Ph. Ch 24 Drugs used to Treat Angina Pectoris

Question 1

occurs while the patient is at rest, caused by vasospasms of the coronary artery, diagnosed by combination of history and exercise testing

Answer 1

Varient Angina

Question 2

precipitated by physical exertion or stress, lasts only a few minutes, relieved by nitroglycerin

Answer 2

Chronic Stable Angina

Question 3

unpredictable chest pain; changes in onset, frequency, duration, and intensity

Answer 3

Unstable Angina

Question 4

supply of oxygen needed by the heart cells is inadequate

Answer 4

Ischemia

Question 5

feeling of chest discomfort arising from the heart

Answer 5

Angina Pectoris

Question 6

Scenario: A 52-year-old male patient was admitted
through the emergency department to a telemetry unit
after experiencing sudden substernal chest pain radiat-
ing down his left arm. He complains of indigestion and
indicates feeling faint. He was a history of urinary reten-
tion, palpitations, insomnia, and depression.

Objective: Discuss angina pectoris and identify
assessment data needed to evaluate an anginal
attack.
NCLEX item type: multiple choice
Cognitive skill: explain

The nurse educates the patient in scenario #1 on the
underlying cause of anginal pain, which is a result
of what? (397)
1. A cardiac dysrhythmia
2. A severe increase in blood pressure
3. Decreased circulation to the chest muscles
4. The lack of an adequate oxygen supply to the cells in the heart

Answer 6

The lack of an adequate oxygen supply to the cells in the heart

Question 7

NCLEX item type: multiple choice
Cognitive skill: application

The patient in scenario #1 has various presenting
symptoms of angina, in addition to the substernal
chest pain radiating down his left arm. Which symr
toms will the nurse assess for that indicate? (Select
all that apply.) (399)

1. Palpitations
2. Depression
3. Insomnia
4. Feeling faint
5. Urinary retention

Answer 7

Palpitations, Feeling Faint

Question 8

NCLEX item type: multiple response
Cognitive skill: analyze

The nurse needs to gather which initial assessmen
data from the patient in scenario #1 who presents
with angina? (Select all that apply.) (389-399)

1.Any smoking history
2. What medications are being taken
3. Vital signs and pulse checks
4. The onset, duration, and intensity of pain
5. The degree of understanding regarding life
modifications

Answer 8

Any smoking history
What medications are being taken
The onset, duration, and intensity of pain

Question 9

Objective: Differentiate between chronic stable
angina and unstable angina.
NCLEX item type: multiple choice
Cognitive skill: knowledge

The nurse recognized that the patient in scenario #l
is considered to have which type of angina? (397)

1. Variant angina
2. Unstable angina
3. Chronic angina
4. Stable angina

Answer 9

Unstable Angina

Question 10

NCLEX item type: multiple choice
Cognitive skill: compare

The patient asks the nurse to explain the difference
between unstable angina and chronic stable angina.
Which statement by the nurse is accurate (397)

1. “Chronic angina is relieved with rest and unstable angina is relieved with exercise.”
2. “Unstable angina is caused by vasospasm and chronic angina is caused by a fixed obstruction.
3. “Chronic angina is unpredictable in nature and
   unstable angina occurs at regular intervals.
4. “Unstable angina is relieved with nitroglycerin and chronic angina is relieved with statin drugs”.

Answer 10

“Unstable angina is caused by vasospasm and chronic angina is caused by a fixed obstruction.”

Question 11

11. The nurse explaining to the patient in scenario #1 the
    treatment goals for angina will include which state-
    ments in the discussion? (Select all that apply.) (397-398)
12. “The choices you have for treatment therapies
    are designed to prevent a heart attack.”
13. “Your healthcare team wants to improve quality
    of life by relieving your anginal pain.”
14. “You may have the choice of either angioplasty
    or bypass surgery depending on the results of
    further tests.”
15. “Depending on the results of your tests, you
    will be instructed to make changes in your
    lifestyle prior to starting on any drug therapy.”
16. “In the future, when you have anginal pain,
    you can take a Tylenol first before taking any
    nitroglycerin.”

Answer 11

1. “The choices you have for treatment therapies
   are designed to prevent a heart attack.”
2. “Your healthcare team wants to improve quality
   of life by relieving your anginal pain.”
3. “You may have the choice of either angioplasty
   or bypass surgery depending on the results of
   further tests.”
4. “Depending on the results of your tests, you
   will be instructed to make changes in your
   lifestyle prior to starting on any drug therapy.”

Question 12

2: A patient with a history of coronary artery

disease who has chronic stable angina comes to the clinic
for a routine physical checkup and after having an echordiogram was started on an additional treatment to
event ischemic attacks. The patient also has a history
diabetes, hypertension, dyslipidemia, and COPD.

Objective: Describe the actions and the adverse
effects of the drug classifications used to treat angina.

NCLEX item type: multiple response
Cognitive skill: application

The nurse will perform which premedication assess-
ments for the patient in scenario #1 prior to adminis-
tering nitrates? (Select all that apply.) (401)

1. Any history of gastritis
2. The location, duration, and pattern of pain
3. When the most recent nitrate was used
4. Checking laboratory results of HDLs
5. The ability to place the medication under the tongue correctly

Answer 12

2 The location, duration, and pattern of pain
3 When the most recent nitrate was used
5 The ability to place the medication under the tongue correctly

Question 13

NCLEX item type: multiple response
Cognitive skill: compare

The nurse expects the desired action of calcium channel blockers in the treatment of angina is to have what effect? (Select all that apply.) (404)

1. Decrease myocardial oxygen demand
2. Decrease resistance to blood flow
3. Decrease the peripheral circulation
4. Dilate the peripheral blood vessels
5. Increase myocardial blood supply via coronary
   arteries

Answer 13

1 Decrease myocardial oxygen demand
2 Decrease resistance to blood flow
4 Dilate the peripheral blood vessels

Question 14

NCLEX item type: extended multiple response
Cognitive skill: recognize cues

The nurse expects that angiotensin-converting enzyme inhibitors used for the treatment of cardiovascular disease are used because they will have which actions? (Select all that apply.) (405)

1. Promote vasodilation
2. Induce tachypnea
3. Minimize platelet aggregation
4. Prevent hypotension
5. Effect the walls of coronary arteries
6. Inhibit urinary retention
7. Reduce tinnitus
8. Prevent thrombus formation

Answer 14

1 Promote vasodilation
3 Minimize platelet aggregation
5 Effect the walls of coronary arteries
8 Prevent thrombus formation

Question 15

NCLEX item type: multiple response
Cognitive skill: application

The nurse administering nitrates to the patient in scenario #1 knows they are used for treatment of angina have they have which therapeutic outcomes?
Select all that apply. (401)

1. Cause the relief of anginal pain during an attack
2. Prevent platelet aggregation
3. Lower the amount of circulating LDLs
4. Reduce the frequency and severity of anginal
   attacks
5. Increased tolerance of activity

Answer 15

1 Cause the relief of anginal pain during an attack
4 Reduce the frequency and severity of anginal
attacks
5 Increased tolerance of activity

Question 16

NCLEX item type: multiple choice
Cognitive skill: compare

The nurse reviews the mechanism of action for ACE inhibitors which are effective in relieving anginal attacks because they have which effect? (405)
1. Prolong the QT interval
2. Decrease serum creatinine
3. Stabilize the sodium channels in myocardium
4. Promote vasodilation and minimize platelet aggregation

Answer 16

Promote vasodilation and minimize platelet aggregation

Question 17

NCLEX item type: multiple choice
Cognitive skill: explain

When educating the patient in scenario #2 regarding the calcium channel blocker diltiazem the nurse explains the actions of the drug. Which statement by the nurse is correct? (404)
1. “The medication you are on, diltiazem will prevent platelet aggregation.
2. “It is part of the properties of calcium channel blockers to lower the amount of circulating LDLs.
3. “Calcium channel blockers such as diltiazem have the effect of increasing calcium levels in the blood.”
4. “An important effect that diltiazem does is dilate the peripheral vessels and inhibit smooth muscle contractions.”

Answer 17

“An important effect that diltiazem does is dilate the peripheral vessels and inhibit smooth muscle contractions.”

Question 18

Objective: Discuss risk factor management and
healthy lifestyle changes that are taught to prevent
disease progression and myocardial infarction or
death.

NCLEX item type: extended multiple response
Cognitive skill: evaluate cues

The nurse will teach the patient in scenario 2 life-
style modifications that will include which recommendations? Select all that apply. (400)

1. Report poor pain control to the healthcare provider
2. Allow alcohol when taking nitrates
3. Limit sexual activity and social interaction
4. Dietary recommendations include a low sodium
   diet and to maintain ideal weight
5. Participate in regular exercise is essential
6. Manage stress with relaxation techniques or
   meditation
7. Push to attain the degree of activity hoped for
   with drug therapy*

Answer 18

1 Report poor pain control to the healthcare provider
4 Dietary recommendations include a low sodium
diet and to maintain ideal weight
5 Participate in regular exercise is essential
6 Manage stress with relaxation techniques or
meditation

Question 19

NCLEX item type: multiple response
Cognitive skill: analyze

In addition to weight control and a structured
exercise program, the nurse should also educate
the patient in scenario #2 on other ways of improv-
ing cardiovascular health such as managing which
conditions? (Select all that apply.) (398)
1. Migraines
2. Dyslipidemia
3. Hypertension
4. Hypothyroidism
5. Diabetes mellitus

Answer 19

2 Dyslipidemia
3 Hypertension
5 Diabetes mellitus

Question 20

NCLEX item type: multiple response
Cognitive skill: application

The nurse was explaining to the patient in scenario
#1 about the need to avoid activities that precipitate
attacks of angina, which may include what examples? (Select all that apply.) (397)
1. Watching TV
2. Eating a light lunch
3. Lifting heavy boxes
4. Climbing a flight of stair
5. Exposure to cold temperatures

Answer 20

3 Lifting heavy boxes
4 Climbing a flight of stair
5 Exposure to cold temperatures