Deck 28: Drugs for Angina Pectoris and Myocardial Infarction

Question 1

A patient has been prescribed transdermal nitroglycerin patches. What medication education should the nurse provide?

A) Place the patch on the upper arm or leg.
B) Rotate sites of application.
C) Remove the patch for an hour each day.
D) Cleanse the skin under the patch after removal.
E) Triple wrap the patch in plastic wrap for disposal.

Answer 1

Rotate sites of application.
Cleanse the skin under the patch after removal.

Question 2

The patient is being treated for angina. He asks the nurse if angina is the same thing as having a heart attack. What is the best response by the nurse?

A) "They have some things in common, for example, severe emotional distress and panic can accompany both angina and myocardial infarction."
B) "Angina means heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died."
C) "Actually, it depends on what type of angina you mean; there are several types."
D) "They are basically the same."

Answer 2

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

Question 3

Which drugs reduce the heart's demand for oxygen by lowering heart rate?

A) Anticoagulants and beta-adrenergic blockers
B) Calcium channel blockers and anticoagulants
C) Organic nitrates and calcium channel blockers
D) Beta-adrenergic blockers and calcium channel blockers

Answer 3

Beta-adrenergic blockers and calcium channel blockers

Question 4

Which adverse effect is common for patients taking topical nitroglycerin paste?

A) Rash
B) Shortness of breath
C) Headache
D) Ventricular tachycardia

Question 5

The patient in the emergency department experienced an acute myocardial infarction (MI) 8 hours ago. The nurse is administering reteplase (Retavase) intravenously (IV). The patient asks the nurse what is being done. What is the best response by the nurse?

A) "This medicine is widening the arteries in your heart so they can get more oxygen."
B) "This medication is dissolving the clot that is causing your heart attack."
C) "This medicine is thinning your blood so more clots will not develop."
D) No response is indicated; the patient is past the time frame where thrombolytic therapy is effective.

Question 6

The primary pharmacologic goal in treating patients experiencing stable angina is to

A) increase venous blood flow to the right atrium.
B) eliminate blockages by using thrombolytics.
C) establish a regular exercise program and diet plan.
D) increase cardiac oxygen supply and reduce cardiac oxygen demand.

Question 7

What is the most likely reason that atherosclerotic plaque would be responsible for producing a myocardial infarction?

A) Atherosclerotic plaque builds up on the endocardium, preventing blood from leaving the atriums.
B) Atherosclerotic plaque results in a narrowing of 50% of the coronary arteries.
C) Atherosclerotic plaque impairs the ability of coronary arteries to constrict and dilate.
D) Atherosclerotic plaque causes a blockage that prevents blood from reaching the myocardium.

Question 8

The myocardium receives blood via coronary arteries that attach to

A) the aortic arch.
B) the superior vena cava.
C) the pulmonary vein.
D) the base of the aorta.

Question 9

The nurse has completed medication education with the patient who is receiving nitroglycerine (Nitrostat) as therapy for angina. The nurse determines that additional teaching is necessary when the patient makes which statement?

A) "I can keep taking tablets until the pain is gone, but I should not use more than five tablets."
B) "If my pain is not reduced 5 minutes after taking one tablet I should call EMS."
C) "I should take a tablet as soon as chest pain occurs.."
D) "I can take three tablets, one every 5 minutes."

Question 10

The patient is receiving diltiazem (Cardizem) and wants to know why he developed a headache after taking the medication. What is the best response by the nurse?

A) "Diltiazem (Cardizem) causes the blood vessels in your brain to widen, giving you the headache."
B) "Diltiazem (Cardizem) increases prostaglandin synthesis, giving you the headache."
C) "Diltiazem (Cardizem) releases Substance P, activating pain receptors in your brain and giving you the headache."
D) "Diltiazem (Cardizem) causes the blood vessels in your brain to narrow, giving you the headache."

Question 11

A patient reports the following symptoms. Which symptoms would the nurse evaluate as probable unstable angina?

A) "My chest has started hurting even if I am just watching television."
B) "My chest starts hurting if I climb one set of stairs."
C) "My attacks of chest pain are coming more frequently now."
D) "The pain is intense and moves up into my neck."
E) "The pain is worse than it used to be."

Question 12

The nurse is conducting an education class about myocardial blood supply for patients with coronary artery disease (CAD). The nurse determines that learning has occurred when the patients make which statements.

A) "The heart has right and left arteries that arise from the aorta."
B) "The coronary arteries carry blood away from the heart to the right atrium."
C) "The heart receives its oxygen through the blood that fills it."
D) "Coronary arteries primarily carry blood to the left ventricle."
E) "The right and left arteries have smaller branches that go around the heart."

Question 13

The patient says to the nurse, "My doctor said I can't have fried chicken anymore because I have heart disease. I've eaten it all my life and am fine except for some indigestion lately." What is the best response by the nurse?

A) "Did your doctor mention exercise? That is the most important lifestyle change to slow the progression of your heart disease."
B) "Your indigestion is an indication that your body cannot tolerate fatty foods; this causes an increased workload for your heart."
C) "Fried chicken is actually okay, but you must be very careful with the type of fat that you fry the chicken in."
D) "Your indigestion could actually be chest pain caused by narrowed coronary arteries; you will need a low-fat diet."

Question 14

Which symptom is most likely to be related to angina as opposed to a myocardial infarction?

A) Chest pain relieved by one sublingual nitroglycerin
B) Chest pain that radiates to the patient's back
C) Chest pain that occurred while the patient was eating breakfast
D) Chest pain accompanied by shortness of breath

Question 15

The nurse has completed medication education with the patient who is receiving atenolol (Tenormin). The nurse determines that teaching is effective when the patient makes which statement?

A) "I must avoid grapefruit juice when I take this medicine."
B) "I must call my doctor if I want to stop this medicine."
C) "I must check my pulse before taking the medicine and call the doctor if it is less than 50."
D) "I must take this medicine with food so it will be properly absorbed."

Question 16

The nurse is planning to teach a class on antianginal drugs to a group of patients who have experienced myocardial infarctions (MIs). The nurse includes which information in this class?

A) "These medications decrease how much oxygen your heart needs."
B) "These medications thin your blood so your heart receives more oxygen."
C) "These medications increase the amount of oxygen your heart receives."
D) "These medications increase oxygen to your heart by increasing nitric oxide production."

Question 17

The patient receives reteplase (Retavase) intravenously (IV). The nurse assesses the patient for orientation and level of consciousness. The patient's wife asks the nurse why this is being done. What does the nurse indicate as the reason for the assessment?

A) The medication can alter fluid balance; this affects orientation and level of consciousness.
B) The medication can cause bleeding in the brain; this affects orientation and level of consciousness.
C) The medication causes hypoglycemia; this affects orientation and level of consciousness.
D) The medication decreases oxygen to the brain; this decreases orientation and level of consciousness.

Question 18

The nurse is providing care to a patient who has experienced several episodes of angina. What is the primary desired outcome for this patient?

A) The patient will experience relief of chest pain with anticoagulant therapy.
B) The patient will experience relief of chest pain with nitrate therapy.
C) The patient will experience relief of chest pain with aspirin therapy.
D) The patient will experience relief of chest pain with therapeutic lifestyle changes.

Question 19

The nurse is preparing to administer nitroglycerine via the intravenous route. What must the nurse plan to do prior to administering this medication?

A) Use gloves to prevent self-administration.
B) Instruct the patient to avoid moving the arm in which the medication is infusing.
C) Cover the intravenous (IV) bottle to decrease light exposure.
D) Darken the room to decrease light exposure.

Question 20

The patient takes nitroglycerine (Nitrostat) for relief of occasional stable angina. The nurse would be most concerned about which statement made by the patient?

A) "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem."
B) "I'm going water skiing tomorrow; I hope my angina isn't a problem."
C) "I really don't like those little pills. I've heard about patches: can I try them?"
D) "My angina has been a little more frequent. Do I need a painkiller too?"

Question 21

Which patient who has had a myocardial infarction would be a candidate for reteplase (Retavase) therapy?

A) 54-year-old female with type 2 diabetes
B) 45-year-old female with a 2-week-old cranial artery repair
C) 62-year-old with a recent hemorrhagic stroke
D) 70-year-old male with active GI bleed

Question 22

Which drug is indicated for the prevention of blood clots?

A) Captopril (Capoten)
B) Reteplase (Retavase)
C) Morphine
D) Abciximab (ReoPro)

Question 23

The nurse knows that the basic strategies of antianginal therapy are

A) decreased oxygen consumption of the brain.
B) increased myocardial contractility.
C) increased blood flow to the peripheral blood vessels.
D) increased blood flow to the myocardium.
E) decreased myocardial oxygen demand.

Question 24

The nurse is caring for a patient who is recovering from a myocardial infarction (MI). The nurse anticipates that the patient will be prescribed which medications in order to reduce post-MI mortality?

A) Aspirin
B) Beta blockers
C) Narcotic analgesics
D) ACE inhibitors
E) Antidysrhythmics

Question 25

Following a myocardial infarction, elevations in which cardiac marker would be seen first and are cardiac tissue-specific?

A) White blood cells
B) Troponin I
C) Myoglobin
D) Creatine kinase

Question 26

A patient asks which conditions will cause his heart to need more oxygen. The nurse answers with which statements?

A) "Increasing physical activity."
B) "Watching a television show."
C) "Emotional stress."
D) "Eating a meal."
E) "Listening to music."

Question 27

The nurse is preparing to teach a patient therapeutic lifestyle changes that can decrease the risk of coronary artery disease. The nurse plans to include which topics in the teaching?

A) Eliminating the consumption of alcohol
B) Eliminating foods high in cholesterol and saturated fats
C) Maintaining blood pressure within normal levels
D) Exercising and maintaining a healthy weight
E) Decreasing the number of cigarettes smoked

Question 28

The nurse is reviewing the health history for a patient who may be a candidate for thrombolytic therapy for the treatment of an MI. The nurse knows that therapy is contraindicated in which circumstances?

A) Menses
B) A history of intracranial hemorrhage
C) Hemophilia
D) Liver disease
E) Peptic ulcer disease

Question 29

The nurse is teaching a patient about the pharmacological management of angina. The nurse plans to include which points in the patient teaching?

A) The medications increase the heart rate.
B) The medications dilate the veins so that the heart receives less blood.
C) The medications cause the heart to contract with less force.
D) The medications increase blood pressure.
E) The medications increase the ability of the body to produce red blood cells.

Question 30

A patient has been prescribed nitroglycerin ointment for transdermal application. The nurse should teach the patient to hold the medication and contact the prescriber if which situations occur?

A) Dyspnea
B) Cough with frothy sputum
C) Headache
D) Fever
E) Confusion