Meds for Angina
For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]? 1 Aspirin 2 Heparin 3 ACE inhibitor 4 Alteplase [Activase]
1
A patient is admitted to the emergency department complaining of chest pain, and the electrocardiogram (ECG) shows an evolving ST-segment elevation myocardial infarction (STEMI). Which intervention should the nurse anticipate? 1 Administer nitroglycerin. 2 Administer 400 mg of ibuprofen. 3 Provide oxygen by nasal cannula. 4 Administer an ACE inhibitor within 1 week of the onset of chest pain.
1
A patient is admitted to the emergency department with a diagnosis of ST-segment elevation myocardial infarction (STEMI). Which is the priority nursing action? 1 Having the patient chew a 325-mg aspirin 2 Administering meperidine [Demerol] for pain relief 3 Giving verapamil [Calan] to lower blood pressure 4 Preparing an insulin drip to manage complications
1
What is the primary effect of calcium channel blockers (CCBs)? 1 To treat acute myocardial infarction (MI) 2 To reduce exercise-induced elevations in heart rate 3 To prolong the QT interval on the electrocardiogram (ECG) 4 To decrease the afterload and reduce the workload of the heart
4
Which adverse effect is the greatest concern with thrombolytic therapy? 1 Hemophilia 2 Anaphylaxis 3 Cerebral edema 4 Intracranial hemorrhage
4
Which event is likely to induce a cardiac event in a patient who is prescribed sublingual nitroglycerin [Nitrostat]? 1 Migraine 2 Syncope 3 A late-night dinner 4 Sexual intercourse
4
Which statement by a patient demonstrates a need for further teaching regarding nitroglycerin [Nitrostat]? 1 "I should keep my nitroglycerin in a cool, dry place." 2 "I will change positions slowly to avoid getting dizzy." 3 "If I get a headache, I should use acetaminophen for pain relief." 4 "I will take up to five tablets at 3-minute intervals for chest pain."
4
Which statement by the nursing student about the use of organic nitrates indicates understanding? 1 Nitrates slow conduction. 2 Nitrates are used for atrial fibrillation. 3 These drugs have no adverse effects. 4 Organic nitrates dilate all blood vessels.
4
Which are types of chest pain? Select all that apply. A Unstable angina B Hypotensive angina C Vasospastic angina D Chronic stable angina E Nitrate-induced angina
A, C, D
Which classes of drugs are used in the treatment of angina pectoris? Select all that apply. A Nitrates B Diuretics C Beta blockers D Antihistamines E Calcium channel blockers
A, C, E
Which are the main types of drugs used to prevent or relieve anginal pain? Select all that apply. A Statins B Nitrates C Beta blockers D Platelet inhibitors E Calcium channel blockers
B, C, E
Before the nurse administers isosorbide mononitrate [Imdur], what is a priority nursing assessment? 1 Assess blood pressure. 2 Assess serum electrolytes. 3 Monitor level of consciousness. 4 Measure blood urea nitrogen and creatinine.
1
The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching? 1 "I will limit my alcohol to one drink per day." 2 "I will move slowly when changing positions." 3 "I will remove my patch at bedtime each evening." 4 "I will not use Viagra as long as I am on nitroglycerin."
1
What is the most appropriate outcome criteria for a patient who has been prescribed a calcium channel blocker? 1 Absence of chest pain 2 Increased cardiac output 3 Systolic blood pressure 140 mm Hg 4 Weight gain in one week greater than or equal to 5 lb
1
What is the primary cause of ischemic heart disease in a patient? 1 Atherosclerosis 2 Angina pectoris 3 Coronary artery disease 4 Myocardial infarction (MI)
1
Which form of nitroglycerin is likely to have a large first-pass effect? 1 Oral 2 Sublingual 3 Transdermal 4 Intravenous
1
Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? 1 "Apply the patch to a hairless, nonfatty area of the upper torso or arm." 2 "If you get a headache, remove the patch for 4 hours and then reapply." 3 "If you experience chest pain, apply a second patch right next to the first patch." 4 "Apply the patch to the same site each day to maintain consistent drug absorption."
1
Which is the most beneficial treatment for patients experiencing an ST-segment elevation myocardial infarction (STEMI)? 1 Reperfusion therapy 2 Lidocaine [Xylocaine] 3 Metoprolol [Lopressor] 4 Oxygen administration
1
Which patient assessment would assist the nurse in evaluating the therapeutic effects of a calcium channel blocker? 1 Absence of chest pain 2 Patient denies dizziness 3 Patient states that she feels stronger 4 Decreased swelling in the ankles and feet
1
A patient taking sublingual nitroglycerin complains of flushing and headaches. What instruction does the nurse give the patient? 1 "Stop taking the tablets immediately." 2 "These effects will subside over time." 3 "You should take a lower dose of the drug." 4 "You should get diagnostic testing immediately."
2
A patient who is prescribed sublingual nitroglycerin [Nitrostat] reports after 6 months that she left the bottle in her car for a few weeks. The nurse instructs the patient to obtain a new prescription from the primary healthcare provider. What is the purpose of obtaining a new prescription? 1 The drug can cause toxicity. 2 The drug has lost its potency. 3 The patient needs a lower drug dose. 4 The patient has developed drug tolerance.
2
Nitroglycerin therapy is ineffective in preventing angina in a patient, and so the patient is prescribed ranolazine [Ranexa]. Which assessment finding in the patient will the nurse report to the primary healthcare provider? 1 Migraine 2 Hepatic impairment 3 Ischemic heart disease 4 Blood pressure higher than 90 mm Hg
2
The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse? 1 Have the patient swallow the pill, because it cannot be crushed. 2 Call the healthcare provider about an alternate form of nitrate for administration. 3 Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia. 4 Crush the isosorbide mononitrate [Imdur] into a fine powder, dilute it with water, and administer it via the enteral tube.
2
Which condition indicates a need for administering acetaminophen [Tylenol] to a patient who is on nitroglycerin therapy? 1 The patient feels dizzy. 2 The patient has a headache. 3 The patient has drug-induced fever. 4 The patient has drug-induced cough.
2
Which medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain? 1 Aspirin 2 Morphine 3 Lorazepam [Ativan] 4 Hydromorphone [Dilaudid]
2
Which statement made by a patient about nitroglycerin indicates understanding? 1 "I will refill my prescription once a year to maintain potency." 2 "I will keep the nitroglycerin stored in the bottle it comes in." 3 "I will take a nitroglycerin tablet 2 hours before I engage in physical activity." 4 "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone."
2
A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include? 1 "Effects of sublingual nitroglycerin begin in 5 to 10 minutes." 2 "The tablets are only good for 1 month after the container is opened." 3 "Store the tablets in the original container and tightly close it after use." 4 "Sublingual nitroglycerin tablets are also effective when swallowed whole."
3
The nurse is teaching a patient who has had an ST-segment elevation myocardial infarction (STEMI) about home medications. Which agent represents a drug category that should be taken by all post-myocardial infarction (post-MI) patients unless contraindicated? 1 Diltiazem [Cardizem] 2 Lovastatin [Mevacor] 3 Metoprolol [Lopressor] 4 Hydrochlorothiazide (HCTZ)
3
What does the nurse administer when a patient has a sudden attack of angina? 1 Atenolol 2 Nifedipine 3 Nitroglycerin [Nitrostat] 4 Transdermal nitroglycerin patch
3
What is the duration of action of a nitroglycerin transdermal patch [Nitro-Dur]? 1 3 to 5 minutes 2 0.5 to 1 hour 3 Up to 24 hours 4 4 to 6 hours
3
Which assessment finding could indicate a myocardial infarction (MI) in a patient who is taking nitroglycerin [Nitrostat] for angina? 1 The patient has a headache after taking the drug. 2 There is sudden and severe hypotension in the patient. 3 Chest pain is not relieved by administering nitroglycerin. 4 The patient complains of feeling dizzy when trying to move.
3
Which assessment finding in a patient with cardiac risk factors needs to be reported if the patient is taking a nonselective beta blocker? 1 Chest pain 2 Weight loss 3 History of asthma 4 History of alcohol abuse
3
A patient has not had relief from angina using beta blockers, calcium channel blockers (CCBs), and nitrates. What is the patient's next choice? 1 Take daily acetaminophen. 2 Start antidysrhythmic medications. 3 Add opioids to the medication regimen. 4 Assess the need for coronary artery bypass grafting.
4
A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention? 1 Report of increased frequency of urination 2 A change in blood pressure from 122/70 to 108/66 mm Hg 3 A headache the patient rates as a 5 on a pain scale of 0 to 10 4 An increase in the resting heart rate to 110 beats/min from baseline rates of 72 beats/min
4
The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching? 1 Rotates the application sites to minimize skin irritation 2 Uses the applicator paper to measure the prescribed dose 3 Removes ointment from a previous dose before applying the next dose 4 Applies the prescribed ribbon of ointment to the applicator paper and always places it over the heart
4
The nurse is caring for a patient receiving nitrates for relief of angina. Which pharmacodynamic action is responsible for the relief of anginal pain with nitrates? 1 Vasoconstriction leads to improved cardiac output. 2 Decreased force of contraction leads to decreased oxygen demand. 3 Influx of calcium ions leads to relaxation of vascular smooth muscle. 4 Vasodilation leads to decreased preload, which decreases oxygen demand.
4
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug? 1 Frequent bloody stools 2 Blood pressure of 90/50 mm Hg 3 Respiratory rate of 12 breaths/min 4 QT prolongation on the electrocardiogram (ECG)
4
The nurse understands that ventricular fibrillation is a common cause of death after myocardial infarction (MI). Which drug should be readily available to treat ventricular fibrillation? 1 Dobutamine 2 Valsartan [Diovan] 3 Propranolol [Inderal] 4 Amiodarone [Cordarone]
4
What does the nurse instruct a patient, who is prescribed nitroglycerin patches [Nitro-Dur], to do to prevent the development of tolerance to nitrates? 1 "Apply the nitroglycerin patch every other day." 2 "Use the nitroglycerin patch for acute episodes of angina only." 3 "Use sublingual nitroglycerin if your systolic blood pressure is 140 mm Hg." 4 "Apply the nitroglycerin patch each day, and remove it for 10 hours at night."
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