Unstable Angina Flashcards
Which type of angina increases in frequency, duration, and severity as the time progresses? 1 Unstable angina 2 Prinzmetal’s angina 3 Microvascular angina 4 Chronic stable angina
ANS:1
Unstable angina is a chronic stable angina that increases in frequency, duration, and severity as the time progresses. Prinzmetal’s angina occurs primarily at rest and is triggered by smoking and increased levels of substances, such as histamine and epinephrine. Microvascular angina is triggered by activities of daily life and exertion. Chronic stable angina is provoked by exertion and relieved by rest.
The nurse is caring for a patient who complains of a squeezing, heavy, choking sensation when performing physical activity. What would be the priority nursing action in this situation?
1 Instruct the patient to take aspirin if the pain occurs again.
2 Instruct the patient to take acetaminophen if the pain persists.
3 Instruct the patient to lie down and rest until the pain is relieved.
4 Instruct the patient to get an electrocardiogram (ECG) immediately.
ANS: 3
The symptoms described by the patient may be due to angina. The patient should be advised to lie down until the pain disappears because stable angina is due to exertion and can be relieved by resting. The patient should be advised to take aspirin to decrease the incidence of atherosclerosis. The patient may be instructed to take acetaminophen only if the patient experiences headache or any other muscle pain. The patient must be advised to get an electrocardiogram (ECG) in order to rule out the presence of any heart disease.
What instruction should the nurse provide a patient who shows an ST segment depression in the electrocardiogram (ECG) to help relieve symptoms of pain between the shoulder blades?
1 Eat a full meal until you are satisfied.
2 Perform vigorous exercise to relieve the pain.
3 Take nitroglycerine immediately after any strenuous activity.
4Abstain from any kind of sexual activity until it’s deemed safe by a cardiologist
ANS: 4
The patient should abstain from sexual activity, which increases the cardiac workload and promotes sympathetic stimulation because it may precipitate angina. The patient should not eat a full meal or perform vigorous exercise to avoid increasing the cardiac workload that could precipitate an angina attack. Patients with stable angina should take nitroglycerin tablets before performing strenuous physical activity, rather than after, in order to prevent the occurrence of anginal attack.
Which instructions should the nurse provide to a patient who is on nitroglycerin therapy? Select all that apply
1 “Place the nitroglycerin tablet under the tongue.”
2 “Change your position slowly after taking the medicine.”
3 “Store nitroglycerin tablets in a warm and bright environment.”
4 “Replace nitroglycerin tablets annually once the bottle is opened.”
5 “Discard nitroglycerin tablets if they do not cause a tingling sensation.”
ANS: 1,2,5
Nitroglycerin tablets should be placed under the tongue and allowed to dissolve. Nitroglycerin causes orthostatic hypotension on administration, so the patient should be advised to change position slowly. Nitroglycerin should cause a tingling sensation when administered; if there is not a tingling sensation, the medication should be discarded. The patient should be instructed to store nitroglycerin away from light and heat to protect it from degradation. Once the nitroglycerin bottle is opened, the tablets lose their potency and need to be replaced every six months.
Which nursing intervention will be beneficial in patients with angina?
1 Position the patient upright and supply oxygen.
2 Rest the patient in recumbent position during attack.
3 Encourage the patient to perform isometric exercises.
4 Include a salt-rich diet to prevent orthostatic hypotension.
ANS. 1
A patient with angina should be placed in an upright position and supplied oxygen to provide comfort and to attain an appropriate amount of oxygen in blood unless contraindicated. A recumbent positioning of the patient may precipitate the attack. Isometric exercises are stressful and may exacerbate the symptoms by increasing the cardiac workload. Salt and saturated fat foods are restricted in the patient to prevent further complications.
A patient with angina is prescribed a calcium channel blocker (CCB). Upon reviewing the medication history, the nurse finds that the patient is on digoxin. Which intervention by the nurse helps in ensuring safe care?
1 Monitor for QT prolongation
2 Monitor for increase in weight
3 Monitor for decrease in blood pressure
4 Monitor for increase in serum digoxin levels
ANS: 4
CCB directly acts on cardiac and vascular smooth muscles and promotes smooth muscle relaxation and vasodilation of coronary and systemic arteries, thereby increasing the blood flow. The nurse should closely monitor the serum digoxin levels for toxicity because CCB potentiates the action of digoxin by increasing serum digoxin levels. QT wave prolongation should be monitored upon administration of sodium current inhibitors. Weight should be monitored in patients taking beta blockers. Long-acting nitrates such as isosorbide dinitrate and isosorbide mononitrate can cause hypotension, resulting in orthostatic hypotension
Which drugs are used in the dual antiplatelet therapy after a stent placement? Select all that apply. 1 Aspirin 2 Losartan 3 Captopril 4 Ticagrelor 5 Ranolazine
ANS: 1, 4
Aspirin is an antiplatelet drug that helps prevent thrombosis around the stent. Ticagrelor is also an antiplatelet drug and helps prevent clotting around the stent, thus maintaining its patency. Captopril is an angiotensin-converting enzyme inhibitor used to treat high risk chronic stable angina. Losartan is an angiotensin II receptor blocker used in patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors. Ranolazine is a sodium current inhibitor, used to treat chronic angina refractory to other medications.
A patient with sudden stabbing pain in the chest, arms, and shoulders at unusual times of the day and night is on short-acting nitrates. Which intervention helps promote better care management in the patient?
1 Monitor for QT interval prolongation.
2 Monitor for decrease in the heart rate.
3 Monitor for decrease in blood pressure.
4 Monitor for decreased ejection fraction
ANS: 3
The patient has symptoms of unstable angina. The patient on short-acting nitrates such as nitroglycerin may experience orthostatic hypotension, so the blood pressure of the patient should be monitored regularly and the patient asked to make slow movements. A patient on fluoxetine must undergo monitoring for QT interval prolongation because this medication prolongs the QT interval. The patient on beta-adrenergic blockers may experience bradycardia and should be monitored for a decrease in the heart rate. The patients with heart failure should be monitored for ejection fraction.
Which medication is responsible for the condition of a patient prescribed medications to treat stable angina and with a history of asthma who is admitted to the emergency department complaining of severe chest pain and breathlessness? 1 Short acting nitrates 2 Beta adrenergic blocker 3 Calcium channel blocker 4 Angiotensin II receptor blocker
ANS:2
The patient with a history of asthma should avoid beta-adrenergic blockers because they can cause bronchoconstriction, resulting in increased breathlessness. Short-acting nitrates are the first line treatment for a patient with angina and can be used safely in asthma patients. Calcium channel blockers are used in patients if β-blockers are contraindicated, poorly tolerated, or do not control anginal symptoms. Angiotensin II receptor blockers can be given to the patient safely, because they have no harmful effects on the respiratory system.
A client diagnosed with stable angina is undergoing a 12-lead electrocardiogram. Which of the following results is not expected?
- ST segment depression
- ST segment elevation
- T-wave flattening
- T-wave inversion
ANS: 2
During an episode of angina, T-wave flattening or inversions and ST segment depression may be seen on the electrocardiogram due to subendocardial ischemia(Non-STEMI). ST segment elevation is seen with impending or acute myocardial infarction.
A client is scheduled for a cardiac angiogram. Which of the following should the nurse instruct the client about this diagnostic test?
- It is noninvasive.
- Contrast dye is injected.
- Clients can move about after the procedure.
- General anesthesia is used.
ANS: 2
A cardiac angiogram is a procedure that visualizes the structures of the heart and vessels. This is an invasive procedure; however, it does not need general anesthesia. The client is awake during the procedure. A contrast dye is injected, and the client may feel a warm sensation. The client must maintain bed rest with the leg straight for up to 4 to 6 hours after the catheter is removed.
.When planning the care of a client diagnosed with stable angina, which of the following would be considered a goal of treatment?
- Decrease in ischemia and episodes of angina
- Prevent myocardial infection
- Reduction of risk factors
- Reduction of stress by education
ANS: 1
The primary goal for the treatment of stable angina is to improve the quality of life by decreasing episodes of angina and ischemia. The second goal is to increase the quantity of life by preventing progression to myocardial infarction and death. Reduction of risk factors and education are both parts of a treatment plan.
.A client tells the nurse that using nitroglycerin tablets causes a tingling sensation and a headache. The nurse knows that this is:
- an emergency.
- an allergic reaction.
- evidence of toxicity.
- expected.
ANS: 4
Nitroglycerin tablets will cause a tingling sensation and can cause feelings of the heart pounding, as well as flushing and headache. These symptoms are not an emergency, an allergic reaction, or evidence of toxicity. These symptoms are expected with nitroglycerin tablets.
A nurse is considering contraindications to fibrinolytic therapy. Which of the following patients is an appropriate candidate for fibrinolytic therapy?
- A patent with a peptic ulcer disease
- A patient with a history of hemorrhagic stroke
- A patient with a history of a motor vehicle accident 1 year ago
- A patient with inflammatory bowel disease
ANS: 3
Contraindications to fibrinolytic therapy include active internal bleeding, active inflammatory bowel disease, active peptic ulcer disease, active pericarditis, defective homeostasis, gastrointestinal/genitourinary bleeding for less than 6 months, history of hemorrhagic stroke, known bleeding disorders, neurologic procedure within the past 2 months, recent surgery or trauma within 2 months, pregnancy, suspected aortic dissection, and uncontrolled hypertension.
- The nurse is assessing the pain of a client experiencing angina. Which of the following should be included in this assessment? (Select all that apply.)
- Precipitating event
- Quality
- Radiation
- Severity
- Timing
- Medication
ANS: 1, 2, 3, 4, 5
The memory aid PQRST can be used to assess a client experiencing symptoms of angina, and it includes precipitating event, quality, radiation, severity, and timing. Medication is not a part of this assessment.