Nokea
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.
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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.
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.
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.
When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?
- A. To treat acute chest pain
- B. To relieve shortness of breath
- C. To prevent the occurrence of angina
- D. To keep the heart rate from rising too high during exercise
Correct Answer: C
Rationale: Transdermal nitroglycerin patches are used for long-term prophylaxis to prevent angina, not for acute chest pain, shortness of breath, or heart rate control during exercise.
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.