Question 1

A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?

Accepted Answer

Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect.

Question 2

What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy?

Accepted Answer

To prevent tolerance, remove the trAnswerdermal patch at night for 8 hours, and apply a new patch in the morning. TrAnswerdermal patches must never be cut or left on for 2 days, and doses must not be omitted.

Question 3

A patient with a history of angina will be started on ranolazine ( Ranexa ). The nurse is reviewing the patient's history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.)

Accepted Answer

Ranolazine is contraindicated in patients with preexisting QT prolongation or hepatic impairment. The other options are not contraindications.

Question 4

While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?

Accepted Answer

Adverse effects of beta blockers include bradycardia, hypotension, dizziness, drowsiness, impotence, and several other effects, but not dry cough.

Question 5

A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after 1 or 2 sublingual nitroglycerin tablets and rest. What type of angina is he experiencing?

Accepted Answer

Classic, or chronic stable, angina is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.

Question 6

The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication?

Accepted Answer

The non-PVC infusion kits are used to avoid absorption and/or uptake of the nitrate by the intravenous tubing and bag and/or decomposition of the nitrate. The medication is given by infusion via an infusion pump and not with other medications. It is not given by bolus injection. If the parenteral solution is discolored blue or green, it should be discarded.

Question 7

When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?

Accepted Answer

Application sites for trAnswerdermal nitroglycerin patches need to be rotated. Apply the trAnswerdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleAnswered.

Question 8

When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?

Accepted Answer

TrAnswerdermal dosage formulations of nitroglycerin are used for the long-term prophylactic management (prevention) of angina pectoris. TrAnswerdermal nitroglycerin patches are not appropriate for the relief of shortness of breath, to prevent palpitations, or to control the heart rate during exercise.

Question 9

A patient has been taking a beta blocker for 4 weeks as part of his antianginal therapy. He also has type II diabetes and hyperthyroidism. When discussing possible adverse effects, the nurse will include which information?

Accepted Answer

Beta blockers can cause both hypoglycemia and hyperglycemia. They may also cause weight gain if heart failure is developing, and decreased pulse rate. The use of hot tubs and saunas is not recommended because of the possibility of hypotensive episodes.

Question 10

A calcium channel blocker ( CCB ) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct?

Accepted Answer

Constipation is a common effect of CCBs, and a high-fiber diet and plenty of fluids will help to prevent it. Grapefruit juice decreases the metabolism of CCBs. Extended-release tablets must never be chewed or crushed. These medications should never be discontinued abruptly because of the risk for rebound hypertension.

Question 11

A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?

Accepted Answer

According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved.

Question 12

A patient will be receiving metoprolol (Lopressor) 5 mg IV push ´ 3 doses for angina. The medication is available in a strength of 1 mg/mL. How much medication will the nurse draw up for each dose?

Accepted Answer

The answer of A patient will be receiving metoprolol (Lopressor)...

Question 13

The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, "What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you." Which actions by the patient are appropriate in this situation? (Select all that apply.)

Accepted Answer

With sublingual forms, the medication is taken at the first sign of chest pain, not delayed until the pain is severe. The patient needs to sit down or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. Placing a tablet between the gum and cheek is the buccal route.

Question 14

When the nurse is administering topical nitroglycerin ointment, which technique is correct?

Accepted Answer

The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.

Quiz 23: Antianginal Drugs