adverse effect of this drug class

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 clean the previous site where I remove an old patch with soap and water and dry it thoroughly." • "I will rotate placement of the transdermal patch on my chest, abdomen, and thighs." • "I will remove the patch and fold it on itself to prevent my dog or grandchildren from touching it." • "I will apply the patch for 24 hours and then remove it, and place another transdermal patch."

• "I will apply the patch for 24 hours and then remove it, and place another transdermal patch." Explanation: The nurse should provide further teaching about the nitroglycerin transdermal patch needs to be applied in the morning, and then removed after 10-12 hours, and left off until the next morning. The patch delivers a constant amount of the drug, which without removal of the drug leads to tolerance of the drug, making it ineffective. The client is correct in rotating sites of placement of the transdermal patch and to place it on chest, abdomen, and thighs. The client should avoid lower legs. It is important to fold the patch in half before disposing of it in the trash to prevent a person or pet from encountering the drug that remains in the delivery system. Cleaning the skin is important in removing any residual drug from the skin.

A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided? • "I will take one tablet and lay down for an hour." • "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." • "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider." • "I will take three tables every 5 minutes until the chest pain subsides."

• "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." Explanation: 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 caring for a client with angina who has been prescribed nitroglycerin. What health teaching about the client's lifestyle should the nurse provide? • "It's best to eliminate or reduce your intake of alcoholic beverages." • "Avoid drinking grapefruit juice because it will interfere with how your body processes nitroglycerin." • "Make sure that you're able to get at least 6 hours of sleep each night, if possible." • "It's important not to take nitroglycerin unless you're actually experiencing chest pain."

• "It's best to eliminate or reduce your intake of alcoholic beverages." Explanation: 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.

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

• "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache." 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

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

• "You may experience headaches as an adverse reaction to nitroglycerin." Explanation: 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 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? • Have the client swallow a tablet every 5 minutes for 15 minutes. • Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. • Ask the client to lie back and try to relax. • Call the health care provider.

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

The nurse is providing education to a client who has been prescribed nitroglycerin transdermal spray. What instruction should the nurse provide the client concerning how to administer the spray? • Administer the spray after consulting with the health care provider or a nurse. • Administer the spray as soon as chest pain develops. • Do not administer more than one dose. • Administer the spray if the angina pain is unrelieved by 30 minutes of rest.

• Administer the spray as soon as chest pain develops Administration transdermal spray is essential as soon as chest pain develops. It is unnecessary and inappropriate to delay administration. The client can administer as many as three doses

A client with angina has been prescribed nifedipine 15 mg PO t.i.d. The client has received the first two doses of the medication and reports dizziness. What is the nurse's best action? • Reassure the client that this is an expected adverse effect. • Withhold the next scheduled dose and implement falls precautions. • Report this finding to the client's care provider. • Assess the client's blood pressure.

• Assess the client's blood pressure. Explanation: 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 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? • Daily weights and abdominal girth • Blood pressure • Respiratory status • Level of consciousness

• Blood pressure Explanation: Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client's blood pressure carefully. Changes to LOC, respiratory status, and fluid balance are less likely to result from this particular combination.

Prior to the administration of nitroglycerin, the nurse would assess which of the following? • EKG • Blood pressure • Breath sounds • Pulse

• Blood pressure Explanation: 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.

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? • Respiratory status • Daily weights and abdominal girth • Level of consciousness • Blood pressure

• Blood pressure Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client's blood pressure carefully. Changes to LOC, respiratory status, and fluid balance are less likely to result from this particular combination

Prior to the administration of nitroglycerin, the nurse would assess which of the following? • Pulse • Blood pressure • Breath sounds • EKG

• Blood pressure 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

A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe? • Pneumonia • Hypoglycemia • Pleural effusion • Bronchospasm

• Bronchospasm When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung

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

• Chest pain that is relieved by rest 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

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? • Current respiratory rate • Susceptibility of the client to intracranial pressure • Susceptibility of the client to renal insufficiency • Current blood pressure

• Current blood pressure 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.

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

• Decreased oxygenation to the myocardium Explanation: 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.

Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism? • Increasing blood pressure, which increases the amount of blood returned to the heart • Increasing conduction to the atrioventricular node, thereby increasing cardiac output • Increasing cardiac output, thereby increasing the oxygen supplied to the heart • Decreasing the heart rate, allowing for longer filling time and increased blood to the heart

• Decreasing the heart rate, allowing for longer filling time and increased blood to the heart Beta-blockers prevent the beta-adrenergic receptors from being stimulated. These drugs have multiple effects on the heart and cardiovascular system, including slowing the heart rate, depressing atrioventricular (AV) conduction, decreasing cardiac output, and reducing systolic and diastolic blood pressure at rest and during exercise. These effects decrease the oxygen demands of the heart and thereby decrease angina.

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? • Sick sinus syndrome • Atrioventricular (AV) block • Prinzmetal angina • Cardiogenic shock

• Prinzmetal angina 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

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

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

When describing the possible adverse effects associated with nitroglycerin, what would the nurse include? • Chills • Constipation • Dizziness • Hypertension

• Dizziness Explanation: Dizziness is a possible adverse effect. Hypotension is a possible adverse effect. Flushing is a possible adverse effect. Constipation is not associated with nitroglycerin.

A male client does not respond to traditional treatment for his chronic angina. The health care provider orders ranolazine (Ranexa) and orders a baseline ECG prior to medication administration. Three months later, the health care provider orders a repeat ECG. For what reason is the provider monitoring the client? • Dose-dependent ectopic beats • Dose-dependent ST elevation • Dose-dependent QT prolongation • Dose-dependent premature ventricular beats

• Dose-dependent QT prolongation Ranolazine (Ranexa) represents a new classification of antianginal medication, metabolic modulators, used in people with chronic angina. The drug is labeled for use in combination with amlodipine, beta-blockers, or nitrates. After oral administration, peak plasma concentrations are reached within 2 to 5 hours. The drug is rapidly and extensively metabolized in the liver. Because of a risk of dose-dependent QT prolongation on electrocardiogram, ranolazine is reserved for the treatment of clients with chronic angina who have not achieved a satisfactory antianginal response with traditional drugs

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

• Headache and dizziness Explanation: Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.

The nurse is caring for a client with angina who is taking a calcium-channel blocker. What adverse effects would the nurse caution this client about? • Nausea and diarrhea • Headache and dizziness • Itching and rash • Hypertension and tachycardia

• Headache and dizziness Explanation: 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 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The health care provider adds nifedipine to the client's regimen. The nurse should observe the client for what adverse effects? • Renal insufficiency • Hypoglycemia • Hypotension • Hypokalemia

• Hypotension Explanation: 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.

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? • Hypokalemia • Renal insufficiency • Sedation • Hypotension

• Hypotension Adverse effects of nitroglycerin include hypotension, dizziness, lightheadedness, palpitations, and headache. Adverse reactions of nitroglycerine do not include hypokalemia, renal insufficiency or sedation.

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? • Nadolol • Propranolol • Metoprolol • Isosorbide

• Isosorbide Explanation: Isosorbide is a nitrate. Metoprolol is a beta blocker. Nadolol is a beta blocker. Propranolol is a beta blocker.

Which would a nurse identify as a nitrate? • Nicardipine • Amlodipine • Isosorbide • Metoprolol

• Isosorbide 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? • Cilostazol • Isospin • Nicardipine • Papaverine

• Nicardipine 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

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

• Oral Explanation: Propranolol is used orally as treatment for angina.

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

• Oral Propranolol is used orally as treatment for 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? • Depression and use of a selective serotonin reuptake inhibitor • Orthostatic hypotension • Gastroesophageal reflux disease (GERD) • Reynaud syndrome

• Orthostatic hypotension Explanation: Underlying hypotension can be exacerbated by nitroglycerin, creating a risk for syncope or falls. GERD, depression, and Reynaud syndrome do not complicate the use of nitrates for angina.

The nurse would avoid administering nitrates to clients using which medication? • Simvastatin • Sildenafil • Albuterol • Lisinopril

• Sildenafil Explanation: 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.

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

• Store oral nitroglycerin with the container lid tightly sealed. • Store oral nitroglycerin away from light exposure. • Store oral nitroglycerin in the original container. 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.

The nurse knows that what are the goals of antianginal drug therapy? (Select all that apply.) • To improve exercise tolerance and quality of life • To relieve acute anginal pain • To prevent anginal episodes • To increase the vascularity of the heart • To prevent MI and sudden cardiac death

• To improve exercise tolerance and quality of life • To relieve acute anginal pain • To prevent MI and sudden cardiac death The goals of antianginal drug therapy are to relieve acute anginal pain, to reduce the number and severity of acute anginal attacks, to improve exercise tolerance and quality of life, to delay progression of CAD, to prevent MI, and to prevent sudden cardiac death. Antianginal drug therapy does not increase the vascularity of the heart.

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? • Use an applicator for applying the ointment. • Apply a thick layer of the ointment. • Rub the ointment onto the skin. • Apply on the same site during every application.

• Use an applicator for applying the ointment. Explanation: 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.

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

• inhibiting the influx of calcium through slow channels. Explanation: 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 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? • age of 62 • client ethnicity • father had a myocardial infarction at 48 • obese 40% over total body weight

• obese 40% over total body weight Explanation: 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.