Chapter 46

"I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."

A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided?

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

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain?

A greater incidence of adverse drug effects

A 75-year-old client is being treated for type 2 diabetes, hypertension, gout, angina, coronary artery disease, and peptic ulcer disease. The nurse is concerned because the client is taking a traditional antianginal drug in combination with seven other medications. The nurse understands that what could be the consequence?

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

A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client?

Decreased oxygenation to the myocardium

A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina?

"The combination can cause a severe decrease in blood pressure."

A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil?

90 mg

A client is to take diltiazem (Cardizem) 360 mg/d PO in four divided doses. How many mg will the client take per dose?

3

A client may administer a maximum of how many doses of sublingual nitroglycerin in a 15-minute period?

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

A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond?

Location Cause Relief Intensity

A client presents with chest pain in the emergency room. The nurse would assess what factors related to pain? Select all that apply.

Angina pectoris

A client reports substernal chest pain that radiates to the neck. The pain lasts 5 minutes and then subsides with relaxation. What is the most likely cause of the chest pain?

Every 5 minutes times 3

A client should be instructed to take sublingual NTG how often if he experiences chest pain?

Nitroglycerin will increase intracranial pressure.

A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets?

Decreased heart rate

A client with angina is prescribed atenolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

"Nitroglycerin and sildenafil cause a severe decrease in blood pressure."

A client, diagnosed with erectile dysfunction, is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated?

Glucose control

A current client, an overweight 61-year-old with a history of diabetes mellitus, is status post-MI 1 month and has returned for a cardiology follow-up. Along with dietary changes, the nurse will discuss which nonpharmacologic lifestyle modification to reduce microvascular changes?

It has a longer duration of action than sublingual tablets.

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?

Dose-dependent QT prolongation

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?

"That means that the drug is still potent and working."

A male patient who uses sublingual nitroglycerin tells the nurse that when he puts it under his tongue, he feels a fizzing sensation. Which response by the nurse would be most appropriate?

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

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?

Sublingual Transdermal Parenteral

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.

Decreased cardiac output

A patient has been prescribed a beta-adrenergic blocker to help control angina. What effect might the patient experience as a result of the drug therapy?

Instruct the patient to lie down.

A patient receiving amlodipine for angina reports dizziness. Which intervention should the nurse implement to help alleviate the condition?

The client's angina may necessitate the use of a calcium channel blocker.

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?

Chest pain that is relieved by rest

After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as:

Nadolol

After teaching a group of students about drugs used as antianginal agents, the instructor determines that the teaching was successful when the students identify which as a beta-blocker antianginal agent?

Arrhythmias

After teaching a group of students about myocardial infarction (MI), the instructor determines that the teaching was successful when they identify what as the major cause of death associated with MI?

increased heart rate and decreased blood pressure.

An expected outcome for a patient who has just taken sublingual nitroglycerin should be

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

Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.)

Decreasing the heart rate, allowing for longer filling time and increased blood to the heart

Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism?

Current blood pressure

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?

decreased oxygen supply to the heart.

The chest pain and pressure a client experiences during an anginal attack is caused by which of the following?

Nitrostat

The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?

Bradycardia

The client is taking a calcium channel blocker. Which assessment findings would the nurse expect?

Intravenous nitroglycerine

The nurse is caring for a client whose chest pain has not been relieved with sublingual organic nitrate. What medication does the nurse suspect will most likely be prescribed by the health care provider?

obese 40% over total body weight

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?

Decreasing heart rate

The nurse is providing education to a client who has been prescribed bisoprolol. During teaching, the nurse explains that the drug achieves a therapeutic effect in what way?

Chronic obstructive pulmonary disease (COPD) Diabetes Asthma All the above

The physician is considering prescribing a beta blocker for a patient who is experiencing angina. For which condition should the patient be assessed before the physician orders the medication?

route changed to transdermal

What effect, if any, would extensive facial and oral trauma have on a client's sublingual nitroglycerin therapy prescribed to manage the angina?

"I should feel a fizzing or burning sensation."

What indicates that a client understands how to use sublingual nitroglycerin?

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

What should the nurse tell the client about storage of oral nitroglycerin products? (Select all that apply.)

inhibiting the influx of calcium through slow channels.

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?

Check the inside of the cheeks for ulcers or breakdown.

Which would be important to do when administering nitroglycerin transbuccally?

should be replaced every six months.

While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it: