Studied by 6 people
A nurse is providing education to a client who has been experiencing unstable angina. What is the nurse’s best explanation of this condition?
A) “A coronary vessel has become completely plugged and is unable to deliver blood to your heart.”
B) “The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing.”
C) “There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart.”
D) “Your body’s response to a lack of oxygen in the heart muscle is causing the pain you are feeling.”
C) “There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart.”
Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetal angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the body’s response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition.
The nurse is working with a client who is taking nadolol for angina. What action should the nurse perform to best address the likely adverse effects?
A) Ensure that the client sips water throughout the day to relieve dry mouth.
B) Spread out the client’s activities to prevent fatigue or overexertion.
C) Administer stool softeners to the client as prescribed.
D) Have the client void on a scheduled basis at the beginning of therapy.
B) Spread out the client’s activities to prevent fatigue or overexertion.
Nadolol is a beta-blocker that can cause a decreased tolerance to exercise because of the inability to experience the effects of the stress reaction. Dry mouth and constipation are often seen with anticholinergic drugs but not with beta-blockers. There is no need to have the client void because urinary function is rarely affected.
Diltiazem has been prescribed for a client who has been taking cyclosporine to prevent rejection of a kidney transplant. What is the nurse’s best action?
A) Ensure that the client is frequently assessed for signs and symptoms of diltiazem toxicity.
B) Notify the primary health care provider about the potential for elevated or toxic cyclosporine levels.
C) Monitor the client’s renal function closely for signs or symptoms of kidney rejection. D) Ensure that the client’s cyclosporine is administered at least 2 hours before or after diltiazem.
B) Notify the primary health care provider about the potential for elevated or toxic cyclosporine levels.
Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of cyclosporine if taken with diltiazem. This combination is not associated with diltiazem toxicity. Changing the timing of the medications does not remove the risk for cyclosporine toxicity. This drug would not cause rejection of a transplanted kidney.
A client has received a new prescription for sublingual nitroglycerin. The nurse is teaching the client how to take the medication. What does the nurse instruct the client to do first?
A) Check a radial pulse.
B) Place the tablet in the buccal cavity.
C) Take a sip of water.
D) Lie down for 15 minutes before administration.
C) Take a sip of water.
The nurse should instruct the client to take a sip of water to moisten the mucous membranes, so the tablet will dissolve quickly. The client does not need to take the pulse or lie down before drug administration. For sublingual administration, the client will place the tablet under the tongue and not in the buccal cavity (cheek area).
A nurse is caring for a client taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring because of what comorbidity?
A) chronic obstructive pulmonary disease (COPD)
B) rheumatoid arthritis (RA)
C) irritable bowel syndrome (IBS)
D) chronic urinary tract infection (UTI)
A) chronic obstructive pulmonary disease (COPD)
The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition. RA, IBS, and chronic UTIs are not affected by the use of beta-blockers or nitrates to treat angina.
A client with a long-standing diagnosis of angina has been prescribed nitroglycerin and diltiazem. In addition to monitoring the client’s heart rate, the nurse should prioritize what assessment?
A) blood pressure
B) level of consciousness
C) daily weights
D) respiratory status
A) blood pressure
Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client’s blood pressure carefully. Changes to LOC, respiratory status, and fluid balance (checked with daily weights) are less likely to result from this particular combination.
An older adult client who is taking metformin has just been seen in the clinic. The primary health care provider prescribes metoprolol for angina. What assessment data should the nurse prioritize due to this drug combination?
A) white cell differential
B) blood glucose
C) urine specific gravity
D) intake and output
B) blood glucose
Metformin is an antidiabetic drug, and the nurse should monitor the client’s blood glucose frequently throughout the day because the client may not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Urine specific gravity, leukocyte counts, and intake and output are less likely to be affected by this drug–drug combination.
The client who has been diagnosed with angina reports chest pain. The client has a prescription for oral sublingual nitroglycerin as needed. What action should the nurse take?
A) Place two nitroglycerin tablets under the client’s tongue and call the primary health care provider.
B) Put one tablet under the client’s tongue and repeat every 5 minutes to a maximum of three tablets until pain has been relieved.
C) Have the client swallow a tablet with an 8-ounce glass of water and repeat the same medication administration again in 10 minutes.
D) Give the client one nitroglycerin table, placed under the client’s tongue, and then administer two more tablets in 5 minutes if pain remains.
B) Put one tablet under the client’s tongue and repeat every 5 minutes to a maximum of three tablets until pain has been relieved.
The correct administration for sublingual administration is to place one tablet under the client’s tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the primary health care provider should be notified. Nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects.
The nurse is caring for a client who reports chest pain. The nurse is to administer 40 mg of isosorbide dinitrate to the client. What assessment finding would contraindicate the safe use of this drug?
A) platelets 202 ×109/L (202 ×103/μL)
B) orientation to person and place but not time
C) hemoglobin 88 g/L (8.8 g/dL)
D) active sinusitis
C) hemoglobin 88 g/L (8.8 g/dL)
The nurse should assess for anemia because the decrease in cardiac output could be detrimental in a client who already has a decreased ability to deliver oxygen because of a low red blood cell count. Sinusitis would not be a contraindication to the drug. Decreased level of consciousness is not a contraindication. This client’s platelet level is within reference ranges.
A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The primary health care provider adds nifedipine to the client’s regimen. The nurse should observe the client for what adverse effect?
A) hypokalemia
B) renal insufficiency
C) hypotension
D) hypoglycemia
C) hypotension
Both nitroglycerin and nifedipine have hypotension as a potential adverse effect, so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.
A nurse is teaching a 54-year-old client how to take sublingual nitroglycerin. What statement by the client indicates an understanding of the nurse’s instructions?
A) “A headache means a toxic level has been reached.”
B) “I can take up to three tablets at 5-minute intervals.”
C) “I can take the drug as needed because it is not habit forming.”
D) “If I become dizzy after taking the medication, I should stop taking it.”
B) “I can take up to three tablets at 5-minute intervals.”
Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation, so no more than three tablets should be taken, even though it is not habit forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate that the client should stop taking it.
When the nurse administers a beta-adrenergic blocker to a client with angina, the nurse expects the drug will help to control angina. What other effect does a beta- adrenergic blocker have?
A) increased heart rate
B) increased oxygen consumption
C) decreased strength of heart muscle contraction
D) decreased urinary output
C) decreased strength of heart muscle contraction
Beta-blockers competitively block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart. As a result, it decreases the strength of cardiac contraction, reducing cardiac output, which results in lowered blood pressure and decreased cardiac workload. It does not impact urinary output.
The nurse is caring for a client who has been prescribed nitroglycerin sublingually. When providing client education, the nurse should tell the client to expect relief of chest pain within what period of time?
A) 1 to 3 minutes
B) 5 to 10 minutes
C) 15 to 20 minutes
D) 30 to 60 minutes
A) 1 to 3 minutes
Sublingual nitroglycerin acts within 1 to 3 minutes. The medication does not take 5 or more minutes to act. The primary health care provider should be notified if the medication does not work in the expected time.
When providing client education about nitroglycerin to the client, what should the nurse include in the teaching plan about a nitroglycerin patch?
A) “It only has to be changed every 3 days.”
B) “It is more effective than tablets in treating angina.”
C) “One patch lasts an entire day.”
D) “It is faster acting than the tablets.”
C) “One patch lasts an entire day.”
Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.
Which statement by the client would lead the nurse to believe that the client has understood the teaching provided regarding angina?
A) “I will not exercise because it precipitates angina.”
B) “As long as I take the medicine, I can maintain my current lifestyle.”
C) “There is no correlation between my hypertension and angina.”
D) “Heavy meals and cigarette smoking can precipitate an angina attack.”
D) “Heavy meals and cigarette smoking can precipitate an angina attack.”
The client should avoid stressful activities, especially in combination. For example, if the client eats a big meal the client should not drink coffee or alcoholic beverages with that meal. If the client has just eaten a big meal, the client should not climb stairs; instead, the client should rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks, so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake, and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.
The nurse is caring for a client diagnosed with angina who is taking a calcium channel blocker. What adverse effects would the nurse caution this client about?
A) hypertension and tachycardia
B) headache and dizziness
C) itching and rash
D) nausea and diarrhea
B) headache and dizziness
The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.
A client diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The client has received the first two doses of the medication and reports dizziness. What is the nurse’s best action?
A) Reassure the client that this is an expected adverse effect.
B) Report this finding to the client’s primary health care provider.
C) Assess the client’s blood pressure.
D) Withhold the next scheduled dose and implement falls precautions.
C) Assess the client’s blood pressure.
If a client reports dizziness after beginning treatment with a calcium channel blocker, hypotension is a likely cause. The nurse should obtain objective data by assessing the client’s blood pressure before taking further action. The nurse should not independently withhold the drug. The nurse should assess the client before providing reassurance. There may be no need to report this to the primary health care provider if it is transient.
What adverse reaction does the nurse anticipate if a client takes nitroglycerin with sildenafil?
A) hypotension
B) bradycardia
C) chest pain
D) nausea
A) hypotension
Clients should not combine nitrates with phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, or vardenafil), drugs used to treat erectile dysfunction, because serious hypotension and cardiovascular events could occur. It is best to avoid this combination. Bradycardia, chest pain, and nausea are not associated with this drug combination.
The nurse is caring for four clients. In which client would the use of a beta-blocker most likely be contraindicated?
A) a client with angina pectoris who is trying to become pregnant
B) a client who takes a bisphosphonate for osteoporosis and who has angina
C) a client with angina who recently completed a course of moxifloxacin
D) a client who has angina and diabetic retinopathy
A) a client with angina pectoris who is trying to become pregnant
Pregnancy and lactation preclude the use of a beta-blocker. Beta-blockers can be used concurrently with bisphosphonates and antibiotics. Complications of diabetes do not preclude the use of beta-blockers for the treatment of angina.
The nurse should instruct the client to take what action if nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?
A) Go to the emergency department.
B) Call the primary health care provider.
C) Lie down after taking an aspirin.
D) Take more tablets until pain subsides, to a maximum of six tablets.
A) Go to the emergency department.
A sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses. If pain persists, the client should go to the emergency department. The client should not waste time by calling the primary health care provider or lying down. It would be unsafe to take more tablets.
The nurse is caring for a client who takes metoprolol for angina. The client asks the nurse how long it takes for the medicine to begin working. What is the nurse’s best response?
A) 15 minutes
B) 30 minutes
C) 1 hour
D) 90 minutes
A) 15 minutes
Oral metoprolol has an onset of action of 15 minutes. The nurse would provide the correct information to the client. Stating 30 minutes or more would be incorrect information.
The nurse is caring for a client who has been diagnosed with angina and has been prescribed nitroglycerin. What teaching about the client’s lifestyle should the nurse provide?
A) “It’s important not to take nitroglycerin unless you’re actually experiencing chest pain.”
B) “It is best for your health to eliminate or reduce your intake of alcoholic beverages.”
C) “Since you are taking this medication, you need to avoid drinking grapefruit juice.”
D) “You need to make sure that you are able to get at least 6 hours of sleep each night.”
B) “It is best for your health to eliminate or reduce your intake of alcoholic beverages.”
Clients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. Clients should ideally take nitroglycerin before the onset of chest pain. There is no particular need for adequate sleep, beyond the general benefits of this practice. Grapefruit juice does not interfere with the metabolism of nitroglycerin.
An adult client experiences angina pectoris upon exertion. The nurse informs the client that the leading cause of angina is what?
A) smoking
B) inadequate cardiac output
C) infarction of the myocardium
D) coronary atherosclerosis
D) coronary atherosclerosis
The client with atherosclerosis has a classic supply-and-demand problem. The heart may function without a problem until increases in activity or other stresses place a demand on it to beat faster or harder. Normally, the heart would stimulate the vessels to deliver more blood when this occurs, but the narrowed vessels are not able to respond and cannot supply the blood needed by the working heart. The heart muscle then becomes hypoxic. This imbalance between oxygen supply and demand is manifested as pain, or angina pectoris, which literally means “suffocation of the chest.” Atherosclerosis of the coronary artery can block the coronary artery completely leading to infarction. Smoking causes further vasoconstriction, increasing risk of myocardial infarction or angina. Damage to the heart muscle causes a decrease in cardiac output.
After receiving relief from anginal pain, the client says to the nurse, “That nitroglycerin works great. How does it do that?” What is the nurse’s best response?
A) “It decreases the amount of oxygen the heart needs to function.”
B) “Nitroglycerin makes the coronary arteries open much wider.”
C) “It promotes growth of new, smaller arteries to supply oxygen to the heart.”
D) “This medication decreases preload and afterload.”
A) “It decreases the amount of oxygen the heart needs to function.”
The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance. Because coronary artery disease causes a stiffening and lack of responsiveness in the coronary arteries, the nitrates probably have very little effect on increasing blood flow through the coronary arteries, so it would be incorrect to say that the coronary arteries become much wider. Although both preload and afterload are reduced, this is an explanation that the client would not understand, so it is inappropriate. Nitroglycerin does not promote growth of compensatory circulation.
An adult client experienced symptoms of unstable angina during admission to the hospital. Which finding most concerns the nurse?
A) a lack of knowledge about the disease
B) a fear of death
C) ineffective tissue perfusion
D) noncompliance with lifestyle changes
C) ineffective tissue perfusion
The most concerning finding is ineffective tissue perfusion due to reduced oxygen supply to the heart because this is the cause of the client’s pain. Further assessment would be needed regarding the client’s lack of knowledge, fears death, and lifestyle changes; however, these are not priority over ineffective tissue perfusion.
The nurse is preparing to administer sublingual nitroglycerin to a client for the first time. What effect might the client experience right after administration?
A) nervousness or paresthesia
B) throbbing headache or dizziness
C) drowsiness or blurred vision
D) tinnitus or diplopia
B) throbbing headache or dizziness
Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid self- contamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the client usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.
The nurse is caring for a client who has been diagnosed with human immunodeficiency virus (HIV) and newly diagnosed with angina. What drug would the nurse question if prescribed?
A) ranolazine
B) nitroglycerin
C) propranolol
D) diltiazem
A) ranolazine
Drug–drug interactions can occur with ketoconazole, diltiazem, verapamil, macrolide antibiotics, and HIV protease inhibitors; these combinations should be avoided because ranolazine levels may become extremely high. The nurse should get a complete list of current medications and consult with the health care provider regarding drug interactions before administering the medication as ordered. Nitroglycerin, propranolol, and diltiazem have no contraindication with medications used to treat HIV.
The nurse is managing care for a 10-year-old client. Which diagnosis would cause the nurse to question a prescription for an antianginal medication?
A) coronary artery disease (CAD)
B) hypertension (HTN)
C) migraines
D) paroxysmal supraventricular tachycardia (PSVT)
A) coronary artery disease (CAD)
Nitrates, beta-blockers, calcium channel blockers, and piperazine acetamide are included in the classification of antianginal medication. Pediatric clients are not prescribed antianginal medications to treat CAD. However, some of antianginal medications are indicated for pediatrics to treat HTN, such as amlodipine, and/or cardiac dysrhythmia, such as PSVT. Prophylaxis migraine therapy is another use for the antianginal medication propranolol.
What would the nurse teach the client about the safe and effective use of nitroglycerin? Select all that apply.
A) “The tablet should fizzle or burn when placed under the tongue.”
B) “Protect the drug from heat and light.”
C) “Always replace when past the expiration date.”
D) “Older tablets may require you to use two tablets at one time.”
E) “Nitroglycerin does not lose its potency easily.”
A) “The tablet should fizzle or burn when placed under the tongue.”
B) “Protect the drug from heat and light.”
C) “Always replace when past the expiration date.”
Ask the client if the tablet “fizzles” or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily. The client would not take more than the prescribed amount of one tablet regardless of the date the medication was filled. Nitroglycerin can lose potency if not properly stored and due to time.
The nurse teaches the client how to use topical nitroglycerin patches. Which points will the nurse include in the teaching plan? Select all that apply.
A) “Rotate application sites.”
B) “Assess the skin for signs of breakdown.”
C) “Make sure no one touches the side with the medication.”
D) “Do not shower with the patch in place.”
E) “Increase fluid intake to avoid low blood pressure.”
A) “Rotate application sites.”
B) “Assess the skin for signs of breakdown.”
C) “Make sure no one touches the side with the medication.”
Rotate the sites of topical forms of nitroglycerin to lower the risk of skin abrasion and breakdown; monitor for signs of skin breakdown to arrange for appropriate skin care as needed. Care should be taken not to touch the side of the patch with the medication by the client or anyone assisting in applying the patch. The client may shower with the patch in place. There is no need to increase fluid intake, but clients should be encouraged to maintain adequate intake.
A client has been diagnosed with angina and prescribed nitroglycerin. What aspect of the client’s health history should prompt the nurse to monitor the client particularly closely after administration of the drug?
A) orthostatic hypotension
B) chronic depression
C) Raynaud’s syndrome
D) gastroesophageal reflux disease (GERD)
A) orthostatic hypotension
Underlying hypotension can be exacerbated by nitroglycerin, creating a risk for syncope or falls. GERD, depression, and Raynaud’s syndrome do not complicate the use of nitrates for angina.
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