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Drugs Used to Treat Angina Pectoris > Pharmacology
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Showing 15 questions, Sign in for moreA client is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning client education, what instruction will the nurse include?
The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide?
A nurse is caring for a client who is experiencing chest pain. Place the following nursing interventions in order:
Explanation
When a client experiences chest pain, rapid assessment and safe intervention are critical to prevent myocardial injury and ensure client safety. Nursing management focuses on assessing pain characteristics, evaluating hemodynamic stability, administering rapid-acting antianginal therapy, reassessing the heart rate and blood pressure for effectiveness, and documenting care to maintain continuity and legal standards.
Rationale for the correct answer:
C. Assess the location, quality, and intensity of pain. The first step is a thorough pain assessment to differentiate angina from other causes of chest pain. Evaluating onset, duration, radiation, associated symptoms, and intensity establishes a baseline and informs treatment priorities.
B. Assess heart rate and blood pressure. Before giving nitroglycerin, it is essential to evaluate hemodynamic status. Nitroglycerin can cause vasodilation, leading to hypotension and reflex tachycardia. Baseline vital signs ensure safe administration and allow early detection of adverse effects.
A. Administer nitroglycerin sublingually. Sublingual nitroglycerin provides rapid relief by dilating coronary arteries and reducing myocardial oxygen demand. It should be given after confirming stable vital signs to prevent complications such as hypotension or syncope.
E. Evaluate the location, quality, and intensity of pain. Reassessing pain determines whether the intervention is effective or if further treatment is needed. Persistent or worsening pain may indicate myocardial infarction, requiring urgent escalation of care.
D. Document interventions and outcomes. Accurate documentation of assessments, medications, dosages, vital signs, and client responses is essential for continuity of care, quality monitoring, and legal compliance.
Test-taking strategy:
• Prioritize steps that ensure safety and effectiveness: assess → intervene → evaluate → document.
• Consider the mechanism of action of nitroglycerin and its hemodynamic effects.
• Always reassess both pain and vital signs before repeating or escalating therapy.
Take-home points:
• Assess pain characteristics and vital signs before giving nitroglycerin.
• Reassess pain and hemodynamic status after administration to evaluate effectiveness.
• Document all interventions, assessments, and client responses for safety and continuity of care.
The nurse is educating a client about erectile dysfunction drugs such as sildenafil (Viagra) that are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs?
A client has a new prescription for transdermal nitroglycerin patches. The nurse teaches the client that these patches are most appropriately used for which reason?
The nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which of the following statements is correct?
A 68-year-old male client has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber?
The nurse is reviewing drug interactions with a male client who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? Select all that apply
The nurse is taking a medication history from a client who has angina and is to begin taking ranolazine (Ranexa). The nurse should report which of the following medications in the client’s history that may interact with ranolazine? Select all that apply
Case Scenario
A client seen in the emergency department came in complaining of pain in the chest radiating down the left arm. It started while the client was mowing the lawn.
The client was diagnosed with angina and the nurse was evaluating the anginal attack.
Which assessment data are needed for evaluation? Indicate with an X which data are essential and which are unrelated to evaluating an anginal attack.
Explanation
The nurse is evaluating a client presenting with anginal chest pain, which is typically caused by myocardial ischemia due to reduced coronary blood flow. Proper assessment requires distinguishing clinical signs directly associated with angina from unrelated information, ensuring accurate diagnosis, treatment planning, and timely interventions. Understanding the pattern, associated symptoms, and risk factors is essential for safe and effective management.
Rationale for correct answer:
ESSENTIAL ASSESSMENT DATA
- Pain occurring with exercise. Angina is often exertional, triggered by increased myocardial oxygen demand. Documenting the relationship between activity and pain helps determine the pattern of ischemia.
- Shortness of breath with chest pain. Dyspnea is a common associated symptom of myocardial ischemia and may indicate more severe or extensive cardiac involvement.
- Indigestion or nausea present. Gastrointestinal symptoms, particularly nausea or epigastric discomfort, can occur with angina, especially in older adults or women, and should be noted.
- Family history for heart disease. A positive family history is a significant risk factor for coronary artery disease, providing context for the client’s presentation.
- Feeling faint or lightheaded. Presyncope or dizziness can result from decreased cardiac output during an anginal episode and signals hemodynamic compromise.
- Reporting palpitations. Arrhythmias may accompany angina or precipitate myocardial ischemia, making this symptom clinically relevant.
- Smoking history. Tobacco use increases atherosclerotic risk and directly contributes to coronary artery disease, making it essential in risk assessment.
UNRELATED ASSESSMENT DATA
- Periods of insomnia. While overall health is important, sleep patterns do not directly evaluate an anginal attack.
- Unable to remember recent events. Cognitive deficits are unrelated to the acute assessment of angina.
- Reporting muscle cramps in lower legs. Peripheral muscle cramps are not linked to myocardial ischemia and are unrelated in the context of anginal assessment.
Test-taking strategy:
• Focus on symptoms and risk factors directly associated with myocardial ischemia.
• Eliminate assessment data unrelated to acute angina presentation, such as general health concerns or non-cardiac symptoms.
• Prioritize information that helps determine the pattern, severity, and triggers of anginal attacks.
Take-home points:
• Essential assessment data include pain characteristics, associated symptoms, and cardiac risk factors.
• Distinguish unrelated health information to avoid misprioritization during evaluation.
• Comprehensive assessment allows timely and accurate management of anginal episodes.
Choose the most likely option for the information missing from the following sentence by selecting from the list of options provided.
The nurse discussed with the client in the scenario that there are different types of angina and stated that
Explanation
Correct answer: The nurse discussed with the client in the scenario that there are different types of angina and stated that chronic stable angina occurs with a fixed obstruction; compared with unstable angina, which occurs with new thrombus formation.
The nurse is educating the client about different types of angina, emphasizing the pathophysiology and triggers of each type. Understanding these distinctions helps the client recognize warning signs, respond appropriately to symptoms, and adhere to prescribed interventions. Chronic stable angina and unstable angina differ in their underlying mechanisms, onset, and clinical significance, which directly impacts risk assessment and management strategies.
Rationale for correct answer:
Chronic stable angina occurs with a fixed obstruction; compared with unstable angina, which occurs with new thrombus formation. Chronic stable angina is typically caused by atherosclerotic plaque narrowing the coronary arteries, resulting in predictable episodes of myocardial ischemia, usually triggered by exertion or stress. The obstruction is relatively fixed, so symptoms are consistent in frequency, duration, and intensity, and subside with rest or nitroglycerin.
Unstable angina, in contrast, arises from acute changes in a coronary artery, such as plaque rupture or thrombus formation, leading to sudden partial occlusion. Symptoms are more severe, unpredictable, and can occur at rest, signaling a higher risk for myocardial infarction. Recognizing these distinctions allows clients and healthcare providers to identify urgent cardiac events requiring prompt intervention.
Rationales for incorrect options:
Palpitations are a symptom rather than a type of angina.
Vasodilation does not accurately explain the mechanism of stable versus unstable angina.
Dysrhythmias are a possible complication but not the defining mechanism of chronic stable angina.
A fixed obstruction defines stable angina, not unstable angina; unstable angina involves dynamic obstruction such as thrombus formation.
Test-taking strategy:
• Focus on the pathophysiology and triggers of angina types.
• Recall that chronic stable angina = fixed atherosclerotic obstruction, predictable, whereas unstable angina = dynamic obstruction, unpredictable, new thrombus formation.
• Eliminate options that confuse symptoms, complications, or unrelated mechanisms with the type of angina.
Take-home points:
• Chronic stable angina occurs due to a fixed obstruction, causing predictable, exertion-related symptoms.
• Unstable angina involves new thrombus formation, resulting in unpredictable and potentially life-threatening episodes.
• Accurate knowledge of angina types supports patient education, early symptom recognition, and timely emergency interventions.
After the administration of sublingual nitroglycerin to the client in the scenario with angina, the nurse explained to the client which of the following adverse effects may be experienced? Select all that apply
Choose the most likely option for the information missing from the following sentence by selecting from the list of options provided.
The client in the scenario diagnosed with angina will have their symptoms controlled with medications such as
Explanation
Correct answer: The client in the scenario diagnosed with angina will have their symptoms controlled with medications such as metoprolol and isosorbide dinitrate, which are classified as beta-adrenergic blocker and nitrate, respectively.
The nurse is educating the client about medications used to manage angina, emphasizing their mechanisms of action and therapeutic effects. Proper understanding helps the client adhere to therapy, recognize expected effects, and monitor for adverse reactions. Beta-adrenergic blockers and nitrates are commonly prescribed to prevent anginal episodes, reduce myocardial oxygen demand, and improve exercise tolerance.
Rationale for correct answer:
Metoprolol and isosorbide dinitrate, which are classified as beta-adrenergic blocker and nitrate, respectively. Metoprolol, a beta-adrenergic blocker, works by blocking beta1 receptors in the heart, leading to decreased heart rate, myocardial contractility, and cardiac output, which collectively reduce myocardial oxygen demand. This makes the heart less susceptible to ischemia during exertion.
Isosorbide dinitrate, a nitrate, acts primarily through vasodilation, particularly of the venous system, which reduces preload and myocardial oxygen consumption. Nitrates also dilate coronary arteries to improve oxygen supply to ischemic myocardial tissue. When used together, these drugs complement each other by reducing oxygen demand (beta blocker) and improving oxygen supply (nitrate), effectively preventing anginal attacks.
Rationales for incorrect options:
HMG-CoA inhibitors (statins) lower cholesterol but do not directly control anginal symptoms.
ACE inhibitors and ARBs manage hypertension and heart failure but are not first-line for symptom control in stable angina.
Statins address lipid management, not angina symptom relief, though beta blockers are correct in mechanism.
ARBs like losartan reduce blood pressure and cardiovascular risk but do not directly alleviate anginal symptoms.
Test-taking strategy:
• Identify the medications that directly relieve or prevent angina symptoms.
• Recall mechanisms of action. beta blockers reduce myocardial oxygen demand, nitrates reduce preload and improve coronary perfusion.
• Eliminate options involving drugs that target risk factors rather than acute or exertional anginal symptoms.
Take-home points:
• Beta-adrenergic blockers decrease heart rate and myocardial oxygen demand to prevent angina.
• Nitrates dilate blood vessels, improving oxygen supply and reducing cardiac workload.
• Combining these medications provides complementary mechanisms to optimize angina symptom control.
The nurse administering the calcium channel blocker amlodipine (Norvasc) explained to the client what effect the drug has on the heart. Which statement is appropriate for the nurse to make? Select all that apply
The nurse was discussing risk factor management with the client who was admitted with chest pain and realized that the client needed further education after he made which statement?
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