Chapter 28 Drugs for Angina Pectoris & MI

1) Which client should the nurse anticipate a prescription for reteplase (Retavase) therapy post myocardial infarction? 1. A 54-year-old female with type 2 diabetes 2. A 45-year-old female with a 2-week-old cranial artery repair 3. A 62-year-old with a recent hemorrhagic stroke 4. A 70-year-old male with active GI bleed

1. A 54-year-old female with type 2 diabetes Pg 399

1) Which lifestyle behaviors should the nurse discuss with a client to help reduce their risk of coronary artery disease? Select all that apply. 1. Abstinence from smoking 2. Decrease stress 3. Limit alcohol consumption 4. Maintain optimal weight 5. Limit sodium intake

1. Abstinence from smoking 3. Limit alcohol consumption 5. Limit sodium intake Pg 389

1) The nurse is reviewing the myocardial blood supply for a client with coronary artery disease (CAD). Which statements made by the client indicate an understanding of the information? Select all that apply. 1. "The heart has right and left arteries that arise from the aorta." 2. "The coronary arteries carry blood away from the heart to the right atrium." 3. "The heart receives its oxygen through the blood that fills it." 4. "Coronary arteries primarily carry blood to the left ventricle." 5. "The right and left arteries have smaller branches that go around the heart."

1. "The heart has right and left arteries that arise from the aorta." 5. "The right and left arteries have smaller branches that go around the heart. Pg 388, 391

1) Which prescriptions does the nurse anticipate to be included in the goal to reduce the post-MI mortality of a client? Select all that apply. 1. Aspirin 2. Beta blockers 3. Narcotic analgesics 4. ACE inhibitors 5. Antidysrhythmics

1. Aspirin 2. Beta blockers 4. ACE inhibitors Pg 399-400

1) A client receiving diltiazem (Cardizem) asks the nurse why they get a headache after taking the prescription. Which response should the nurse provide the client? 1. "Diltiazem (Cardizem) causes the blood vessels in your brain to widen, giving you the headache." 2. "Diltiazem (Cardizem) increases prostaglandin synthesis, giving you the headache." 3. "Diltiazem (Cardizem) releases Substance P, activating pain receptors in your brain and giving you the headache." 4. "Diltiazem (Cardizem) causes the blood vessels in your brain to narrow, giving you the headache."

1. "Diltiazem (Cardizem) causes the blood vessels in your brain to widen, giving you the headache." Pg 392

1) The nurse has completed the education for a client with angina prescribed nitroglycerine (Nitrostat). Which statement made by the client indicates further teaching is required? 1. "I can take up to 5 tablets to resolve the chest pain." 2. "If my pain is not reduced 5 minutes after taking one tablet I should call EMS." 3. "I should take a tablet as soon as chest pain occurs." 4. "I can take three tablets, one every 5 minutes."

1. "I can take up to 5 tablets to resolve the chest pain." Pg 393

1) Which statement by the client receiving nitroglycerine (Nitrostat) should the nurse be concerned about? 1. "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem." 2. "I'm going water skiing tomorrow; I hope my angina isn't a problem." 3. "I really don't like taking those little pills, I would like to use a patch." 4. "My angina has been a little more frequent I would like something to take for the pain."

1. "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem." Pg 393

Which statements by the client are specifically associated with unstable angina? Select all that apply. 1. "My chest has started hurting even if I am just watching television." 2. "My chest starts hurting if I climb one set of stairs." 3. "My attacks of chest pain are coming more frequently now." 4. "The pain occurs most often after I eat a meal." 5. "The pain is worse than it used to be."

1. "My chest has started hurting even if I am just watching television." 3. "My attacks of chest pain are coming more frequently now." 5. "The pain is worse than it used to be." Pg 389

1) Which information about the primary therapeutic action of an antianginal prescription should the nurse include in client teaching? 1. "The prescription decreases how much oxygen your heart needs." 2. "This prescription will thin your blood so your heart receives more oxygen." 3. "This prescription increases the amount of oxygen your heart receives." 4. "This prescription increases the oxygen to your heart by increasing nitric oxide production."

1. "The prescription decreases how much oxygen your heart needs."Pg 390,391

1) Which symptom is most likely to be related to angina as opposed to a myocardial infarction? 1. Chest pain relieved by one sublingual nitroglycerin 2. Chest pain that radiates to the patient's back 3. Chest pain that occurred while the patient was eating breakfast 4. Chest pain accompanied by shortness of breath

1. Chest pain relieved by one sublingual nitroglycerin Pg 388-389

1) For which conditions should the nurse instruct a client to hold the application of nitroglycerin ointment and contact the healthcare provider? Select all that apply. 1. Dyspnea 2. Productive cough 3. Headache 4. Fever 5. Confusion

1. Dyspnea 2. Productive cough 5. Confusion Pg 392-3

1) Which information should the nurse include when educating a client about coronary artery disease? Select all that apply. 1. Plaque causes narrowing of the artery. 2. Plaque begins to accrue early in life. 3. Plaque causes narrowing of the veins. 4. Plaque affects the elasticity of the artery. 5. Plaque builds up in the myocardial tissue.

1. Plaque causes narrowing of the artery. 2. Plaque begins to accrue early in life. 4. Plaque affects the elasticity of the artery. Pg 388

1) A client asks which conditions will cause the heart to need more oxygen. Which information should the nurse be prepared to discuss? 1. Sleep apnea 2. Hyperthyroidism 3. Asthma 4. Hepatitis B

1. Sleep apnea Pg 390

A client asks the nurse if angina is the same thing as having a heart attack. Which response should the nurse provide? 1. "They have some things in common, for example, severe emotional distress and panic can accompany both angina and myocardial infarction." 2. "Angina means the heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died." 3. "Actually, it depends on what type of angina you mean; there are several types." 4. "They are basically the same."

2. "Angina means the heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died." Pg 389

1) A client post-acute myocardial infarction asks the nurse why they are prescribed reteplase (Retavase) intravenously (IV). Which response should the nurse provide the client? 1. "The prescription dilates the arteries in the heart so it can get more oxygen." 2. "The prescription is dissolving the clot that has caused your heart attack." 3. "The prescription thins your blood so more clots will not develop." 4. "The prescription will increase the strength of the muscles in the heart during each beat."

2. "The prescription is dissolving the clot that has caused your heart attack." Pg 399

1) Which is a priority assessment for the client receiving reteplase (Retavase) intravenously? 1. Fluid balance 2. Abnormal bleeding 3. Blood glucose 4. Respiratory rate

2. Abnormal bleeding Pg 399

1) A client experiencing bradycardia is suspected of overdosing on diltiazem (Cardizem). Which treatment should the nurse anticipate prescribed? 1. Dopamine 2. Atropine 3. Calcium chloride 4. Narcan

2. Atropine Pg 397

1) Which conditions is the use of thrombolytic therapy contraindicated in? Select all that apply. 1. Venous emboli 2. History of intracranial hemorrhage 3. Hemophilia 4. Liver disease 5. Peptic ulcer disease

2. History of intracranial hemorrhage 3. Hemophilia 4. Liver disease 5. Peptic ulcer disease pg 399

1) Which should the nurse assess a client for prior to administering atenolol (Tenormin)? 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Oxygen saturation

2. Pulse 4. Blood pressure Pg 396

1) Which information should the nurse include in the education for a client prescribed a transdermal nitroglycerin patch? Select all that apply. 1. Place the patch on the upper arm or leg. 2. Rotate sites of application. 3. Remove the patch for an hour each day. 4. Cleanse the skin under the patch after removal. 5. Triple wrap the patch in plastic wrap for disposal.

2. Rotate sites of application. 4. Cleanse the skin under the patch after removal. Pg 391,394

1) Which is the primary desired outcome for a client that has experienced several episodes of angina? 1. The client will experience relief of chest pain with anticoagulant therapy. 2. The client will experience relief of chest pain with nitrate therapy. 3. The client will experience relief of chest pain with aspirin therapy. 4. The client will experience relief of chest pain with therapeutic lifestyle changes.

2. The client will experience relief of chest pain with nitrate therapy. Pg 391

1) Which information should the nurse include in the education for a client prescribed antianginal therapy? Select all that apply. 1. The prescriptions increase the heart rate. 2. The prescriptions dilate the veins so that the heart receives less blood. 3. The prescriptions cause the heart to contract with less force. 4. The prescriptions increase blood pressure. 5. The prescriptions increase the ability of the body to produce red blood cells.

2. The prescriptions dilate the veins so that the heart receives less blood. 3. The prescriptions cause the heart to contract with less force. Pg 390-1

1) Which is the most sensitive and effective biomarker of a myocardial infarction? 1. White blood cells 2. Troponin 3. Myoglobin Creatine kinase

2. Troponin Pg 396

1) The nurse is preparing to administer nitroglycerine via the intravenous route. Which should the nurse do prior to the administration of the prescription? 1. Use gloves to prevent self-administration. 2. Instruct the client to avoid moving the arm in which the prescription is infusing. 3. Cover the intravenous (IV) bottle to decrease light exposure. 4. Darken the room to decrease light exposure.

3. Cover the intravenous (IV) bottle to decrease light exposure. Pg 393

1) Which mechanism of action does beta-adrenergic agonists have on the cardiovascular system? 1. Increase cardiac output 2. Dilate arterial smooth muscle 3. Decrease the contractility of the heart Dilate venous system

3. Decrease the contractility of the heart Pg 391

1) Which adverse effect is common for clients prescribed topical nitroglycerin paste? 1. Rash 2. Shortness of breath 3. Headache 4. Ventricular tachycardia

3. Headache Pg 393

1) Which prescription is indicated for the prevention of blood clots? 1. Captopril (Capoten) 2. Reteplase (Retavase) 3. Morphine 4. Abciximab (ReoPro)

4. Abciximab (ReoPro) Pg 400

1) Which prescriptions reduce the heart's demand for oxygen by lowering heart rate? 1. Anticoagulants and beta-adrenergic blockers 2. Calcium channel blockers and anticoagulants 3. Organic nitrates and calcium channel blockers 4. Beta-adrenergic blockers and calcium channel blockers

4. Beta-adrenergic blockers and calcium channel blockers Pg 391

1) Which is the primary pharmacologic goal in the treatment of a client experiencing stable angina? 1. Increase venous blood flow to the right atrium. 2. Eliminate blockages by using thrombolytics. 3. Establish a regular exercise program and diet plan. 4. Increase cardiac oxygen supply and reduce cardiac oxygen demand.

4. Increase cardiac oxygen supply and reduce cardiac oxygen demand. Pg 390

1) Which are the goals of antianginal therapy? Select all that apply. 1. Decreased oxygen consumption of the brain 2. Increased myocardial contractility 3. Increased blood flow to the peripheral blood vessels 4. Increased blood flow to the myocardium 5. Decreased myocardial oxygen demand

4. Increased blood flow to the myocardium 5. Decreased myocardial oxygen demand Pg 390-1