Lilley Chapter 24: Antianginal Drugs Flashcards
Which of the following should the nurse say while instructing a discharged patient who will be using a transdermal nitroglycerin (Nitro-Dur®) patch?
A. “If you get chest pain, apply a second patch next to the first patch.”
B. “If you get a headache, remove the patch for 4 hours and then reapply.”
C. “Apply the patch to a hairless, nonirritated area of the chest, upper arm, back, or shoulder.”
D. “Make sure to rub a lotion or cream on the skin before putting on a new patch.”
C. “Apply the patch to a hairless, nonirritated area of the chest, upper arm, back, or shoulder.”
For the best and most consistent absorption rates, a nitroglycerin patch should be applied to a clean, residue-free, hairless, nonirritated area. Sites should be rotated to prevent skin irritation, and if a headache occurs, the patient should not change the patch removal schedule to avoid these headaches. Sublingual nitroglycerin should be used to treat chest pain.
The patient states to the nurse, “My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?” Which statement by the nurse explains preload to this patient?
A. “It is the oxygen demand of the heart.”
B. “It is dilation of arteries and veins throughout the body.”
C. “It is the pressure against which the heart must pump.”
D. “It is the blood return to the heart.”
D. “It is the blood return to the heart.”
Preload is determined by the amount of blood in the ventricle just before contraction.
Which statement by the patient demonstrates a need for further education regarding nitroglycerin (Nitrostat®) sublingual tablets?
A. “If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache.”
B. “I can take up to four tablets at 5-minute intervals for chest pain.”
C. “I should change positions slowly to avoid getting dizzy from the drug’s effect on my blood pressure.”
D. “I should keep my nitroglycerin in a cool, dry place.”
B. “I can take up to four tablets at 5-minute intervals for chest pain.”
Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after one dose, the patient (or a family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.
Calcium channel blockers reduce myocardial oxygen demand by decreasing afterload. What would the nurse tell the patient in order to explain afterload?
A. Afterload is the contractility of the heart muscle.
B. Afterload is the force against which the heart must pump.
C. Afterload is the pressure within the four chambers of the heart.
D. Afterload is the total volume of blood in the heart.
B. Afterload is the force against which the heart must pump.
Afterload is the force (systemic vascular resistance) against which the heart must exert itself when delivering blood to the body.
Which dosage form of nitroglycerin has the longest duration of action?
A. Immediate-release tablet
B. Transdermal patch
C. Intravenous (IV) infusion
D. Sublingual tablet
B. Transdermal patch
The transdermal patch has an 8- to 12-hour duration of action compared with 3 minutes to 6 hours for the other dosage forms of nitroglycerin.
To prevent the development of tolerance to nitroglycerin transdermal patches, the nurse instructs the patient to perform which action?
A. Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.
B. Use the nitroglycerin patch for acute episodes of angina only.
C. Apply a new nitroglycerin patch every other day.
D. Apply the nitroglycerin patch in the morning, and remove it at night for 8 hours.
D. Apply the nitroglycerin patch in the morning, and remove it at night for 8 hours.
To avoid development of tolerance to transdermal nitroglycerin patches, maintain a 12-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.
What is the priority nursing intervention to carry out before the nurse administers isosorbide-5-mononitrate (Imdur®) sustained-release tablets to a patient?
A. Emphasize that the patient should swallow the tablet whole.
B. Advise the patient that Tylenol® is used to treat headache.
C. Remind the patient to take the tablet before meals.
D. Obtain a blood pressure reading.
D. Obtain a blood pressure reading.
Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering it.
The patient asks the nurse, “How should sublingual nitroglycerin be stored when I travel?” What is the nurse’s best response?
A. “Keep it in the glove compartment of your car to prevent exposure to heat.”
B. “It’s best to keep it in its original container, away from heat and light.”
C. “You can put a few tablets in a resealable bag and carry it in your pocket.”
D. “You can protect it from heat by placing the bottle in an ice chest.”
B. “It’s best to keep it in its original container, away from heat and light.”
Although sublingual nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest, where it could freeze. It should not be kept in the glove compartment of a car, and it needs to be kept away from heat, but not in a clear plastic bag.
The nurse is explaining the treatment of acute chest pain to a patient prescribed nitroglycerin (Nitrostat®) sublingual tablets. Which of the following instructions should the nurse include?
A. Take 5 tablets every 3 minutes for chest pain.
B. Chew or swallow the tablet for the quickest effect.
C. Keep the tablets locked in a safe place until you need them.
D. Sit or lie down before taking medication.
D. Sit or lie down before taking medication.
Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. They should be placed under the tongue and allowed to dissolve.
The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin sublingual tablets. Which statement by the patient indicates an understanding of the nurse’s discharge instructions about this medication?
A. “My nitroglycerin tablets are not affected by cold or heat.”
B. “I can take some aspirin if I get a headache related to nitroglycerin.”
C. “I will keep my nitroglycerin tablets in their original glass container.”
D. “I will need to refill my prescription when I feel burning under my tongue.”
C. “I will keep my nitroglycerin tablets in their original glass container.”
The sublingual dosage form of nitroglycerin needs to be kept in its original amber-coloured glass container with a metal lid to avoid loss of potency from exposure to heat, light, moisture, and cotton filler. It should be replaced every 3 to 6 months in order to maintain potency. Potency of the sublingual nitroglycerin is noted if there is burning or stinging when the medication is placed under the tongue; if the medication does not burn, then the drug has lost its potency, and a new prescription must be obtained. Headaches associated with nitrates last approximately 20 minutes (with sublingual forms) and may be managed with acetaminophen.
A patient who is taking nitroglycerin (Nitrostat) sublingual tablets is complaining of flushing and headaches. What is the nurse’s best response?
A. “Stop taking the nitroglycerin, because you are experiencing an allergic reaction to the medication.”
B. “These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin.”
C. “Put a cold wet washcloth or use an icepack on your forehead, and lie down in a quiet place.”
D. “Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin.”
B. “These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin.”
Headache, flushing of the face, dizziness, and fainting are the most common adverse effects of nitroglycerin. The headache generally subsides after the start of therapy.
When applying nitroglycerin ointment, which of the following should the nurse do?
A. Massage and then gently rub the ointment into the skin.
B. Apply the ointment to a nonhairy part of the upper torso.
C. Use the fingers to spread the ointment evenly over a 3-inch area.
D. Apply a thick layer of ointment on the nitroglycerin paper.
B. Apply the ointment to a nonhairy part of the upper torso.
Use the proper dosing paper supplied by the drug company to apply a thin layer of ointment on clean, dry, hairless skin on the upper arms or body. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin and subsequent absorption. Do not rub the ointment into the skin; cover the area with an occlusive dressing (e.g., plastic wrap) if not provided.
A patient receiving IV nitroglycerin at 20 mcg/min reports dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, a heart rate of 110 beats/min, and a respiratory rate of 16 breaths/min. What is the nurse’s best action?
A. Increase the IV nitroglycerin by 10 mcg/min.
B. Assess the patient’s lung sounds.
C. Decrease the IV nitroglycerin by 10 mcg/min.
D. Recheck the patient’s vital signs in 1 hour.
C. Decrease the IV nitroglycerin by 10 mcg/min.
Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the IV nitroglycerin infusion.
It is most important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substances?
A. Erectile dysfunction drugs
B. Grapefruit juice
C. Antacids
D. Potassium-sparing diuretics
A. Erectile dysfunction drugs
Concurrent administration of nitrate drugs and erectile dysfunction drugs such as sildenafil citrate (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) can cause an additive hypotensive effect.
When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective ß-blocker in a patient with which pre-existing condition?
A. Bronchial asthma
B. Myocardial infarction
C. Hypertension
D. Atrial fibrillation
A. Bronchial asthma
Noncardioselective ß-blockers should be used with caution in patients with bronchial asthma, because any level of blockade of ß2-receptors can promote bronchoconstriction.
