Nokea
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.
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The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication?
- A. The solution will be slightly colored green or blue.
- B. The intravenous form is given by bolus injection.
- C. It can be given in infusions with other medications.
- D. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.
Correct Answer: D
Rationale: Non-PVC bags and tubing are required for IV nitroglycerin to prevent drug absorption or decomposition. The solution should be clear, not colored, and is given via infusion, not bolus, and not mixed with other medications.
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.
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).
A patient has been taking a beta blocker for 4 weeks as part of his antianginal therapy. He also has type 2 diabetes mellitus and hyperthyroidism. When discussing possible adverse effects, the nurse will include which information?
- A. Watch for unusual weight loss.
- B. Monitor your pulse for increased heart rate.
- C. Use the hot tub and sauna at the gym as long as time is limited to 15 minutes.
- D. Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia.
Correct Answer: D
Rationale: Beta blockers can cause hypoglycemia or hyperglycemia in diabetic patients, necessitating blood glucose monitoring. They may cause weight gain, not loss, and typically reduce heart rate. Hot tubs and saunas increase hypotension risk.
When the nurse is administering topical nitroglycerin ointment, which technique is correct?
- A. Apply the ointment on the skin on the forearm.
- B. Apply the ointment only in the case of a mild angina episode.
- C. Remove the old ointment before new ointment is applied.
- D. Massage the ointment gently into the skin, and then cover the area with plastic wrap.
Correct Answer: C
Rationale: Removing old nitroglycerin ointment before applying a new dose ensures proper dosing and prevents accumulation. The ointment should be applied to the upper arms or body, not massaged, and is used for prophylaxis, not acute angina treatment.