A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain? Show Have the client swallow a tablet every 5 minutes for 15 minutes. Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided. The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the client's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the client to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the health care provider if the pain has subsided by the third tablet. If the pain has not subsided, the client is considered to be having an acute MI, and it would be urgent to call the provider. Nitroglycerin does not come in oral form; therefore, it would not be swallowed. A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this client's angina? The client's angina may necessitate the use of a calcium channel blocker. The client's angina may necessitate the use of a calcium channel blocker. Calcium channel blockers are used in chronic stable angina when the client cannot tolerate beta blockers, or if the symptoms are not adequately controlled while on this therapy. Regularly scheduled beta blockers are not administered intravenously. Low molecular weight heparin is not typically used in the treatment of stable angina, and antiplatelet medications do not need to precede the use of nitrates. Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose? Current blood pressure Current blood pressure For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy. The nurse should administer bisoprolol with an understanding that it achieves a therapeutic effect in what way? decreasing heart rate decreasing heart rate Bisoprolol reduces the workload of the heart and decreases myocardial oxygen demand by decreasing heart rate and the force of myocardial contractions. It does not prolong the QT interval or shorten the time required for repolarization. A client's angina pectoris is being successfully treated on an outclient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication? "This is actually a result of your angina, not the nitroglycerin." "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache." The most common adverse effect of nitroglycerin is a severe headache, which is typically treated with acetaminophen. Taking the drug on a full stomach is ineffective, and headaches do not contraindicate the use of the drug. What effect, if any, would extensive facial and oral trauma have on a client's sublingual nitroglycerin therapy prescribed to manage the angina? no effect route changed to transdermal Oral trauma would be expected to affect sublingual nitroglycerin circulation. Changing the route to transdermal will provide an effective route unaffected by the accident's trauma. Discontinuing the nitroglycerin will only endanger the client; increasing the sublingual dose does not change the potential for uneven absorption due to tissue trauma. The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack? Every 5 minutes Every 5 minutes Sublingual nitroglycerin should be taken every 5 minutes up to a maximum number of 3 tablets in 15 minutes. The client should seek medical care if pain is not relieved after the 3 doses. After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.) Sildenafil Sildenafil Sildenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Tadalafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Vardenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Heparin's effectiveness is decreased when combined with nitrates; dosage adjustments may be necessary. Ergot derivatives when combined with nitrates may increase the risk of hypertension and decreased antianginal effects; dosage adjustments may be necessary. The nurse would avoid administering nitrates to clients using which medication? Sildenafil Sildenafil Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs. Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) Relieve the pain of acute anginal attacks. Relieve the pain of acute anginal attacks. Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides. When caring for a patient with angina, the nurse instructs the patient to place the nitroglycerin tablet between the cheek and the gums. Which route of administration is the nurse referring to? Sublingual Buccal The nurse is referring to the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the patient to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the patient to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, transdermal, and translingual routes mentioned. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the front or back of the chest. In translingual nitroglycerin, the spray is directed under or onto the tongue. A client reports substernal chest pain that radiates to the neck. The pain lasts 5 minutes and then subsides with relaxation. What is the most likely cause of the chest pain? myocardial infarction angina pectoris Classic angina pain related to angina pectoris is substernal chest pain that can radiate to the jaw. Chest pain that lasts longer than 5 minutes is not associated with angina but is associated with myocardial infarction. Hypertension is usually a condition in which the client is pain free. Intermittent claudication is not associated with chest pain. A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil (Viagra)? "Nitroglycerine and Viagra cause a severe decrease in blood pressure." "Nitroglycerine and Viagra cause a severe decrease in blood pressure." Nitrates and phosphodiesterase enzyme type 5 inhibitors decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension. A client with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem? bronchospasm bronchospasm Clients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client will not experience hyperglycemia, pleural effusion, or pneumonia as a result of this medication. A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided? "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider." "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." The client with stable or unstable angina will be prescribed sublingual nitroglycerin to relieve chest pain symptoms. The client may take up to three tablets of sublingual nitroglycerin 5 minutes apart. If the chest pain is unrelieved, the client needs to seek emergency medical care immediately. A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client? Hypolkalemia Hypotension Adverse effects of nitroglycerin include hypotension, dizziness, lightheadedness, palpitations, and headache. Adverse reactions of nitroglycerine do not include hypokalemia, renal insufficiency or sedation. A 54-year-old client has been prescribed sublingual nitroglycerin. After the nurse has finished teaching the client about the medication, what statement could the client make to suggest that the client understands proper self-administration? "I should take three tablets as soon as I start to feel chest pain." "I can take up to three tablets at five-minute intervals." Clients may take up to three doses of sublingual nitroglycerin at five-minute intervals to relieve anginal chest pain. They should take as few doses as necessary to relieve pain. Administration should begin at the first sign of pain. A health care provider has prescribed sublingual nitroglycerin and the nitroglycerin patch for a client. When the nurse explains the medications to the client, what advantage of the patch might the nurse mention? It only has to be administered once a week. It has a longer duration of action than sublingual tablets. Although the nitroglycerin patch does not act as quickly as the sublingual version of the drug, it is effective for a longer period of time (12 or more hours). A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement? "I will keep my medication in the original container." "I will take a pill every 15 minutes until the pain subsides." When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension. The 47-year-old client is experiencing chest pain and has taken three sublingual nitrogylcerin tablets, but the pain remains. What should the client do next? Have someone take him to the emergency department. Call 911 Nitroglycerin should be administered every five minutes, times three doses. If the pain persists, 911 or the emergency system should be activated. The client should not take additional medication. It is not safe to be transported by private car having chest pain. For relief of acute angina and for prophylaxis before events that cause acute angina, what is the primary drug of choice? Nitroglycerin Nitroglycerin For relief of acute angina and for prophylaxis before events that cause acute angina, nitroglycerin (sublingual tablets or translingual spray) is usually the primary drug of choice. A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets? Nitroglycerin will raise the
client's blood pressure. Nitroglycerin will increase intracranial pressure. Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose. A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect? relief of fatigue decreased heart rate Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature. An older adult client whose medical history includes angina experiences a sudden onset of chest pain. This client would most likely administer a dose of nitroglycerin by what route? subcutaneous injection transmucosal spray For relief of sudden-onset angina, fast-acting preparations of nitroglycerin include sublingual and chewable tablets and transmucosal spray. Subcutaneous injections, sustained-release tablets, and nebulizers are not used since they would not deliver the medication either effectively or quickly enough. Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritizewhat assessment? level of consciousness (LOC) blood pressure (BP) Atenolol and other beta-blockers have an antihypertensive effect, making the monitoring of blood pressure a priority. They are unlikely to affect temperature, LOC, or oxygen saturation levels. A male patient who uses sublingual nitroglycerin tells the nurse that when he puts it under his tongue, he feels a fizzing sensation. Which response by the nurse would be most appropriate? "You need a new supply because the drug has deteriorated." "That means that the drug is still potent and working." Fizzing indicates potency, not irritation or deterioration. A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina? Nicardipine Nicardipine Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isoxsuprine, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases. What medication will most likely be prescribed for a client whose chest pain that is not relieved with sublingual organic nitrate? oral nonsteroidal anti-inflammatory agents intravenous nitroglycerine Intravenous nitroglycerin is used to manage angina that is unresponsive to organic nitrates via other routes since it quickly increases blood flow to the heart. The use of intravenous morphine sulfate will decrease pain but will not increase needed blood flow. Oral nonsteroidal anti-inflammatory agents will not assist in decreasing pain or increasing needed blood flow. The application of a fentanyl patch will not increase needed blood flow. A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hyperkalemia Hypotension When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension. The client is experiencing an acute onset of angina. The nurse would most likely administer which medication? Procardia Nitrostat Nitrostat is administered for acute relief of angina. Nitro-Dur is used to prevent angina. Procardia and Norvasc are indicated for chronic angina. After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: Chest pain that occurs with coronary artery disease Chest pain that is relieved by rest Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal's angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem. A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client? "The heart muscle has become damaged due to blocked blood flow." "The heart muscle isn't getting enough oxygen." The body's response to a lack of oxygen in the heart muscle is pain, which is called angina. The narrowing of arteries due to fatty deposits is called atherosclerosis. Although left ventricular enlargement may occur with coronary artery disease, it is not the underlying mechanism involved with angina. Damage to the heart muscle in response to ischemia is called a myocardial infarction. Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism? Increasing conduction to the atrioventricular node, thereby increasing cardiac output Decreasing the heart rate, allowing for longer filling time and increased blood to the heart Beta-blockers prevent the beta-adrenergic receptors from being stimulated. These drugs have multiple effects on the heart and cardiovascular system, including slowing the heart rate, depressing atrioventricular (AV) conduction, decreasing cardiac output, and reducing systolic and diastolic blood pressure at rest and during exercise. These effects decrease the oxygen demands of the heart and thereby decrease angina. The client is taking a calcium channel blocker. Which assessment findings would the nurse expect? Vomiting Bradycardia Calcium channel blockers slow the conduction velocity of the cardiac impulse and the client may experience bradycardia. Palpitations, vomiting, and restlessness are associated with peripheral vasodilators. The nurse knows that nitroglycerin can be administered in what ways? (Select all that apply.) Oral IV Because oral nitroglycerin is rapidly metabolized in the liver, relatively small proportions reach systemic circulation; transmucosal, transdermal, and IV preparations are more effective. Nitroglycerin is not administered intrathecally.
A current patient, an overweight, 61-year-old man with a history of diabetes mellitus, is status post-MI 1 month and has returned for his cardiology follow-up. Included with his dietary changes, the cardiologist recommended which nonpharmacological lifestyle changes to reduce microvascular changes? Increased nicotine use Glucose control For patients with diabetes mellitus, glucose and blood pressure control can reduce the microvascular changes associated with the condition. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease. Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) Relieve the pain of acute anginal attacks. Relieve the pain of acute anginal attacks. Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides. Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose? Current respiratory rate Current blood pressure For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy. The client is taking a calcium-channel blocker. What adverse effects might the client experience? Fever and bronchospasm Headache and dizziness Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation. A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets? Nitroglycerin will raise the client's blood pressure. Nitroglycerin will increase intracranial pressure. Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose. A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route? Sublingual Oral Propranolol is used orally as treatment for angina. A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this client's angina? The client indicates a need for daily low-molecular weight heparin therapy The client's angina may necessitate the use of a calcium channel blocker. Calcium channel blockers are used in chronic stable angina when the client cannot tolerate beta blockers, or if the symptoms are not adequately controlled while on this therapy. Regularly scheduled beta blockers are not administered intravenously. Low molecular weight heparin is not typically used in the treatment of stable angina, and antiplatelet medications do not need to precede the use of nitrates. The health care provider prescribes calcium channel blockers for a client who is diagnosed with angina pectoris. What is the action of calcium channel blockers? Induce coronary artery vasospasm Improve blood supply to the myocardium In angina pectoris, calcium channel blockers improve blood supply to the myocardium by dilating coronary arteries and decrease the workload of the heart by dilating peripheral arteries; in variant angina, the drugs reduce coronary artery vasospasm. A client, diagnosed with erectile dysfunction, is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated? "Nitroglycerin decreases the effect of sildenafil for erectile dysfunction." "Nitroglycerin and sildenafil cause a severe decrease in blood pressure." Nitrates and phosphodiesterase enzyme type 5 inhibitors like sildenafil decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension. None of the remaining options are accurate statements regarding sildenafil. A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect? decreased heart rate decreased heart rate Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature. The nurse is caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within: fifteen to twenty minutes. one to three minutes. Sublingual nitroglycerin acts within one to three minutes and lasts thirty minutes to an hour. While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it: has an indefinite shelf life. should be replaced every six months. Sublingual nitroglycerin tablets should be replaced every 6 months because they become ineffective over time. A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hypotension Hypotension When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension. A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? A
reduction in plaque secondary to atherosclerosis Decreased oxygenation to the myocardium Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries. A client may administer a maximum of how many doses of sublingual nitroglycerin in a 15-minute period? 2 3 A client may administer a maximum of 3 doses of sublingual nitroglycerin in a 15- minute period. After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: Chest
pain that occurs with coronary artery disease Chest pain that is relieved by rest Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal's angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem. A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker? Propranolol Isosorbide Isosorbide is a nitrate. Metoprolol is a beta blocker. Nadolol is a beta blocker. Propranolol is a beta blocker. The nurse would avoid administering nitrates to clients using which medication? Albuterol Sildenafil Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs. Which statement correctly distinguishes between the therapeutic effects of sublingual isosorbide and sublingual nitroglycerin? Sublingual isosorbide is not as effective as sublingual nitroglycerin. Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Sublingual isosorbide has a slower onset and a longer duration of action than sublingual nitroglycerin. Because sublingual isosorbide does not relieve chest pain as rapidly as nitroglycerin, isosorbide is limited to treating acute angina in patients intolerant of or unresponsive to sublingual nitroglycerin. Although nitroglycerin may be used occasionally, with adequate monitoring during the early phases of acute MI, isosorbide should never be used, because of its greater sustained effects. The client is taking a calcium channel blocker. Which assessment findings would the nurse expect? Restlessness Bradycardia Calcium channel blockers slow the conduction velocity of the cardiac impulse and the client may experience bradycardia. Palpitations, vomiting, and restlessness are associated with peripheral vasodilators. The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports: that he gets a headache
each time the ointment is applied. no episodes of angina since ointment was initiated. Topical nitroglycerin is used to manage angina. The treatment is effective if the client reports no episodes of angina. Headache and dizziness are adverse effects of the medication. A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? A reduction in plaque secondary to atherosclerosis Decreased oxygenation to the myocardium Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries. Which would a nurse identify as a nitrate? Nicardipine Isosorbide Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers. Which agent would be most appropriate for a client with Prinzmetal's angina? Metoprolol Amlodipine Calcium channel blockers such as amlodipine are indicated as treatment for Prinzmetal's angina because they relieve coronary artery vasospasm. Nitroglycerin is indicated for acute angina attacks. Metoprolol and nadolol would be contraindicated for clients with Prinzmetal's angina. What medication will most likely be prescribed for a client whose chest pain that is not relieved with sublingual organic nitrate? fentanyl topical patch intravenous nitroglycerine Intravenous nitroglycerin is used to manage angina that is unresponsive to organic nitrates via other routes since it quickly increases blood flow to the heart. The use of intravenous morphine sulfate will decrease pain but will not increase needed blood flow. Oral nonsteroidal anti-inflammatory agents will not assist in decreasing pain or increasing needed blood flow. The application of a fentanyl patch will not increase needed blood flow. Which electrocardiogram change should prompt the nurse to question the use of ranolazine for the treatment of a client diagnosed with chronic angina? normal ST segment QT prolongation Ranolazine is contraindicated in clients with preexisting QT prolongation. It is not contraindicated with a normal ST segment, inverted P wave, or shortened QRS. A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hyperkalemia Hypotension When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension. A client presents with chest pain in the emergency room. The nurse would assess what factors related to pain? Select all that apply. Blood pressure Location It is important that the location, quality, duration, intensity, and perceived cause and remedies used to relieve the pain are assessed. Blood pressure is not a sole indicator of pain. A 75-year-old client is being treated for type 2 diabetes, hypertension, gout, angina, coronary artery disease, and peptic ulcer disease. The nurse is concerned because the client is taking a traditional antianginal drug in combination with seven other medications. The nurse understands that what could be the consequence? Decreased effectiveness of the antianginal drug A greater incidence of adverse drug effects Traditional antianginal drugs that act via hemodynamic mechanisms (e.g., beta-blockers, calcium antagonists, nitrates) can pose a problem in older adults because of the associated higher risk of drug interactions and greater incidence of adverse drug effects. A current patient, an overweight, 61-year-old man with a history of diabetes mellitus, is status post-MI 1 month and has returned for his cardiology follow-up. Included with his dietary changes, the cardiologist recommended which nonpharmacological lifestyle changes to reduce microvascular changes? Glucose control Glucose control For patients with diabetes mellitus, glucose and blood pressure control can reduce the microvascular changes associated with the condition. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease. After teaching a group of students about myocardial infarction (MI), the instructor determines that the teaching was successful when they identify what as the major cause of death associated with MI? Arrhythmias Arrhythmias Most of the deaths caused by MI occur as a result of fatal arrhythmias. The client is taking a calcium channel blocker. Which assessment findings would the nurse expect? Bradycardia Bradycardia Calcium channel blockers slow the conduction velocity of the cardiac impulse and the client may experience bradycardia. Palpitations, vomiting, and restlessness are associated with peripheral vasodilators. A male client does not respond to traditional treatment for his chronic angina. The health care provider orders ranolazine (Ranexa) and orders a baseline ECG prior to medication administration. Three months later, the health care provider orders a repeat ECG. For what reason is the provider monitoring the client? Dose-dependent ST elevation Dose-dependent QT prolongation Ranolazine (Ranexa) represents a new classification of antianginal medication, metabolic modulators, used in people with chronic angina. The drug is labeled for use in combination with amlodipine, beta-blockers, or nitrates. After oral administration, peak plasma concentrations are reached within 2 to 5 hours. The drug is rapidly and extensively metabolized in the liver. Because of a risk of dose-dependent QT prolongation on electrocardiogram, ranolazine is reserved for the treatment of clients with chronic angina who have not achieved a satisfactory antianginal response with traditional drugs. What indicates that a client understands how to use sublingual nitroglycerin? "I can chew the tablet once it starts dissolving." "I should feel a fizzing or burning sensation." A fizzing or burning sensation indicates that the tablet is potent. The client should place the tablet under his tongue and away from any lesions or abrasions. If needed, the client can take a sip of water to moisten the mucous membranes so that the tablet will dissolve quickly. After placing the tablet under the tongue, the client should close his mouth and wait until the table has dissolved. A nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which sign or symptom would the nurse attribute to being a common adverse effect of this medication? Bradycardia Dizziness The most common adverse effects from ranolazine are dizziness, headache, constipation (not diarrhea), and nausea. Bradycardia is not an identified adverse effect of ranolazine therapy. Perspiring skin that is cold to the touch is a manifestation usually associated with a nitroglycerin overdose. A patient has been prescribed a beta-adrenergic blocker to help control angina. What effect might the patient experience as a result of the drug therapy? Decreased cardiac output Decreased cardiac output Beta-adrenergic blockers reduce heart rate, cardiac output, and blood pressure. This reduces the heart's oxygen demand, which in turn decreases angina. Antianginal drugs are most often used to manage what conditions? (Select all that apply.) Severe angina Severe angina Antianginal drugs have multiple cardiovascular effects and may be used alone or in combination with other cardiovascular drugs in clients with critical illness. They are probably used most often to manage severe angina, severe hypertension, or serious cardiac dysrhythmias. They are not indicated for treatment of serious heart failure. When describing the action of ranolazine, which would be most appropriate? Decreases heart rate Decreases myocardial workload Although the exact mechanism of action of the drug is not understood, it does prolong the QT interval. It does not decrease heart rate or blood pressure but does decrease myocardial workload, bringing the supply and demand for oxygen back into balance. A male client asks the nurse why the health care provider has added combined aspirin, antilipemics, and antihypertensives to his medication regimen when he feels fine and hasn't experienced an anginal episode in a year. The nurse explains that this combination of drugs is given for what reason? Prevents cerebral edema and subsequent CVA Prevents progression of myocardial ischemia to MI Aspirin, antilipemics, and antihypertensives are used in conjunction with antianginal drugs to prevent progression of myocardial ischemia to MI. A client is using transdermal nitroglycerin. The nurse would instruct the client to apply a new patch at which frequency? Every day Every day Transdermal nitroglycerin is applied once daily. The patch has a duration of 24 hours. Isosorbide dinitrate can be used before an activity that may cause chest pain. Sublingual, translingual spray, or buccal nitroglycerin is used with episodes of acute angina. A client was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse? "The head trauma is the priority at this point." "Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage." Nitroglycerin should not be used in clients with head trauma because it increases blood flow through the vessels and may increase pressure within the brain. Nitroglycerin affects all vessels of the body. After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.) Heparin
Sildenafil Sildenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Tadalafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Vardenafil is a PDE-5 inhibitor that can cause severe hypotension and cardiovascular events when combined with nitrates. Heparin's effectiveness is decreased when combined with nitrates; dosage adjustments may be necessary. Ergot derivatives when combined with nitrates may increase the risk of hypertension and decreased antianginal effects; dosage adjustments may be necessary. A client arrives at the urgent care center complaining of chest pain. After diagnosis, the health care provider prescribes amlodipine for the client's condition. The nurse understands that this drug is indicated for which condition? Cardiogenic shock Prinzmetal angina The nurse should identify Prinzmetal angina as the condition for which amlodipine is indicated. Prinzmetal angina is a vasospastic angina for which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome, and AV block are the conditions for which amlodipine is contraindicated. Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? The woman may experience paradoxical vasoconstriction when taking nitroglycerin. The woman will be more susceptible to hypotension than a younger patient. Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age.
Which would a nurse identify as a nitrate? Metoprolol Isosorbide Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers. A client, age 55 years, is started on calcium channel blockers for anginal attacks. The nurse would assess the client for which reaction? Select all that apply. Loss of weight Peripheral edema The nurse should assess for signs of heart failure (HF) in clients receiving calcium channel blockers. These include dyspnea, peripheral edema, weight gain, jugular vein distention, and abnormal lung sounds. There is weight gain and not loss of weight in CHF. When calcium channel blockers are administered, they cause a decrease and not an increase in the pulse rate. For which adverse effects would the nurse assess the patient after administering nitrates?Common side effects of nitrates include headache, dizziness, flushing, nausea and vomiting. Another important side effect of nitrates is orthostatic hypotension, where the blood pressure falls significantly when the client stands up too quickly.
Which assessment finding indicates the client is experiencing digoxin toxicity?Vision changes should be reported because this could indicate Digoxin toxicity. The answers are B, D, and E. GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.
What would the nurse would identify as the drug most commonly prescribed for heart failure?Commonly prescribed include: Bisoprolol (Zebeta) Metoprolol succinate (Toprol XL) Carvedilol (Coreg)
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The client is taking a calcium channel blocker. which assessment findings would the nurse expect?
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