Unit6: Chapter 46 (Karch 7th Ed) - Antianginal Agents Flashcards
- A nurse is providing patient teaching to a patient who has been experiencing unstable angina. What will
the nurse’s explanation of this condition include?
A) A coronary vessel has become completely occluded 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 that is causing a reduction in oxygen to the heart.
D) Your body’s response to a lack of oxygen in the heart muscle is pain.
Ans: C
Feedback:
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’s 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.
2. The nurse cautions the patient taking nadolol (Corgard) for angina that they may experience what adverse effect? A) Dry mouth B) Decreased exercise tolerance C) Constipation D) Problems with urination
Ans: B
Feedback:
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, constipation, and problems with urination are
effects often seen with anticholinergic drugs but not with beta-blockers.
- A patient who has been taking cyclosporine to prevent rejection of a kidney transplant has had diltiazem ordered. Why would the nurse question this order?
A) Serious diltiazem toxicity could occur.
B) The combination may result in elevated or even toxic cyclosporine levels.
C) The combination could lead to kidney rejection.
D) A kidney recipient would not effectively excrete the diltiazem.
Ans: B
Feedback:
Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of
cyclosporine if they are taken with diltiazem. This combination is not associated with diltiazem
toxicity. A functioning implanted kidney should still excrete diltiazem. This drug would not cause
rejection of a transplanted kidney.
- A nurse is teaching the patient newly prescribed sublingual nitroglycerin how to take the medication.
What will the nurse instruct the patient to do first?
A) To check his radial pulse
B) To place the tablet in the buccal cavity
C) To take a sip of water
D) To lie down for 15 minutes before administration
Ans: C
Feedback:
The nurse should instruct the patient to take a sip of water to moisten the mucous membranes so the
tablet will dissolve quickly. The patient does not need to take his pulse or lie down before drug
administration. For sublingual administration, the patient will place the tablet under his tongue and not
in the buccal cavity (cheek area).
- The nurse, caring for a patient taking a beta-blocker and a nitrate to treat angina, recognizes the need
for careful monitoring as the result of what secondary diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Rheumatoid arthritis (RA)
C) Irritable bowel syndrome (IBS)
D) Chronic urinary tract infection (UTI)
Ans: A
Feedback:
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 UTI are
not affected by the use of beta-blockers or nitrates to treat angina.
- What drug would the nurse administer to the patient to control angina caused by atherosclerosis that
would also slow the development of further plaque buildup on the arterial wall?
A) Diltiazem (Cardizem)
B) Propranolol (Inderal)
C) Amyl Nitrates (generic)
D) Isosorbide dinitrate (Isordil)
Ans: A
Feedback:
Diltiazem is a calcium channel blocker that is indicated to treat Prinzmetal’s angina, chronic angina,
effort-associated angina, and hypertension. Research has indicated these agents slow the development
of atherosclerosis. Beta-blockers are indicated for long-term management of angina caused by
atherosclerosis, but they do not slow the development of plaque deposits on the artery wall. Propranolol
is a beta-blocker. Isosorbide dinitrate and amyl nitrate are nitrates and are indicated for relief acute
anginal pain, but they are not used to prevent angina and have no effect on the progression of
atherosclerosis.
- An older adult patient who is taking metformin (Glucophage) has just been seen in the clinic. The
doctor has ordered metoprolol (Toprol) for angina. What assessment data should the nurse monitor due
to this drug combination?
A) Blood pressure
B) Blood glucose
C) Heart rate
D) Intake and output
Ans: B
Feedback:
Metformin is an antidiabetic drug and the nurse should monitor the patient’s blood glucose frequently
throughout the day. The patient will not have the usual signs and symptoms of hypoglycemia or
hyperglycemia. Blood pressure, heart rate, and intake and output would not be affected by this
drug drug combination.
8. A patient is to receive diltiazem (Cardizem) 360 mg/d orally in four divided doses. How many mg will the nurse administer per dose? A) 30 mg B) 60 mg C) 90 mg D) 120 mg
Ans: C
Feedback:
The patient will take 90 mg/dose (360 divided by 4 doses equals 90 mg/dose). Therefore, the other
options are incorrect.
- The patient, diagnosed with angina, tells the nurse he is having chest pain. There is an order for oral
sublingual nitroglycerin as needed. What action should the nurse take?
A) Place two nitroglycerin tablets under the patient’s tongue and call the physician.
B) Place one tablet under the patient’s tongue and repeat every 5 minutes for total of three tablets until
pain has been relieved.
C) Have the patient swallow a tablet with a full glass of water and repeat in 10 minutes.
D) Apply a nitroglycerin transdermal patch to the patient’s back.
Ans: B
Feedback: The correct administration for sublingual administration is to place one tablet under the patient’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 health care provider should be notified. Transdermal application would be
inappropriate and 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 patient who is complaining of chest pain. The nurse is to administer 40 mg of
isosorbide dinitrate (Isordil) to the patient. What is the nurse’s priority assessment before administering
the drug?
A) Jaundice
B) Headache
C) Anemia
D) Sinusitis
Ans: C
Feedback:
The nurse should assess for anemia because the decrease in cardiac output could be detrimental in a
patient who already has a decreased ability to deliver oxygen because of a low red blood cell count.
Jaundice and sinusitis would not be a contraindication to the drug. Headache is an adverse effect of
isosorbide and would be expected after administration of the drug.
- A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin
(Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe
the patient for what adverse effects?
A) Hypokalemia
B) Renal insufficiency
C) Hypotension
D) Hypoglycemia
Ans: C
Feedback:
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
- What statements by the 54-year-old patient indicates an understanding of the nurse’s teaching about
how to take sublingual nitroglycerin?
A) A headache means a toxic level has been reached.
B) I can take up to 3 tablets at 5-minute intervals.
C) I can take as much nitroglycerin as I need because it is not habit forming.
D) If I become dizzy after taking the medication, I should stop taking it.
Ans: B
Feedback:
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 the patient should stop taking it.
- When the nurse administers a beta-adrenergic blocker to the patient with angina, the nurse expects the
drug will help to control angina, but it also has what other effect?
A) Increased heart rate
B) Increased oxygen consumption
C) Decreased strength of heart muscle contraction
D) Decreased urinary output
Ans: C
Feedback:
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 patient who takes nitroglycerin sublingually. When providing patient
education, the nurse would tell the patient that she can 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
Ans: A
Feedback:
Nitroglycerin acts within 1 to 3 minutes. Other options are incorrect.
- When providing patient education about nitroglycerin to the patient, what would the nurse include in
the teaching plan about a nitroglycerin patch?
A) It only has to be administered once a week.
B) It is more effective than tablets in treating angina.
C) It has a longer duration of action.
D) It is faster acting than the tablets
Ans: C
Feedback:
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.