Question 1

What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?

Accepted Answer

An 8 to 12 hour nitrate free period will eliminate the development of tolerance to nitroglycerin.Route of administration and medication storage methods do not affect tolerance.

Question 2

Which medication combinations may be beneficial in treating angina pectoris?

Accepted Answer

ACE inhibitors and statins are often combined to treat angina pectoris.Antidysrhythmics and platelet active agents are not used in combination to treat angina because angina does not typically result in rhythm disturbances.Vasoconstrictors would exacerbate angina and are not used with diuretics.Analgesics and thrombolytics are not used in combination to treat angina because angina is not caused by a clot, so thrombolytics are not necessary.

Question 3

The nurse is teaching a patient about nitroglycerin prior to discharge to home.Which instruction will the nurse provide the patient?

Accepted Answer

Non hospitalized patients should carry nitroglycerin at all times.Headache is an expected adverse effect.Heat causes the medication to deteriorate, so being carried next to the body would cause it to become ineffective.Tablets are degraded by sunlight.

Question 4

When are sustained release nitroglycerin tablets administered?

Accepted Answer

Sustained release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours.If gastritis develops, it may be necessary to take these tablets with food.To be effective, sustained release nitroglycerin must be taken more often.Sustained release nitroglycerin is taken to prevent angina; waiting until symptoms occur decreases its effectiveness.

Question 5

Which lifestyle modification(s) will the nurse include when educating the patient with angina pectoris? (Select all that apply.)

Accepted Answer

Although medications can control angina attacks, lifestyle changes such as maintaining an ideal weight are important in managing the disease.Smoking cessation is a vital component to include when educating the patient with angina pectoris.Limiting potassium is not a recommendation for treatment of angina pectoris.The patient should always consult the health care provider before participating in any exercise regimen.

Question 6

Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?

Accepted Answer

Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate.The ointment is not applied to the lower extremities, including the legs.The ointment should not be rubbed into the skin.Shaving is not recommended prior to application because of possible skin irritation.

Question 7

What is the rationale behind administering calcium channel blockers to patients with angina?

Accepted Answer

By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow.Dilation of peripheral vessels reduces the workload of the heart.Calcium channel blockers are not given to decrease heart rate in patients with angina.Calcium channel blockers do not increase cardiac contractility or promote fluid excretion.

Question 8

What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results?

Accepted Answer

Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently.Allergy to nitrates is highly unlikely.Increasing dosages and frequency of nitrate use is more likely to reflect deterioration of cardiac function than dependence on the medication.Nausea is not a common adverse effect of nitrate treatment.

Question 9

Which therapy(ies) is/are used in the treatment of angina pectoris? (Select all that apply.)

Accepted Answer

Coronary artery bypass and coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation.Avoiding caffeine and emotional stress and use of nitrates is standard treatment of angina pectoris.An ECG is not a procedure for the treatment of angina.

Question 10

A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level.The health care provider has prescribed HMG CoA reductase inhibitor.What is the primary indication in using this medication?

Accepted Answer

HMG CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels.This medication prevents added atherosclerotic vessel build up and further narrowing of the coronary arteries.Statins do not affect vascular spasms or oxygen requirements of cells.Statins do not dilate coronary arteries.

Question 11

Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?

Accepted Answer

The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes.Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes if pain is not relieved.Nitrates are taken at the indication of pain.Sublingual nitrates are not swallowed.

Question 12

What will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.)

Accepted Answer

Lifestyle modifications such as relaxation techniques are essential for many individuals with angina.Nitrates should be stored in dark, airtight containers.Pain assessment and rating is an important part of nitrate therapy.Increasing caffeine in the diet should be discouraged.Participation in a regular, moderate exercise program is essential, but exercise should not be strenuous or isometric in patients with angina.

Question 13

The nurse is assisting with a patient admission to the telemetry unit.The patient is diagnosed with angina pectoris.When obtaining information for angina therapy in regard to the central nervous system (CNS), the nurse will document:

Accepted Answer

Anxiety level is a component of assessing the CNS.History of smoking is included when assessing the cardiovascular system.Diet is included when assessing nutritional history.Heart rate is included when assessing the cardiovascular system.

Question 14

Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?

Accepted Answer

Translingual nitroglycerin spray should be sprayed onto or under the tongue.The container should not be shaken because the bubbles formed may slow the release of the medication.The spray should not be inhaled or swallowed.Shaking the container can cause bubbles that will slow the release of nitroglycerin.The dose should not be inhaled or swallowed.

Question 15

Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?

Accepted Answer

The most common adverse effect of nitrate therapy is headache.Analgesics, such as acetaminophen, may be used if needed.The medication should not be discontinued.When administered sublingually, this medication is taken as needed for chest pain.Lying down will not prevent the occurrence of a headache.

Question 16

How frequently are nitroglycerin tablets discarded and prescriptions refilled?

Accepted Answer

Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded.Nitroglycerin has a longer shelf life than 1 or 3 months but does not have a shelf life as long as 1 year.

Question 17

How do beta adrenergic blocking agents reduce myocardial oxygen demand?

Accepted Answer

Beta adrenergic blocking agents prevent the stimulation of epinephrine and norepinephrine, which normally increase heart rate.Dopamine and acetylcholine are not beta adrenergic neurotransmitters.Beta blockers do not delay the destruction of these enzymes.Beta blockers do not enhance the sensitivity of alpha adrenergic and beta receptor sites.

Question 18

The nurse is performing pain assessment on a patient admitted for evaluation of angina.Which type of angina is precipitated by physical exertion and is relieved by rest?

Accepted Answer

Chronic stable angina is precipitated by physical exertion or stress, lasts only a few minutes, and is relieved by rest or nitroglycerin.Nocturnal is not a designated classification.Unstable angina is unpredictable.Variant angina occurs at rest.

Question 19

Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true?

Accepted Answer

Baseline and follow up ECGs should be obtained to evaluate the effects on the patient's QT incorrect interval.Increased coronary artery vasodilation is not an effect of this medication.This medication causes GI side effects such as abdominal pain.This medication does not elevate LDL levels.

Question 20

Which statement is true regarding the pain associated with angina?

Accepted Answer

The presentation of angina pectoris is highly variable.The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness.Pain or discomfort may radiate to the neck, lower jaw, shoulder, and arm.Attacks can last from 30 seconds to 30 minutes.Anginal pain usually does subside with rest.Sustained pain is usually indicative of a myocardial infarction.Although angina pain may subside in this way, in general, it is highly variable in how it is manifested.Anginal pain may or may not correlate with the amount of myocardial damage.

Quiz 25: Drugs Used to Treat Angina Pectoris