Nokea
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.
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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.
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 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 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.
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.