By what mechanism do loop diuretics reduce pulmonary and peripheral edema?
a)Increasing the sodium concentration within the urine b)Promoting fluid movement from the interstitial spaces to the vascular space c)Decreasing preload in the heart d)Increasing urinary output
Promoting fluid movement from the interstitial spaces to the vascular spaceExplanation:
All of the above play a role in the mechanism of action of diuretics. Loop diuretics are used to decrease fluid volume and edema present in CHF. In general, diuretics act in the nephrons of the kidney to increase urinary output and electrolyte loss. This action decreases circulating volume and peripheral resistance, reducing the workload on the failing heart. Removal of fluid from the vascular space allows mobilization of edema from the interstitial spaces. With less volume in the vascular space, less blood is returned to the heart (decreased preload) and cardiac output is decreased. (less)
The pre-administration physical assessment for cardiotonic drugs should include which of the following? Select all that apply:
In a discussion of heart failure, the nursing instructor is explaining preload and afterload. Which of the following statements regarding preload and afterload is accurate?
a)Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle. b)Preload is related to the ejection of blood from the ventricle, and afterload is related to the filling of the ventricle. c)Preload is related to the filling of the right ventricle, and afterload is related to the filling of the left ventricle. d)Preload is related to the filling of the left ventricle, and afterload is related to the filling of the right ventricle.
Preload is the filling pressure of the ventricle. Afterload is the pressure associated with the ejection of blood from the ventricle.
Which of the following is the result of positive inotropic activity? (Choose one)
Normal serum potassium level is 3.5 to 5.0. Therefore Options A, C, and D are incorrect.
A patient presents to the Emergency Department (ED) with rales, wheezing, and blood-tinged sputum. The nurse suspects the patient is in congestive heart failure (CHF). What would the nurse suspect the patient is experiencing?
In left sided heart failure, the left ventricle pumps inefficiently. Blood backs up into the lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue. In severe cases pulmonary edema occurs. The patient will present with rales, wheezes, blood-tinged sputum, low oxygenation, and development of a third heart sound. Cardiomyopathy can occur as a result of a viral infection, alcoholism, anabolic steroid abuse, or a collagen disorder. It causes muscle alterations and ineffective contraction and pumping. Cardiomegaly is an enlargement of the heart due to compensatory mechanisms in CHF and leads to ineffective pumping and eventually to increased CHF. Valvular heart disease leads to an overload of the ventricles because the valves do not close adequately causing blood to leak backward into the ventricles. This causes muscle stretching and increased demand for oxygen and energy.
Nesiritide, a drug that is identical to human B-type natriuretic peptide, is used in the treatment of acute heart failure. How does the health care provider assess the effectiveness of this drug?
A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will
a)administer the initial IV bolus over approximately 60 seconds. b)use the reconstituted solution within a 36-hour period. c)shake the vial vigorously to mix the medication for reconstitution. d)add the reconstituted vial of medication to a 1,000 mL IV bag.
administer the initial IV bolus over approximately 60 seconds.Explanation:
Nesiritide must be reconstituted and then further diluted for infusion. Reconstitute one vial by adding 5 mL of diluent that has been removed from a 250-mL plastic IV bag. Do not shake the vial. Rock the vial gently so that all surfaces, including the stopper, are in contact with the diluent. Add the entire contents of the reconstituted vial back to the 250-mL plastic IV bag and invert the bag several times to ensure complete mixing. Use the reconstituted nesiritide solution within 24 hours. The initial IV bolus must be drawn from the prepared infusion bag and administered over approximately 60 seconds through an IV port. (
After receiving a loading dose of milrinone (Primacor), a client is most likely to experience which of the following? Select all that apply:
The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, and hypokalemia
Which of the following labs would the nurse expect to see ordered prior to administration of a cardiotonic? Select all that apply:
a)Liver function tests b)Complete blood count c)Renal function tests d)Blood glucose e)Electrolyte levels
• Liver function tests • Renal function tests • Complete blood count • Electrolyte levels Explanation:
A, B, C and D with the addition of serum electrolytes and an electrocardiogram complete the lab work up prior to initiating therapy with a cardiotonic drug. It is not necessary to obtain serum blood glucose, but it might appear with other lab work that has been gathered.
A patient presents to the ED with rales, wheezing, and blood-tinged sputum. The nurse suspects the patient is experiencing pulmonary edema. Pulmonary edema stems from
Observe for relief of symptoms, which include weight loss, increased urine output, less extremity edema, easier breathing, improved activity tolerance and self-care ability, and slower heart rate.
What would a priority nursing assessment for a patient who is about to begin digoxin therapy be?
a)Blood glucose levels b)Liver function c)Neurological function d)Renal function
Digoxin is primarily excreted unchanged in the urine and caution should be exercised if renal impairment is present. Blood glucose levels, neurological, and liver function would not be of great concern for this patient.
You are giving an IV dose of digoxin to a patient in the Emergency Department. You would expect this medication to take effect in what period of time?
a)1 hour b)2 hours c)1 minute d)15 minutes
When heart failure occurs one of the results is increased preload. What is this?
a)The amount of blood returning to the heart b)The resistance the heart must overcome c)The amount of blood pooled in the extremities d)The pulse rate caused by venous distention
he amount of blood returning to the heartCorrectExplanation:
Vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins thereby decreasing preload of the heart and helping to improve function. Therefore Options B, C, and D are incorrect
Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston?
a)The correct technique for using a home blood pressure cuff b)The importance of having required laboratory work performed on time c)The need to take the medication at the same time each day regardless of her heart rate d)Timing household activities to coincide with the administration times of her digoxin
The importance of having required laboratory work performed on timeCorrectExplanation:
Patients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the patient is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for patients who are taking digoxin
A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?
a)The man's chest sounds are clear and his ankle edema is lessened. b)The man's potassium and sodium levels remain with reference ranges. c)The man's glomerular filtration rate and creatinine levels are within reference ranges. d)The man's heart rate is between 60 and 70 beats per minute with a regular rhythm.
The man's chest sounds are clear and his ankle edema is lessened.Explanation:
Appropriate diuretic therapy leads to the resolution of pulmonary and peripheral edema. Healthy kidney function, cardiac rhythm, and electrolyte levels are all desirable outcomes, but they are not directly indicative of the therapeutic action of diuretics in the treatment of CHF. (less)
To help control the nausea and anorexia that may occur as an adverse reaction during digoxin therapy, the nurse should recommend which of the following? Select all that apply:
a)Restricting fluids at mealtime. b)Avoid fluid intake one hour before and after meals c)Maintain good oral hygiene. d)Eat more protein. e)Eat frequent smaller meals.
• Eat frequent smaller meals. • Restricting fluids at mealtime. • Maintain good oral hygiene. • Avoid fluid intake one hour before and after meals Explanation:
A, B, C and E are always to help decrease nausea and anorexia as adverse reactions of digoxin therapy. Eating more protein has no effect on anorexia or nausea.
The use of cardiotonics leads to which of the following? Select all that apply:
a)Improved perfusion to all body tissues b)Increase in peripheral edema c)Improved myocardial contractility d)Increased myocardial efficiency e)Increase in blood pressure
• Improved myocardial contractility • Increased myocardial efficiency • Improved perfusion to all body tissues
What would the nurse recognize as increased signs and symptoms of heart failure?
Increased crackles in lung fieldsCorrectExplanation:
Fluid may accumulate in the lungs due to left sided heart failure.
When preparing a care plan for chronic heart failure, you base your recommendations on the newest research about prior treatment for CHF. Based on your knowledge of the guidelines, which drug combination therapy has been shown to decrease mortality from CHF?
a)An ACE inhibitor, a beta-blocker, and a diuretic b)Digoxin and an ACE inhibitor c)Digoxin and a beta-blocker d)Digoxin, a beta-blocker, and a diuretic
An ACE inhibitor, a beta-blocker, and a diureticExplanation:
The combination of an ACE inhibitor, a beta-blocker, and a diuretic has been shown to decrease mortality from CHF. This is the recommended therapy. Digoxin does not decrease mortality from CHF but it decreases symptoms and improves exercise tolerance, thereby improving the quality of life.
A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's
a)exercise tolerance. b)intake and output. c)blood pressure. d)cognition.
Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.
Increases in neurohormonal activity cause which of the following to occur in clients with heart failure? Select all that apply:
a)Decreased secretion of catecholamines b)Remodeling of the cardiac muscle cells c)Hypertrophy of the heart d)Cardiac necrosis e)Increased need for oxygen
• Remodeling of the cardiac muscle cells • Hypertrophy of the heart • Increased need for oxygen • Cardiac necrosis Explanation:
Increased catecholamines lead to increases in neurohormonal activity that cause remodeling of the cardiac muscle cells, leading to hypertrophy of the heart, increased need for oxygen, and cardiac necrosis, which worsen the heart failure. (less)
Which of the following classes of medications are currently used as first line treatments of heart failure? (Select all that apply)
The cardiotonics are contraindicated in the presence of digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardimyopathy, or AV block.
A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication?
a)“This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable.” b)“Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin.” c)“This will lessen the workload of your heart by reducing your blood pressure.” d)“By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump.”
Correct response:“This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable.”Explanation:
Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction.
The margin of safety for digoxin is small. When a child is to receive digoxin, what action should the nurse take initially before administering the medication?
a)Identify the patient by asking the parents his name and checking the patient's arm identification b)Wash her hands c)Check the child's apical pulse d)Have another nurse check the dosage
Have another nurse check the dosageExplanation:
Since there is a very narrow margin of safety in which the therapeutic dose is very close to the toxic dose extreme care should be taken when administering this drug. A second nurse should always recheck the dosage. The other options are important and the nurse should implement all three. However, when concerned with the margin of safety, a second dosage check is most important.
What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?
The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and verapamil (Calan SR). Aliskiren (Tekturna) is a rennin inhibitor. Atenolol (Tenormin) and Metoprolol (Lopressor) are beta blockers, not calcium channel blocker. (less)
The physician prescribes captopril (Capoten) for your patient and you provide the patient with the appropriate patient education for this drug. What statement by your patient lets you know that your teaching has been effective?
a)“I will take a laxative along with the antihypertensive medication.” b)“I will make sure that I rise slowly from a supine position.” c)“I will limit my fluid intake to 1200 cc daily.” d)“I will decrease my intake of foods high in potassium.”
“I will make sure that I rise slowly from a supine position.”Explanation:
Acute hypotension may occur when the ACE is started. There would be no appropriate reason to limit the patient's fluid intake, take a laxative, or decrease foods high in potassium.
A patient has been prescribed Losartan (Cozaar) for their hypertension. What should patient teaching for this drug include?
a)Take the drug on an empty stomach to limit absorption b)Take the drug early in the day to prevent sleepiness c)Take the medication with food to decrease GI distress d)Limit fluid intake to decrease urinary output
Losartan is an angiotensin II receptor blocker that can be administered without regard to meals. If GI distress occurs it can be given with food to decrease GI symptoms. However, ACE inhibitors works best if taken on an empty stomach, which promotes absorption. Fluid intake should be normal and the drug does not cause sleepiness. (
A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued?
Rebound hypertension will occur in patients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse effects of antihypertensive drug usage and may not occur on stopping the drug (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 28: Drug Therapy for Hypertension, p. 526.
You are a staff nurse on a renal unit and you know that most of your patients require treatment for hypertensive disease. What would you expect to assess prior to the beginning of antihypertensive treatment?
a)A temporary increase in renal function b)A sustained increase in renal dysfunction c)Baseline renal function. d)A sustained decrease in renal function
Baseline renal function.Explanation:
Antihypertensive drugs are frequently required by patients with renal impairment ranging from mild insufficiency to end-stage failure. It would be necessary to assess baseline renal function in these patients prior to beginning antihypertensive therapy. (less)
The incidence of hypertension in the United States is staggering. It is estimated that at least 20% of the people in the United States have hypertension, and many are unaware of it. What does hypertension increase the risk of? (Mark all that apply.)
Hypertension is a common chronic disorder. It is estimated that at least 20% of the people in the United States have hypertension. Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. It does not increase the risk of hypotension or migraine headache.
A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which of the following nursing actions?
a)Checking the patient's blood glucose levels before each meal and at bedtime b)Supervision of the patient when performing activities of daily living c)Close monitoring of the patient's electrolyte levels d)Frequent assessment of the patient's cardiac status
Frequent assessment of the patient's cardiac statusCorrectExplanation:
Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihypertensive, but it is unnecessary to supervise all of the patient's ADLs. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 28: Drug Therapy for Hypertension, p. 533.
Hypertension increases a persons risk for which of the following? (Select all that apply)
A patient newly diagnosed with hypertension has just been given a prescription for medication. What would be the most important outcome for this patient?
a)Verbalization of why he should take blood pressure medication b)Having taken his first dose of medication c)A discussion with his insurance company about the cost of the drug d)A blood pressure of 120/80
Having taken his first dose of medicationExplanation:
All of the options are realistic outcomes for this patient. However, compliance is a great concern for people who are in need of hypertensive agents. It would be most important for his health care provider to know that he has filled the prescription and has taken his first dose of medication. (less)
While reviewing a client's lab work, the nurse notices the client's potassium is elevated. Which of the following can result in hyperkalemia? Select all that apply:
Angiotensin-converting enzyme inhibitors (eg, benazepril), angiotensin II receptor antagonists (eg, valsartan), and direct renin inhibitors (eg, aliskiren) can cause hyperkalemia.
A nurse is educating a group of nursing students on the mechanism of actions of angiotensin converting enzyme inhibitors (ACEI). Which of the following should the nurse explain as the hormone produced by the adrenal cortex?
a)Enalapril b)Renin c)Angiotensin d)Aldosterone
The nurse should explain that aldosterone is the hormone produced by the adrenal cortex. Renin and angiotensin are hormones produced in the kidneys, and not by the adrenal cortex. Enalapril is not a hormone; it is an ACEI antihypertensive drug. (less)
Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which of the following are vasoconstrictive substances? Select all that apply.
a)Angiotensin II b)Endothelin-1 c)Histamine d)Bradykinin
• Angiotensin II • Endothelin-1 Explanation:
Vasoconstricting substances, which increase vascular tone and blood pressure, include angiotensin II and endothelin-1. (less)
Which of the following questions would be most important for a nurse to ask a female patient who is starting on an angiotensin II receptor blocker for hypertension?
a)“Do you eat something when you take your medications?” b)“Have you always weighed 150 pounds?” c)“How much physical exercise do you get?” d)“When was your last menstrual period?”
“When was your last menstrual period?”Explanation:
It would be important to know when the patient's LMP occurred and that the patient is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the patient who is beginning angiotensin II receptor blocker therapy. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical
The squad brought a 48-year-old man to your ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the patient reports severe headache and drowsiness. He becomes disoriented and vomits. What is your primary goal in this hypertensive emergency?
a)Lower blood pressure as quickly as possible b)Lower blood pressure gradually c)Obtain complete medical history d)Observe for signs and symptoms of cause of hypertension before proceeding
Lower blood pressure as quickly as possibleExplanation:
Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs.
The nurse should notify the physician when any of the following occur while a client is receiving an antihypertensive. Select all that apply:
a)Headache b)Weight gain of 2 lb or more per day. c)Edema d)Insomnia e)Sedation
• Weight gain of 2 lb or more per day. • Edema Explanation:
The nurse should notify the physician if a client has a 2 lb or more weight gain per day or edema of the hands, fingers, feet, legs, or sacral area. (less)
A diabetic patient with hypertension has come to the clinic with vague complaints of “just not feeling well.” Physical assessment shows that this patient does not have well-controlled hypertension. The nurse practitioner changes the patient's medication regimen from Lisinopril, 10 mg/qd to Accuretic, 10/12.5 mg/qd. What is the rationale for choosing this drug to better control the patient's hypertension?
a)ACE inhibitors, combined with a thiazide diuretic, decrease glucosuria and slows the development of neuropathy in diabetic patients. b)ARBs, combined with a thiazide diuretic, decreases proteinuria and slows the development of nephropathy in diabetic patients. c)Beta-blockers, combined with a thiazide diuretic, decrease diabetic retinopathy. d)ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients.
ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients.Explanation:
ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. Although the drugs can cause or aggravate proteinuria and renal damage in non-diabetic people, they decrease proteinuria and slow the development of nephropathy in diabetic patients. Options B, C, and D are incorrect responses for this question as they are distracters. (less)
Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which of the following are vasodilative substances? Select all that apply.
a)Serotonin b)Nitric oxide c)Angiotensin II d)Bradykinin
• Nitric oxide • Bradykinin Explanation:
Vasodilating substances, which decrease vascular tone and blood press
The classification of blood pressures published in 2003 offers new "stages" of blood pressures, ranging from normal to Stage 2 hypertension. Your patient, an 80-year-old retired teacher, consistently has blood pressure readings of 146/86 mm Hg. In the 2003 guidelines, what would her blood pressure be designated?
A systolic pressure of 140 or above, with a diastolic pressure below 90, is called isolated systolic hypertension and is more common in the elderly.
A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is the appropriate action by the nurse?
a)Ask the prescriber to reduce the dose b)Give the nitroprusside at the ordered rate c)Obtain an order for naloxone d)Slow the rate of the infusion
Slow the rate of the infusionExplanation:
Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.
Losartan is frequently prescribed for hypertension management. For which patient would the physician write a smaller starting dose of the medication, based on medical history and age?
a)Nick, age 35, who is suffering from hepatic impairment b)Cole, age 88, who is suffering from hypertension c)Judy, age 36, who is pregnant d)Luke, age 28, who is suffering from hypertension
Nick, age 35, who is suffering from hepatic impairmentExplanation:
Patients who have impaired liver function have increased bioavailability of losartan because metabolism is impaired. They should be given a lower starting dose of the drug and be monitored for therapeutic and adverse effects. No dosage adjustments seem to be necessary for older adults because losartan is just as safe and effective in this group as it is in younger adults. Because losartan has essentially no contraindications, older adults with hypertension and other comorbidities can still be prescribed losartan. The drug should not be used during pregnancy because of adverse effects on the fetus
A geriatric patient with a diagnosis of essential hypertension recently underwent a change in his medication regimen and was prescribed metoprolol 12.5 mg PO bid. Which of the following statements by the patient may suggest a need to alter or discontinue this medication?
a)“It might be my imagination, but I sometimes feel like my heart skips a beat.” b)“I usually have a good appetite, but that hasn't been the case this week.” c)“I hardly ever get headaches, but the last two mornings I've woken up with one.” d)“I don't ever recall feeling so hopeless as I have in the last couple of weeks.”
“I don't ever recall feeling so hopeless as I have in the last couple of weeks.”Explanation:
One adverse effect common to metoproplol and all beta blocker is depression. Anorexia, heart palpitations, and headaches are not adverse effects typically associated with the use of beta blockers.
Primary hypertension comprises 90% to 95% of hypertensive cases. It is hypertension for which no cause can be found. Which drug groups are used in the management of primary hypertension? Select all that apply.
a)Antiadrenergics b)ACE inhibitors c)Angiotensin II receptor blockers d)Direct vasoconstrictors
Drugs used in the management of primary hypertension belong to several different groups, including angiotensin-converting enzyme (ACE) inhibitors; angiotensin II receptor blockers (ARBs), and antiadrenergics. They decrease blood pressure by decreasing cardiac output or peripheral vascular resistance.
A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)
Because of its effects on blocking beta-1 receptors, metoprolol slows the heart rate, the speed of conduction, and decreases the force of contraction, thus cardiac output is decreased, decreasing blood pressure. Consequently, it is necessary to assess the patient's heart rate in addition to his or her blood pressure. Neither beta blockers nor thiazide diuretics create a direct need for the assessment of temperature, respiratory rate, or oxygen saturation level. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Ther
Which of the following tasks should a nurse assist a client with in the ambulatory setting in regards to hypertensive management? Select all that apply:
a)Finds local resources in the community for taking blood pressure. b)Schedules an appointment to see a cardiologist. c)Schedules regular monitoring of weight and blood pressure. d)Teaches client how to properly record weight and blood pressure. e)Schedules an appointment to see a nephrologist.
• Finds local resources in the community for taking blood pressure. • Teaches client how to properly record weight and blood pressure. • Schedules regular monitoring of weight and blood pressure. Explanation:
In the ambulatory setting, the nurse helps plan a schedule of regular monitoring of weight and blood pressure, finds local resources for taking blood pressure in the community, and teaches the client to record weight and blood pressure reading. (less)
A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent which of the following?
Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
Once a client develops primary hypertension, therapy should last for how long? (Choose one)
a)Lifelong b)One year c)Until blood pressure is 120/80 mmHg d)5 years
Once primary hypertension develops, management of the disorder becomes a lifetime task.
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 28: Drug Therapy
You are providing an educational class on childhood hypertension at a local town meeting. Included in your information are non-pharmacologic measures to treat hypertension. What is a non-pharmacologic method of treating/managing hypertension? (Mark all that apply.)
a)Weight loss b)Obesity c)Exercise d)Diet e)Meditation
• Exercise • Diet • Weight loss Explanation:
Treatment of childhood hypertension should be done very cautiously because the long-term effects of the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy if at all possible. Weight loss and increased activity may bring an elevated blood pressure back to normal in many children. As in adults, prevention of obesity, avoiding excessive sodium intake, and exercise are important non-pharmacologic measures. Obese adolescents who lose weight may lower their blood pressure, especially when they also increase physical activity. The efficacy of meditation in treating childhood hypertension has not been proven. Obesity is not a non-pharmacologic way of treating hypertension in children. It is a cause of hypertension in children.
While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Mark all that apply.)
The pressure in the cardiovascular system is determined by three elements and they are heart rate, stroke volume, or the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by the volume of blood in the system), and total peripheral resistance, or the resistance of the muscular arteries to the blood being pumped through. The preload and the pulse pressure are not factors that regulate pressure in the cardiovascular system. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014
Your patient, a 37-year-old woman, presents with a blood pressure of 118/86 mm Hg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. Why is that classification significant?
a)Prehypertension values indicate half the likelihood for developing hypertension than do lower pressure values. b)Prehypertension values indicate twice the likelihood for developing hypertension than do lower pressure values. c)No significance. d)Prehypertension values indicate a stronger likelihood for developing hypotension than do lower pressure values.
Prehypertension values indicate twice the likelihood for developing hypertension than do lower pressure values. The other answers are incorrect. (less)
Lack of oxygen, accumulation of products of cellular metabolism, and other forms of tissue injury contribute to the regulation of local blood flow. What tissue factors govern vasodilation and vasoconstriction? Select all that apply.
These abnormal sites of impulse formation are ectopic foci. These ectopic pacemakers may result from hypokalemia, myocardial ischemia, emotional stress, or hypoxia. Ectopic foci may arise in atrial, nodal, Purkinje, or ventricular muscle. (less)
Which of the following is part of the nurse's evaluation of anti-arrhythmic drug therapy? Select all that apply:
a)No evidence of injury seen. b)No evidence of infection is seen. c)Patient is free of nausea. d)Patient urinates adequately. e)Oral mucus membranes are intake and moist.
• No evidence of injury seen. • No evidence of infection is seen. • Patient is free of nausea. • Patient urinates adequately. • Oral mucus membranes are intake and moist. Explanation:
A, B, C, D and E are part of the nurse's evaluation of anti-arrhythmic drug therapy. Therapeutic response, identification of adverse reactions, and demonstration of client and family's understanding are also included in the nurse's evaluation of anti-arrhythmic drug therapy.
Ms. Ross has used long-acting nitroglycerin pills, which the physician prescribed at a dosage of twice per day, for the last 6 months. She contacts the physician office and states that the medication is not working as well as when she started taking the medication. What would be the most appropriate nursing action?
a)Ask Ms. Ross how she is currently taking the medication so that you can determine whether she is taking the medication properly. b)Advise Ms. Ross to take the medication early in the evening after dinner. c)Advise Ms. Ross that the period of ineffectiveness will resolve shortly. d)Advise Ms. Ross not to take the medication for several days and then to restart the medication at the previous dose.
Ask Ms. Ross how she is currently taking the medication so that you can determine whether she is taking the medication properly.Explanation:
Answers to the nurse's inquiries would guide the next step in patient education. The patient developed a tolerance to the medication, but the reason for this is unclear without obtaining additional information from the patient. Tolerance to the vascular and antianginal effects may develop. Tolerance is minimized by starting with as small a dose as possible and removing the nitroglycerin (paste or transdermal patches) from the patient for 10 to 12 hours a day. The sublingual and translingual spray forms of the drug are the least likely to produce tolerance. The transmucosal form also appears to produce minimal tolerance.
A nurse is caring for a patient who has been experiencing unstable angina. Which of the following factors may have played a role in obstructing blood flow through the affected coronary artery?
a)Thrombus b)Plaque c)Both plaque and thrombus d)Neither plaque nor thrombus
Both plaque and thrombusCorrectExplanation:
Unstable angina usually develops when a minor injury ruptures atherosclerotic plaque in a coronary artery. In response to the resulting injury, platelets aggregate, forming a thrombus. The combination of the disrupted plaque and thrombus (along with any associated vasoconstriction) obstruct the flow of blood through the artery.
A nurse is providing patient education for a patient who has just been prescribed nitroglycerin. The nurse is teaching the patient about the sublingual administration of nitroglycerin. What will the nurse instruct the patient to do first?
a)Place the tablet in the buccal cavity b)Take a sip of water c)Lie down for 15 minutes prior to administration d)Check his radial pulse
Take a sip of waterExplanation:
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 prior to administration. For sublingual administration the patient will place the tablet under his tongue and not in the buccal cavity (cheek area).
Anti-anginal drugs are used in the treatment of cardiac disease for which of the following? Select all that apply.
• Relieve the pain of acute anginal attacks. • Prevent angina attacks. • Treatment chronic stable angina pectoris. CorrectExplanation:
Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.
You are caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within
a)five to ten minutes. b)fifteen to twenty minutes. c)thirty minutes to an hour. d)one to three minutes.
one to three minutes.Explanation:
Sublingual nitroglycerin acts within one to three minutes and lasts thirty minutes to an hour.
A 62-year-old woman with a history of MI is brought by the squad to your trauma center after an MVA in which she suffered extensive facial and oral trauma. She uses sublingual nitroglycerin in the management of her angina. What effect, if any, would this latest development have in her angina management?
a)No effect b)Change nitroglycerin route to transdermal c)Discontinue nitroglycerin use d)Increase nitroglycerin dosage
Change nitroglycerin route to transdermalExplanation:
Oral trauma would be expected to affect sublingual nitroglycerin circulation. Changing the route to transdermal will provide an effective route unaffected by the accident's trauma. Discontinuing the nitroglycerin will only endanger the patient; increasing the sublingual dose doesn't change the potential for uneven absorption due to tissue trauma.
Which of the following should the nurse tell the client about storage of oral nitroglycSelect all that apply:a)Store oral nitroglycerin in the original container. b)Store oral nitroglycerin with the container lid tightly sealed. c)Store oral nitroglycerin and other medications in the container. d)Store oral nitroglycerin in a plastic pill box so doses are not missed. e)Store oral nitroglycerin away from light exposure.
• Store oral nitroglycerin in the original container. • Store oral nitroglycerin with the container lid tightly sealed. • Store oral nitroglycerin away from light exposure. CorrectExplanation:
The proper storage of oral nitroglycerin includes keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, and always replace the container tightly and as soon as the drug is removed.
A nurse is creating a plan of care for a 68-year-old woman with a recent diagnosis of unstable angina and new prescription for nitroglycerin. Which of the following nursing diagnoses should the nurse prioritize in the planning of this patient's care?
a)Acute Pain, Headache, related to adverse effects of drug therapy b)Confusion, Acute, related to adverse effects of drug therapy c)Incontinence, Functional, related to adverse effects of drug therapy d)Risk for Fluid Volume Deficit related to adverse effects of drug therapy
Acute Pain, Headache, related to adverse effects of drug therapyCorrectExplanation:
The vasodilation associated with the use of nitroglycerin can cause severe headaches. The drug does not typically cause urinary incontinence, fluid volume deficit, or confusion.
A patient receiving amlodipine for angina is complaining of dizziness. Which of the following interventions should the nurse implement to help alleviate the condition?
a)Reduce the dosage of amlodipine. b)Instruct the patient to lie down. c)Apply a cold cloth over the forehead. d)Instruct the patient to drink more water.
Instruct the patient to lie down.Explanation:
Dizziness is a common central nervous adverse effect seen with calcium channel use. The nurse should instruct the patient to lie down until dizziness passes. Applying a cold cloth over the forehead will not relieve the dizziness. The dosage should not be reduced or altered unless instructed by the practitioner. Increasing the fluid consumption will also not help in alleviating dizziness.
To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the patient. Which of the following is an action of nitroglycerin?
a)Decreases myocardial oxygen consumption b)Causes venous constriction c)Causes arterial constriction d)Decreases collateral circulation in the heart
The nitrates relax and dilate veins, arteries, and capillaries, allowing increased blood flow through the vessels and lowering systemic blood pressure because of a drop in resistance. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance.
The use of nitrates should be avoided in clients taking which of the following medications? (Choose one)
The nurse's physical assessment of a client with angina should include blood pressure, respiratory rate, apical and radial pulses. The physical assessment may also include weight, inspection of the extremities for edema, and auscultation of the lungs, depending on the type of heart failure.
A man has left his most recent visit to his primary care provider with a new prescription for a transdermal nitroglycerin patch. What patient education should the nurse provide to this patient?
a)“Remove your old patch and put on a new one each morning.” b)“Put your patch on a part of your skin that doesn't have too much hair on it.” c)“Apply one additional patch if you experience a sudden onset of chest pain.” d)“If your patch loses its adhesion during the day, replace it with a new one.”
“Put your patch on a part of your skin that doesn't have too much hair on it.”CorrectExplanation:
Transdermal nitroglycerin patches should be applied to a hairless, or nearly hairless, area of the skin to promote absorption. Loose patches should be reinforced rather than replaced. Patches should be discontinued in the evening and they are not used for acute treatment of chest pain.
People receiving nifedipine (Adalat) should be assessed for which of the following adverse effects?
a)Peripheral edema b)Asthma c)Tetany d)Ascites
Peripheral edema, heart failure, and pulmonary edema can occur with calcium-channel blockers.
A patient is to take nifedipine (Procardia) 10 mg PO tid. How many milligrams will he take per dose?
a)10 mg b)15 mg c)30 mg d)3.3 mg
The patient will take 10 mg of nifedipine three times each day, for a total of 30 mg in each 24-hour period.... (more)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 26: Drug Therapy for Angina, p. 487.
Nitrates are available in which of the following dosage forms? (Select all that apply)
Nitrates are available in which of the following dosage forms? (Select all that apply)You selected:• Parenteral • Transdermal • Sublingual Correct
You are teaching a patient about his new prescription for oral propranolol. If the patient asks you how long it will take for the medication to relieve pain, what will you say in response?
a)"It will start working in about ten minutes." b)"It will start working in about a minute." c)""It will start working in about a half hour." d)"It will start working in about fifteen minutes."
""It will start working in about a half hour."Explanation:
The onset of action is approximately thirty minutes for oral propranolol and one to two minutes for IV propranolol. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 26: Drug Therapy for Angina, p. 486.
Your client is taking a calcium-channel blocker. What adverse effects might the client experience?
a)Fever and bronchospasm b)Hypertension and tachycardia c)Flushing and rash d)Headache and dizziness
Headache and dizzinessCorrectExplanation:
Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.
After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as which of the following?
a)Chest pain that occurs due to vasospasm b)Chest pain that occurs with coronary artery disease c)Chest pain that is relieved by rest d)Chest pain that occurs at rest
Chest pain that is relieved by restExplanation:
Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal's angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.
A nurse is caring for a patient who is prescribed transdermal nitroglycerin for angina. For how many hours should the transdermal patch be applied?
a)12 to 14 hours b)10 to 12 hours c)Four to six hours d)Six to eight hours
10 to 12 hoursExplanation:
The transdermal nitroglycerin patch should be applied every day for 10 to 12 hours. If the patch is applied for a shorter time, the therapeutic dosage may not be delivered. Applying the patch for a longer time will result in the development of tolerance to the anti-anginal effects. Applying the patch in the morning and leaving it for 10 to 12 hours, followed by a patch-free period of 10 to 12 hours, delays the development of tolerance.
A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this patient's angina?
a)The patient indicates a need for daily low-molecular weight heparin therapy b)The patient will likely have a trial of antiplatelet drugs before being prescribed nitrates. c)The patient's angina may necessitate the use of a calcium channel blocker. d)The patient would benefit from a weekly intravenous dose of a beta blocker.
The patient's angina may necessitate the use of a calcium channel blocker.CorrectExplanation:
Calcium channel blockers are used in chronic stable angina when the patient cannot tolerate beta blockers, or if the symptoms are not adequately controlled while on this therapy. Regularly-scheduled beta blockers are not administered intravenously. Low molecular weight heparin is not typically used in the treatment of stable angina and antiplatelet medications do not need to precede the use of nitrates.
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
a)decreased heart rate and increased blood pressure. b)increased heart rate and decreased blood pressure. c)decreased heart rate and decreased blood pressure. d)increased heart rate and increased blood pressure.
increased heart rate and decreased blood pressure.Explanation:
Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014, Chapter 26: Drug Therapy for Angina, p. 478.
A patient arrives at the community healthcare center complaining of chest pain. After diagnosis, the healthcare provider has prescribed amlodipine for the patient's condition. Which of the following conditions should the nurse identify as an indication for amlodipine therapy?
The nurse should identify Prinzmetal's angina as the condition where amlodipine is indicated. Prinzmetal's angina is a vasospastic angina in which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome and AV block are the conditions where amlodipine is contrain
Clients suffering from frequent anginal attacks should be instructed to keep a record of each attack. What information should the client document in the record? Select all that apply.
a)Date of attack b)Time of attack c)Dose of drug use to relieve the acute pain d)Blood pressure e)Drug used to relieve the acute pain
Date of attack • Time of attack • Drug used to relieve the acute pain • Dose of drug use to relieve the acute pain Explanation:
Clients should keep a record of the frequency of acute anginal attacks including date, time of attack, drug and dose used to relieve the acute pain. The client should bring this record to each physician visit.
A nurse is providing patient teaching to a patient that has been experiencing unstable angina. What will the nurse's explanation of this condition include?
a)The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing. b)Your body's response to a lack of oxygen in the heart muscle is pain. c)That there is a pronounced narrowing of the coronary arteries and the heart is experiencing episodes of ischemia or lack of oxygen even when you are resting. d)A coronary vessel has become completely occluded and unable to deliver blood to your heart.
That there is a pronounced narrowing of the coronary arteries and the heart is experiencing episodes of ischemia or lack of oxygen even when you are resting.Explanation:
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. In stable angina, the body responds to the lack of oxygen in the heart muscle by causing pain when stressed. (less)
In which of the following situations would a nurse withhold the anti-anginal medication and contact the physician? Select all that apply:
Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isoxsuprine, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.
The nurse needs to follow which of the following when administering nitroglycerin ointment? Select all that apply:
a)The upper arms and legs are areas for appropriate application. b)Wear plastic disposable gloves. c)Cleanse the area of skin before application. d)Use the same application site each time ointment is applied. e)Apply entire tube of ointment to client's skin.
Wear plastic disposable gloves. • Cleanse the area of skin before application. • The upper arms and legs are areas for appropriate application. Explanation:
The nurse should wear plastic gloves while administering ointment and use application paper to measure and apply ointment to the client's chest, abdomen, or upper arms and legs. The application site should be rotated and cleansed with each application. (less)
Which of the following should a client be told in regards to the pain relief anti-anginal drugs provide? Select all that apply:
a)Pain will be completely relieved. b)Pain may be less intense. c)Pain will worsen with continued use. d)Pain may be less frequent. e)Pain will only occur during prolonged exercise.
• Pain may be less intense. • Pain may be less frequent. CorrectExplanation:
Angina pain will not be completely relieved in all clients. In some clients pain may be less intense, frequent, or may only occur during prolonged exercise.
Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin?
a)The woman may experience paradoxical vasoconstriction when taking nitroglycerin. b)The woman will be more susceptible to hypotension than a younger patient. c)Decreased saliva production will inhibit the absorption of the drug in her mucosa. d)The woman will need to allow more time between doses in order to facilitate absorption.
The woman will be more susceptible to hypotension than a younger patient.Explanation:
Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age.
An 83-year-old white man, a resident in the long-term care facility in which you work, has taken nitroglycerin regularly for 15 years for his angina. In the past few years, his angina has decreased but increases as his myocardial workload increases with activity. What would explain the decrease in his resting angina?
a)Development of collateral circulation. b)Decrease in number of plaque lesions. c)Decrease in number of lipid-filled macrophages. d)Auto repair of endothelial injury.
Development of collateral circulation.Explanation:
Collateral circulation develops from anastomotic channels that connect the coronary arteries and allow perfusion of an area by more than one artery. All other options are incorrect.
Prior to administering an anti-anginal drug, the nurse should assess the client for which of the following? Select all that apply:
a)Vital signs b)Auscultates the lungs c)Auscultates the heart d)Pain assessment e)Physical appearance
Client pre-assessment for anti-anginal drugs should include a thorough pain assessment, history of medication allergies and disease processes, assessment of physical appearance, auscultates the lungs for adventitious sounds, obtains a baseline electrocardiogram, and obtains vital signs.
Which of the following if administered with nitrates can cause severe hypotension and possible cardiovascular collapse? Select all that apply:
Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient's angina?
a)Amlodipine will now be contraindicated in the treatment of Mr. Penny's angina. b)Ranolazine confers protection from myocardial infarction but does not relieve symptoms of angina. c)Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker. d)Mr. Penny will need to be taught to monitor his blood pressure and heart rate.
Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.Explanation:
Ranolazine should be used only in combination with other antianginal therapy (either nitrates, beta blockers (metoprolol or atenolol), or amlodipine, a calcium channel blocker. It does not achieve its effects by lowering the heart rate or the blood pressure. Ranolazine has the potential to prevent MI.
A patient calls the clinic and reports that he is having chest pain. The patient states that “I'm scared that I am going to die and I've been pacing up and down my driveway.” After calming the patient, the initial instruction by the nurse would be to
a)have the patient go into his house and sit or lie down. b)have the patient take his pulse for 1 minute. c)ask the patient to call 911 and wait outside for the ambulance to arrive. d)ask the patient to place a nitroglycerin tablet under his tongue immediately.
have the patient go into his house and sit or lie down.Explanation:
The nurse should instruct the patient to sit or lie down before taking nitroglycerin to prevent dizziness or fainting. The nurse should then inform the patient to place the tablet under his tongue and that he can take another tablet in 5 minutes and again in 10 minutes if the pain has not subsided. However, if the pain still has not subsided, the patient should call 911 because the patient may be experiencing a myocardial infarction. The nurse may stay on the phone with the patient while he is taking the medication if the patient is overly anxious. The nurse may ask the patient after the medication administration to check his pulse to help determine the patient's level of anxiety and cardiac function.
A patient is being discharged after being treated with nitroglycerin for angina. Which of the following instructions should the nurse include in the teaching plan for the patient?
a)Recap the container tightly after taking the capsules. b)Store the nitroglycerin capsules in a plastic container. c)Place the nitroglycerin capsules along with other tablets. d)Do not store nitroglycerin in a dark container.
Recap the container tightly after taking the capsules.Explanation:
The nurse should instruct the patient to recap the container tightly after taking the nitroglycerin capsule. This is to ensure that the potency of nitroglycerin is not lost on exposure to air. Nitroglycerin should be stored in a dark container and protected from direct light exposure. The nurse should instruct the patient to never store nitroglycerin under bright sunlight or in a plastic container. Nitroglycerin deteriorates when stored in plastic containers and on exposure to air and light. The nurse should instruct the patient not to store nitroglycerin along with other drugs, as it loses its potency.
Organic nitrates are widely used to decrease cardiac workload, effectively decreasing angina. Nitrate efficacy in lowering systolic blood pressure contraindicates its use with which of the following? (Select all that apply.)
a)Hypervolemia b)Variant angina c)Cerebral hemorrhage d)Phosphodiesterase enzyme type 5 inhibitor
• Cerebral hemorrhage • Phosphodiesterase enzyme type 5 inhibitor CorrectExplanation:
Contraindications include hypersensitivity reactions, severe anemia, hypotension, and hypovolemia. The drugs should be used cautiously in the presence of head injury or cerebral hemorrhage because they may increase intracranial pressure. In addition, males taking nitroglycerin or any other nitrate should not take phosphodiesterase enzyme type 5 inhibitors such as sildenafil (Viagra) and vardenafil (Levitra) for erectile dysfunction because the combined effect can produce profound, life-threatening hypotension.
Which of following should the nurse tell the client in regard to the use of translingual nitroglycerin sprays? Select all that apply:
a)Shake the canister before use. b)At the onset of an anginal attack place one to two metered doses under the tongue. c)Do not exceed three metered doses in 15 minutes. d)Translingual nitroglycerin spray can be sprayed onto or under the tongue. e)Prophylactic use of this dosage form is not recommended.
• At the onset of an anginal attack place one to two metered doses under the tongue. • Do not exceed three metered doses in 15 minutes. • Translingual nitroglycerin spray can be sprayed onto or under the tongue. Explanation:
Clients should be informed of the following when receiving translingual nitroglycerin spray: it can be used prophylactically 5 to 10 minutes prior to engaging in activities that precipitate an anginal attack, do not shake the canister before use, at the onset of an anginal attack spray one or two metered doses onto or under the tongue, do not exceed three metered doses within 15 minutes, and clean canister as directed on package.
After teaching a group of students about nitrates, the instructor determines that the teaching was successful when the students identify which of the following as a contraindication?
Nitrates would be contraindicated in patients with cerebral hemorrhage because the relaxation of the cerebral vessels could cause intracranial bleeding. Nitrates should be used cautiously in patients with hypotension, which could be exacerbated by the drug. Nitrates should be used cautiously in patients with liver dysfunction, which could alter the drug's metabolism. Nitrates should be used cautiously in patients with hypovolemia, which could be exacerbated by the drug therapy. (less)
Frandsen, G., & Pennington, S.S. Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 10th ed., Philadelphia: Wolters Kluwer Health/Lippincott William
Several alternate dosage forms have been developed for nitroglycerin administration to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. Indicate why oral form dosing of nitrates is not the most effective administration route. Select all that apply.
a)Large doses reach systemic circulation quickly. b)Rapid metabolism by the liver. c)Longer duration of action. d)Slow onset of action doesn't relieve acute pain.
• Rapid metabolism by the liver. • Slow onset of action doesn't relieve acute pain.
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