Chapter 51 Flashcards
1
Q
- A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?
a. “I should not participate in aerobic exercise while taking this drug.”
b. “I should take aspirin daily to reduce my need for nitroglycerin.”
c. “If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack.”
d. “I take nitroglycerin to increase the amount of oxygen to my heart.”
A
c. “If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack.”
2
Q
- A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?
a. “Beta blockers are effective in stable angina but not in variant angina.”
b. “In both types of angina, prophylactic treatment is possible.”
c. “Variant angina is primarily treated with vasodilators to increase oxygen supply.”
d. “Variant angina is the result of increased oxygen demand by the heart.”
A
d. “Variant angina is the result of increased oxygen demand by the heart.”
3
Q
- A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient’s lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:
a. an angiotensin-converting enzyme (ACE) inhibitor.
b. intravenous nitroglycerin and a beta blocker.
c. ranolazine (Ranexa) and quinidine.
d. supplemental oxygen and intravenous morphine.
A
b. intravenous nitroglycerin and a beta blocker.
4
Q
- A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, “Nitroglycerin:
a. dilates coronary arteries to increase blood flow to the heart.”
b. increases the oxygen supply to the cardiac muscle.”
c. increases ventricular filling to improve cardiac output.”
d. promotes vasodilation, which reduces preload and oxygen demand.”
A
d. promotes vasodilation, which reduces preload and oxygen demand.”
5
Q
- A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:
a. digoxin [Lanoxin] to slow the heart rate.
b. immediate discontinuation of the nitroglycerin.
c. periods of rest when the heart rate increases.
d. verapamil as an adjunct to nitroglycerin therapy.
A
d. verapamil as an adjunct to nitroglycerin therapy.
6
Q
- A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do?
a. Contact the provider to suggest ordering a transdermal patch for this patient.
b. Question the patient about consumption of grapefruit juice.
c. Suggest that the patient limit walking the dog to shorter distances less frequently.
d. Suggest that the patient take two tablets of nitroglycerin each time, because the symptoms are increasing in frequency.
A
a. Contact the provider to suggest ordering a transdermal patch for this patient.
7
Q
- A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:
a. dilate arterioles to improve myocardial circulation.
b. improve cardiac contractility, which makes the heart more efficient.
c. increase arterial pressure to improve cardiac afterload.
d. increase the time the heart is in diastole.
A
d. increase the time the heart is in diastole.
8
Q
- A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action?
a. Administer the drug as ordered, because this is a desired effect.
b. Withhold the dose and notify the provider of the heart rate.
c. Request an order for a lower dose of the medication.
d. Request an order to change to another antianginal medication.
A
a. Administer the drug as ordered, because this is a desired effect.
9
Q
- A patient is taking a calcium channel blocker (CCB) for stable angina. The patient’s spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:
a. help relax peripheral arterioles to reduce afterload.
b. improve coronary artery perfusion.
c. increase the heart rate to improve myocardial contractility.
d. increase the QT interval.
A
a. help relax peripheral arterioles to reduce afterload.
10
Q
- A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?
a. “A beta1-selective beta blocker could be used for variant angina.”
b. “Beta blockers do not help relax coronary artery spasm.”
c. “Beta blockers do not help to improve the cardiac oxygen supply.”
d. “Beta blockers promote constriction of arterial smooth muscle.”
A
b. “Beta blockers do not help relax coronary artery spasm.”
11
Q
- A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient’s heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient’s care. Which action is correct?
a. Observe the patient closely for signs of respiratory toxicity.
b. Question the order for azithromycin [Zithromax].
c. Report the patient’s increase in blood pressure to the provider.
d. Request an order for a different calcium channel blocker.
A
b. Question the order for azithromycin [Zithromax].
12
Q
- A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching?
a. “An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death.”
b. “Beta blockers can help me control hypertension.”
c. “I should begin regular aerobic exercise.”
d. “Long-acting, slow-release calcium channel blockers can help with anginal pain.”
A
b. “Beta blockers can help me control hypertension.”
13
Q
- A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient?
a. “You may take these two drugs together safely as long as you take them as directed.”
b. “You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other.”
c. “You should discuss another anti-angina medication with your provider.”
d. “You should avoid sexual activity since this increases oxygen demands on the heart.”
A
c. “You should discuss another anti-angina medication with your provider.”
14
Q
- A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient?
a. “You will need to monitor your blood pressure closely while taking this drug.”
b. “You should take this drug 1 hour before or 2 hours after a meal.”
c. “You may experience rapid heart rate while taking this medication.”
d. “You do not need to worry about drug interactions with this medication.”
A
a. “You will need to monitor your blood pressure closely while taking this drug.”
