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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.
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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.
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.
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 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.
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.