Nokea
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.
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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.
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.
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 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 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.