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A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?
- A. Take up to 5 doses at 15-minute intervals for an angina attack.
- B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
- C. If the chest pain is not relieved after one tablet, call 911 immediately.
- D. Wait 1 minute between doses of sublingual tablets, up to 3 doses.
Correct Answer: C
Rationale: Current guidelines advise calling 911 if chest pain persists 5 minutes after one sublingual nitroglycerin tablet, as it may indicate a myocardial infarction. Additional tablets can be taken every 5 minutes up to three total, and tablets should dissolve under the tongue, not be chewed.
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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.
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.
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.
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.
The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, 'What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you.' Which actions by the patient are appropriate in this situation? (Select all that apply.)
- A. Stop the activity, and lie down or sit down.
- B. Call 911 immediately.
- C. Call 911 if the pain is not relieved after taking one sublingual tablet.
- D. Call 911 if the pain is not relieved after taking three sublingual tablets in 30 minutes.
- E. Place a tablet under the tongue.
- F. Place a tablet in the space between the gum and cheek.
- G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.
Correct Answer: A,C,E,G
Rationale: Appropriate actions include stopping activity, sitting or lying down, placing a sublingual tablet under the tongue, calling 911 if pain persists after one tablet, and taking additional tablets every 5 minutes up to three total. The buccal route (gum and cheek) is incorrect, and waiting 30 minutes for three tablets is too long.