Nokea
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.
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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.
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.
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.
What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy?
- A. Omit a dose once a week.
- B. Leave the patch on for 2 days at a time.
- C. Cut the patch in half for 1 week until the tolerance subsides.
- D. Remove the patch at bedtime, and then apply a new one in the morning.
Correct Answer: D
Rationale: Removing the transdermal nitroglycerin patch at night for 8 hours helps prevent tolerance by allowing a nitrate-free interval. Omitting doses, leaving patches on for 2 days, or cutting patches are incorrect and unsafe.
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).