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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).
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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.
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.
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 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.