N123 Chp 34 Chronic Stable Angina
Which type of angina increases in frequency, duration, and severity as the time progresses? 1 Unstable angina 2 Prinzmetal's angina 3 Microvascular angina 4 Chronic stable angina
1 Unstable angina is a chronic stable angina that increases in frequency, duration, and severity as the time progresses. Prinzmetal's angina occurs primarily at rest and is triggered by smoking and increased levels of substances, such as histamine and epinephrine. Microvascular angina is triggered by activities of daily life and exertion. Chronic stable angina is provoked by exertion and relieved by rest. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 742
Which type of angina is caused by coronary vasospasm? 1 Unstable angina 2 Prinzmetal's angina 3 Microvascular angina 4 Chronic stable angina
2 Prinzmetal's angina is caused by coronary vasospasm. Unstable angina is caused by rupture of the thickened plaque. Microvascular angina is caused by myocardial ischemia secondary to microvascular disease. Chronic stable angina is caused by myocardial ischemia, which is usually secondary to coronary artery disease. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 742
Which nursing intervention will be beneficial in patients with angina? 1 Position the patient upright and supply oxygen. 2 Rest the patient in recumbent position during attack. 3 Encourage the patient to perform isometric exercises. 4 Include a salt-rich diet to prevent orthostatic hypotension.
1 A patient with angina should be placed in an upright position and supplied oxygen to provide comfort and to attain an appropriate amount of oxygen in blood unless contraindicated. A recumbent positioning of the patient may precipitate the attack. Isometric exercises are stressful and may exacerbate the symptoms by increasing the cardiac workload. Salt and saturated fat foods are restricted in the patient to prevent further complications. Text Reference - p. 754
Which drug produces an anticoagulant effect by interfering with hepatic synthesis of vitamin K-dependent clotting factors? 1 Warfarin 2 Prasugrel 3 Argatroban 4 Eptifibatide
1 Warfarin interferes with hepatic synthesis of the vitamin K-dependent clotting factors that result in an anticoagulant effect. Prasugrel causes an antiplatelet effect by inhibiting platelet aggregation. Argatroban acts by directly inhibiting the clotting factor thrombin and results in an anticoagulant effect. Eptifibatide prevents the binding of fibrinogen to platelets, thereby blocking platelet aggregation. Text Reference - p. 744
A patient with chronic stable angina has received a prescription for nitroglycerin. The nurse tells the patient that orthostatic hypotension is an important side effect of this drug. To prevent complications associated with the side effect, what should the nurse include in the patient's teaching? 1 Use acetaminophen before taking nitroglycerin to prevent headaches 2 Avoid sudden changes in position after taking nitroglycerin to prevent falls 3 Use NSAIDs before taking nitroglycerin to prevent flushing 4 Do not use the nitroglycerin if it causes a tingling sensation when administered
2 Nitrates cause vasodilatation, which in turn causes peripheral pooling of blood. On changing position suddenly (from recumbent to erect posture), there is a sudden drop of blood pressure, which is known as orthostatic hypotension. This decreases the blood supply to the brain, which may lead to dizziness and falling. Headaches and flushing are not associated with orthostatic hypotension. If there is no tingling sensation on administering the drug, then the medication may be expired or ineffective. Text Reference - p. 743
The nurse is performing an assessment on a newly admitted patient who was brought to the emergency department with complaints of chest pain. Which assessment data would indicate that the patient has stable angina? 1 The patient developed chest pain while sitting and watching television. 2 Pain developed when the patient was jogging and subsided now. 3 The patient developed chest pain shortly after going to bed. 4 Pain starts approximately the same time every day without regard to activity level.
2 Pain of stable angina is precipitated by increased demand of myocardial muscle for oxygen that is happening with exercising or other activity and subsides with rest in 5 to 15 minutes. Prinzmetal's angina (variant angina) occurs at rest. Nocturnal angina occurs when patient is supine in bed. Prinzmetal's angina (variant angina) is characterized by a pain at the same time of the day. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. Text Reference - p. 741
The electrocardiogram (ECG) shows T wave inversion in a patient who comes to the emergency department complaining about a sharp, stabbing pain in the chest that lasted 10 minutes and occurred when lifting a heavy box at home. Which instructions given to the patient will help in managing the symptoms on reoccurrence? 1 You should perform moderate exercise to relieve the pain. 2 Take nitroglycerin before engaging in strenuous activities. 3 You can engage in daily activities after taking the medication. 4 Take nitroglycerin 30 minutes after performing strenuous activities.
2 Ten minutes of a sharp, stabbing pain in the substernal region radiating to the neck and jaw when lifting a heavy box, and a T wave inversion in the ECG indicates that the patient is experiencing an attack of chronic stable angina. The patient should be advised to take nitroglycerin before engaging in activities, because the exertion will provoke angina and the patient may be at a risk. Patients with Prinzmetal's angina may get relief from chest pain by performing moderate exercise. The patient should wait for 30 minutes to one hour after taking the medication before engaging in daily activities. The patient should not take the nitroglycerine 30 minutes after exertion. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 741
The nurse is performing medication teaching to a patient who has been prescribed sublingual (SL) nitroglycerin (NTG) tablets. Which statement by the patient indicates a need for further education? 1 "When I put the tablet under my tongue, I should feel a tingling sensation." 2 "I can take as many tablets as needed until the pain goes away, five minutes apart." 3 "I will need to be careful when I stand up because nitroglycerin can cause dizziness." 4 "If chest pain occurs, I will stop what I'm doing and take one tablet under my tongue."
2 The recommended dose for the patient for whom NTG has been prescribed is one tablet taken SL or one metered spray for symptoms of angina. If symptoms are unchanged or worse after five minutes, the patient should contact the emergency medical services (EMS) system before taking additional NTG. Tell the patient to place an NTG tablet under the tongue and allow it to dissolve. NTG should cause a tingling sensation when administered; otherwise it may be outdated. Warn the patient that a headache, dizziness, or flushing may occur. Caution the patient to change positions slowly after NTG use because orthostatic hypotension may occur. Text Reference - p. 745
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? 1 "I will replace my nitroglycerin supply every six months." 2 "I can take up to five tablets every three minutes for relief of my chest pain." 3 "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." 4 "I will take the nitroglycerin 10 minutes before a planned activity that usually causes chest pain."
2 The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after five minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every five minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely. Text Reference - p. 743
Which statement made by the student nurse indicates effective learning about microvascular angina? 1 "It is more common in a patient with diabetic neuropathy." 2 "It occurs at night and is triggered by the patient lying down." 3 "It is common in women and is triggered even by daily activity." 4 "It is commonly seen during rapid eye movement sleep in the patient."
3 Microvascular angina is a chest pain associated with abnormalities of the coronary microcirculation, occurring especially in women even when performing daily activities. Silent ischemia occurs in the patient with diabetic neuropathy due to the damage of nerves of the cardiovascular system. Nocturnal angina sets in when the patient lies down and is relieved upon standing or sitting. Prinzmetal's angina is very common in patients even during rapid eye movement sleep. Text Reference - p. 752
Which statement made by the student nurse indicates effective learning about microvascular angina? 1 "It is common in smokers and occurs even during sleep." 2 "It occurs due to exertion for 5 to 15 minutes and is relieved upon rest." 3 "It is more common in women and is triggered even when performing daily activities." 4 "It occurs in the patient with diabetic neuropathy, affecting the cardiovascular system."
3 Microvascular angina is a common type of angina in women that occurs due to the absence of coronary atherosclerosis or coronary spasm even while performing daily activities. Chronic stable angina is secondary to coronary artery disease and is not specific to tobacco use or sleep time. Chest pain due to chronic stable angina persists for 5 to 15 minutes and is triggered by exertion and relieved upon rest. Silent ischemia is frequent in the patient with diabetic neuropathy, due to damage of the nerves innervating the cardiovascular system. Text Reference - p. 742
Which statement by a patient diagnosed with stable angina indicates understanding of the disease process? 1 "Decreased oxygen level in blood is causing my chest pain." 2 "Angina is causing an irreversible damage to cardiac muscles by cardiac ischemia." 3 "Anginal pain is caused by increased demand for oxygen or decreased supply of oxygen." 4 "Symptoms of angina start when the process of atherosclerosis completely occludes a coronary artery."
3 Mismatch between oxygen demand of cardiac muscles and supply of oxygen leads to myocardial ischemia, which is manifested as pain. A decreased oxygenation level of blood indicates respiratory problems. Myocardial ischemia is completely reversible. The patient will start to experience symptoms of ischemia when the coronary artery is blocked by 75% or more. Text Reference - p. 740 Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
Which statement made by the student nurse indicates effective learning regarding the instructions to be given to a patient who is on nitroglycerin? 1 "I should direct the patient to inhale the spray containing medication." 2 "I should ask the patient to change position rapidly after the medication use." 3 "I should instruct the patient to report changes in the pattern of pain to the health care provider." 4 "I should encourage the patient to administer the medication every 30 minutes sublingually if symptoms persist."
3 Short-acting nitrates such as nitroglycerin (NTG) are first-line medications for angina. The nurse has to instruct the patient on NTG to report any changes in the pattern of pain, frequency of attack, or nocturnal angina to the health care provider. The nurse must direct the patient to spray the medication on his or her tongue. The nurse should ask the patient to slowly change positions after NTG use to avoid the effects of orthostatic hypotension. The nurse should ask the patient to take NTG every five minutes for a maximum of three doses if symptoms are not resolved. Text Reference - p. 743
The nurse is caring for a patient who complains of a squeezing, heavy, choking sensation when performing physical activity. What would be the priority nursing action in this situation? 1 Instruct the patient to take aspirin if the pain occurs again. 2 Instruct the patient to take acetaminophen if the pain persists. 3 Instruct the patient to lie down and rest until the pain is relieved. 4 Instruct the patient to get an electrocardiogram (ECG) immediately.
3 The symptoms described by the patient may be due to angina. The patient should be advised to lie down until the pain disappears because stable angina is due to exertion and can be relieved by resting. The patient should be advised to take aspirin to decrease the incidence of atherosclerosis. The patient may be instructed to take acetaminophen only if the patient experiences headache or any other muscle pain. The patient must be advised to get an electrocardiogram (ECG) in order to rule out the presence of any heart disease. Text Reference - p. 7
A female patient complains of chest pain while at work. Which contributed to the patient's condition? 1 Angina decubitus 2 Diabetic neuropathy 3 Raynaud's phenomenon 4 Coronary microvascular disease
4 Microvascular angina occurs due to myocardial ischemia, which is associated with abnormalities of the coronary circulation and can also be triggered by daily activities. The patient with angina decubitus experiences chest pain while lying down and is usually relieved by standing or sitting. Diabetic neuropathy leads to damage of the nerves of the coronary system leading to silent ischemia. The patient with a history of Raynaud's phenomenon may experience Prinzmetal's angina. Text Reference - p. 742
What is the reason behind prescribing low-molecular-weight heparin (LMWH) after a stent placement? 1 Because stents can become displaced 2 Because stents can trigger anaphylaxis 3 Because stents can injure the vessel wall 4 Because stents increase the risk of clotting
4 Stent placement is associated with many risks. Stents increase the risk of clotting; therefore, LMWH is prescribed to prevent this risk. LMWH is not an appropriate treatment for stent displacement or anaphylaxis. LMWH does not help healing an injury on the vessel wall. Text Reference - p. 745
The nurse is caring for a female patient whose chest x-ray reveals that there is no significant coronary atherosclerosis but has chest pain while performing daily activities. Which condition is indicated in the patient? 1 Silent ischemia 2 Nocturnal angina 3 Angina decubitus 4 Microvascular angina
4 The patient may have microvascular angina, which is chest pain that occurs in the absence of significant coronary atherosclerosis or coronary spasm; it is especially common in women. The chest pain is related to myocardial ischemia associated with abnormalities of coronary microcirculation. If the ischemia occurs in the absence of any subjective symptoms, then the condition is silent ischemia. Nocturnal angina occurs only at night. Angina decubitus occurs only when the patient is lying down or is in a recumbent position, and is relieved when the patient is in the sitting or standing position. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 742
