Nursing 6005 Chapter 51: Drugs For Angina Pectoris

NURSING 6005 CHAPTER 51: DRUGS FOR ANGINA PECTORIS Test Bank MULTIPLE CHOICE 1. 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.” ANS: C Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina. Aerobic exercise is an important part of nondrug therapy to reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to prevent coronary thrombus formation, but it does not reduce the need for nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase the amount of oxygen available to the heart. DIF: Cognitive Level: Application REF: Organic Nitrates | Nitroglycerin | Mechanism of Antianginal Effects | Summary of Treatment Measures | Drugs Used to Prevent Myocardial Infarction and Death | Antiplatelet Drugs TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. 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.” ANS: D Variant angina is caused by coronary artery spasm, which reduces the oxygen supply to the heart. Beta blockers are not effective in variant angina but are useful with stable angina. Medications may be given to prevent anginal attacks in both types of angina. Vasodilators are used in variant angina to relieve coronary artery spasm and increase the oxygen supply to the heart. DIF: Cognitive Level: Analysis REF: Angina Pectoris: Pathophysiology and Treatment Strategy | Chronic Stable Angina | Variant Angina TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the pain intensifies. 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. ANS: B This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin. DIF: Cognitive Level: Application REF: Unstable Angina | Ranolazine | Drug Interactions TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. 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.” ANS: D Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain. DIF: Cognitive Level: Application REF: Organic Nitrates | Nitroglycerin | Mechanism of Antianginal Effects | Stable Angina TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A hospitalized patient complains of acute chest pain. The nurse administers a 0.3 mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse’s next step? a. Apply a nitroglycerin transdermal patch. b. Continue dosing at 10-minute intervals. c. Give a second dose of nitroglycerin in 5 minutes. d. Request an order for intravenous nitroglycerin. ANS: C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.