Nokea
A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing?
- A. Classic
- B. Variant
- C. Unstable
- D. Prinzmetal
Correct Answer: A
Rationale: Classic (chronic stable) angina is triggered by exertion or stress, like golfing, and is relieved by rest or nitroglycerin. Variant and Prinzmetal angina involve vasospasm, and unstable angina is unpredictable and not necessarily exertion-related.
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A patient with a history of angina will be started on ranolazine. The nurse is reviewing the patient's history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.)
- A. Type 2 diabetes mellitus
- B. Prolonged QT interval on the electrocardiogram
- C. Heart failure
- D. Closed-angle glaucoma
- E. Decreased liver function
Correct Answer: B,E
Rationale: Ranolazine is contraindicated in patients with prolonged QT interval (due to risk of arrhythmias) and decreased liver function (due to hepatic metabolism). Type 2 diabetes, heart failure, and closed-angle glaucoma are not contraindications.
While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?
- A. Nervousness
- B. Hypertension
- C. Bradycardia
- D. Dry cough
Correct Answer: C
Rationale: Beta blockers commonly cause bradycardia due to their effect on slowing heart rate. They do not typically cause nervousness, hypertension, or dry cough (which is more associated with ACE inhibitors).
When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?
- A. Rotate application sites with each dose.
- B. Use only the chest area for application sites.
- C. Temporarily remove the patch if you go swimming.
- D. Apply the patch to the same site each time.
Correct Answer: A
Rationale: Rotating application sites for transdermal nitroglycerin patches prevents skin irritation. The patch can be applied to any nonhairy area, not just the chest, and can remain on during swimming, but should be replaced if it comes off.
A calcium channel blocker is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct?
- A. Chew the tablet for faster release of the medication.
- B. To increase the effect of the drug, take it with grapefruit juice.
- C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
- D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
Correct Answer: D
Rationale: Calcium channel blockers (CCBs) can cause constipation, which can be mitigated by a high-fiber diet and fluids. Chewing tablets, taking with grapefruit juice (which increases drug levels), or abrupt discontinuation are incorrect and unsafe.
A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
- A. Blood pressure of 88/62 mm Hg
- B. Apical pulse rate of 110 beats/min
- C. History of renal disease
- D. History of a myocardial infarction 2 years ago
Correct Answer: A
Rationale: Nitrates can cause hypotension, so a blood pressure of 88/62 mm Hg indicates cautious use due to the risk of further lowering blood pressure. Pulse rate, renal disease, and past myocardial infarction are not contraindications.