Chapter 25: Drugs Used to Treat Angina Pectoris My Nursing Test Banks

Chapter 25: Drugs Used to Treat Angina Pectoris

Test Bank

MULTIPLE CHOICE

1. Which medication combinations may be beneficial in treating angina pectoris?

a.

Antidysrhythmics and platelet active agents

b.

ACE inhibitors and statins

c.

Vasoconstrictors and diuretics

d.

Analgesics and thrombolytics

ANS: B

ACE inhibitors and statins are often combined to treat angina pectoris. Antidysrhythmics and platelet active agents are not used in combination to treat angina because angina does not typically result in rhythm disturbances. Vasoconstrictors would exacerbate angina and are not used with diuretics. Analgesics and thrombolytics are not used in combination to treat angina because angina is not caused by a clot, so thrombolytics are not necessary.

DIF: Cognitive Level: Knowledge REF: p. 405 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG CoA reductase inhibitor. What is the primary indication in using this medication?

a.

Reduce coronary vessel spasm.

b.

Simplify oxygen requirements of the cardiac cells.

c.

Lower cholesterol levels.

d.

Dilate the coronary arteries.

ANS: C

HMG CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels. This medication prevents added atherosclerotic vessel build up and further narrowing of the coronary arteries. Statins do not affect vascular spasms or oxygen requirements of cells. Statins do not dilate coronary arteries.

DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

3. What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?

a.

Use the sublingual form only.

b.

Administer subsequent doses parenterally.

c.

Allow for a daily 8 to 12 hour nitrate free period.

d.

Store the drug in a dark container, free from light and moisture.

ANS: C

An 8 to 12 hour nitrate free period will eliminate the development of tolerance to nitroglycerin. Route of administration and medication storage methods do not affect tolerance.

DIF: Cognitive Level: Comprehension REF: p. 408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?

a.

Take a dose routinely at bedtime.

b.

Place the tablet under the tongue and swallow immediately.

c.

Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes.

d.

Take one tablet every 2 to 3 minutes until relief is obtained.

ANS: C

The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes if pain is not relieved. Nitrates are taken at the indication of pain. Sublingual nitrates are not swallowed.

DIF: Cognitive Level: Application REF: p. 408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

5. How frequently are nitroglycerin tablets discarded and prescriptions refilled?

a.

Monthly

b.

Every 3 months

c.

Every 6 months

d.

Yearly

ANS: C

Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded. Nitroglycerin has a longer shelf life than 1 or 3 months but does not have a shelf life as long as 1 year.

DIF: Cognitive Level: Knowledge REF: p. 408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. When are sustained release nitroglycerin tablets administered?

a.

Once a day

b.

At bedtime

c.

When symptoms of acute angina appear

d.

Every 8 to 12 hours

ANS: D

Sustained release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be necessary to take these tablets with food. To be effective, sustained release nitroglycerin must be taken more often. Sustained release nitroglycerin is taken to prevent angina; waiting until symptoms occur decreases its effectiveness.

DIF: Cognitive Level: Knowledge REF: p. 408 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?

a.

Shake the container to disperse the medication evenly.

b.

Inhale the medication slowly over 1 to 2 minutes.

c.

Administer the medication under the tongue.

d.

Close the mouth and swallow the spray.

ANS: C

Translingual nitroglycerin spray should be sprayed onto or under the tongue. The container should not be shaken because the bubbles formed may slow the release of the medication. The spray should not be inhaled or swallowed. Shaking the container can cause bubbles that will slow the release of nitroglycerin. The dose should not be inhaled or swallowed.

DIF: Cognitive Level: Comprehension REF: p. 408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Which statement is true regarding the pain associated with angina?

a.

It does not subside until treatment is initiated.

b.

It is highly variable in intensity and location.

c.

It typically subsides after 1 to 3 minutes.

d.

It is directly related to the degree of myocardial damage.

ANS: B

The presentation of angina pectoris is highly variable. The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness. Pain or discomfort may radiate to the neck, lower jaw, shoulder, and arm. Attacks can last from 30 seconds to 30 minutes. Anginal pain usually does subside with rest. Sustained pain is usually indicative of a myocardial infarction. Although angina pain may subside in this way, in general, it is highly variable in how it is manifested. Anginal pain may or may not correlate with the amount of myocardial damage.

DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

9. How do beta adrenergic blocking agents reduce myocardial oxygen demand?

a.

By inhibiting the stimulation of norepinephrine and epinephrine

b.

By increasing the production of dopamine and acetylcholine

c.

By delaying the destruction of acetylcholinesterase and cholinesterase

d.

By enhancing the sensitivity of alpha receptors and beta receptors

ANS: A

Beta adrenergic blocking agents prevent the stimulation of epinephrine and norepinephrine, which normally increase heart rate. Dopamine and acetylcholine are not beta adrenergic neurotransmitters. Beta blockers do not delay the destruction of these enzymes. Beta blockers do not enhance the sensitivity of alpha adrenergic and beta receptor sites.

DIF: Cognitive Level: Comprehension REF: p. 411 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient?

a.

Report any headaches following self administration to your health care provider.

b.

Carry the medication in a pocket directly next to the body.

c.

Carry the medication with you at all times.

d.

Store nitroglycerin in a clear glass container with a tight lid.

ANS: C

Non hospitalized patients should carry nitroglycerin at all times. Headache is an expected adverse effect. Heat causes the medication to deteriorate, so being carried next to the body would cause it to become ineffective. Tablets are degraded by sunlight.

DIF: Cognitive Level: Application REF: p. 408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results?

a.

Allergy

b.

Dependence

c.

Tolerance

d.

Nausea

ANS: C

Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently. Allergy to nitrates is highly unlikely. Increasing dosages and frequency of nitrate use is more likely to reflect deterioration of cardiac function than dependence on the medication. Nausea is not a common adverse effect of nitrate treatment.

DIF: Cognitive Level: Comprehension REF: p. 410 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. The nurse is performing pain assessment on a patient admitted for evaluation of angina. Which type of angina is precipitated by physical exertion and is relieved by rest?

a.

Chronic stable

b.

Nocturnal

c.

Unstable

d.

Variant

ANS: A

Chronic stable angina is precipitated by physical exertion or stress, lasts only a few minutes, and is relieved by rest or nitroglycerin. Nocturnal is not a designated classification. Unstable angina is unpredictable. Variant angina occurs at rest.

DIF: Cognitive Level: Knowledge REF: p. 404 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

13. What is the rationale behind administering calcium channel blockers to patients with angina?

a.

They decrease heart rate.

b.

They dilate blood vessels.

c.

They increase cardiac contractility.

d.

They promote fluid excretion.

ANS: B

By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow. Dilation of peripheral vessels reduces the workload of the heart. Calcium channel blockers are not given to decrease heart rate in patients with angina. Calcium channel blockers do not increase cardiac contractility or promote fluid excretion.

DIF: Cognitive Level: Comprehension REF: p. 411 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?

a.

Spread the ointment on the patients legs in a thin, uniform layer.

b.

Cover the patch with a clear plastic wrap.

c.

Rub the ointment into the skin in a circular motion.

d.

Shave the skin prior to application.

ANS: B

Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate. The ointment is not applied to the lower extremities, including the legs. The ointment should not be rubbed into the skin. Shaving is not recommended prior to application because of possible skin irritation.

DIF: Cognitive Level: Application REF: p. 410 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?

a.

This is a common adverse effect that can be managed with acetaminophen.

b.

Discontinue taking this medication.

c.

Try taking this medication at night to minimize the possibility of headaches.

d.

Lie down after using nitroglycerin to avoid a headache.

ANS: A

The most common adverse effect of nitrate therapy is headache. Analgesics, such as acetaminophen, may be used if needed. The medication should not be discontinued. When administered sublingually, this medication is taken as needed for chest pain. Lying down will not prevent the occurrence of a headache.

DIF: Cognitive Level: Application REF: p. 410 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true?

a.

It causes coronary artery vasodilation.

b.

It causes no gastrointestinal (GI) side effects.

c.

It causes QT interval prolongation.

d.

It elevates LDL levels.

ANS: C

Baseline and follow up ECGs should be obtained to evaluate the effects on the patients QT incorrect interval. Increased coronary artery vasodilation is not an effect of this medication. This medication causes GI side effects such as abdominal pain. This medication does not elevate LDL levels.

DIF: Cognitive Level: Comprehension REF: p. 413 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. The nurse is assisting with a patient admission to the telemetry unit. The patient is diagnosed with angina pectoris. When obtaining information for angina therapy in regard to the central nervous system (CNS), the nurse will document:

a.

history of smoking.

b.

diet.

c.

anxiety level.

d.

heart rate.

ANS: C

Anxiety level is a component of assessing the CNS. History of smoking is included when assessing the cardiovascular system. Diet is included when assessing nutritional history. Heart rate is included when assessing the cardiovascular system.

DIF: Cognitive Level: Application REF: p. 406 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

18. Which therapy(ies) is/are used in the treatment of angina pectoris? (Select all that apply.)

a.

ECG

b.

Coronary artery bypass

c.

Coronary angioplasty

d.

Avoidance of caffeine and emotional stress

e.

Use of nitrates

ANS: B, C, D, E

Coronary artery bypass and coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation. Avoiding caffeine and emotional stress and use of nitrates is standard treatment of angina pectoris. An ECG is not a procedure for the treatment of angina.

DIF: Cognitive Level: Knowledge REF: pp. 404-405 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

19. Which lifestyle modification(s) will the nurse include when educating the patient with angina pectoris? (Select all that apply.)

a.

Weight reduction therapy

b.

Low potassium diet

c.

Smoking cessation

d.

Stress management

e.

Independent exercise

ANS: A, C, D

Although medications can control angina attacks, lifestyle changes such as maintaining an ideal weight are important in managing the disease. Smoking cessation is a vital component to include when educating the patient with angina pectoris. Limiting potassium is not a recommendation for treatment of angina pectoris. The patient should always consult the health care provider before participating in any exercise regimen.

DIF: Cognitive Level: Application REF: pp. 404-405 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

20. What will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.)

a.

Increase caffeine in diet

b.

Relaxation techniques

c.

Proper storage of medications

d.

Pain assessment

e.

Isometric exercise program

ANS: B, C, D

Lifestyle modifications such as relaxation techniques are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers. Pain assessment and rating is an important part of nitrate therapy. Increasing caffeine in the diet should be discouraged. Participation in a regular, moderate exercise program is essential, but exercise should not be strenuous or isometric in patients with angina.

DIF: Cognitive Level: Application REF: pp. 407-408 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

21. What will the nurse include in the teaching plan for a patient with angina who is prescribed a beta adrenergic blocking agent? (Select all that apply.)

a.

Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance.

b.

Only some beta blockers are effective in treating angina pectoris.

c.

Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina.

d.

Cardioselective agents minimize pulmonary and peripheral vascular adverse effects.

e.

Stress exercise is an effective way to determine the most appropriate dosage.

f.

Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina.

ANS: A, C, D, E

Beta blockers are used to reduce the frequency of attacks, reduce nitrate use, and improve exercise tolerance. Comorbidities influence product selection in the angina patient.

Cardioselective agents have greater affinity for beta 1 adrenergic receptors (cardiac) than beta 2 adrenergic receptors (bronchi, peripheral blood vessels), thereby reducing the possible pulmonary and vascular adverse effects. Stress exercise is an effective way to determine the most appropriate dosage. All beta blockers are effective in treating angina pectoris. Divided doses are not necessary to provide effective control of angina.

DIF: Cognitive Level: Application REF: p. 411 OBJ: 4

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

22. The nurse transcribes a new order for ranolazine (Ranexa) for a patient with chronic stable angina. Before initiating this medication, the nurse will ensure that which laboratory study result(s) is/are available? (Select all that apply.)

a.

Electrocardiography

b.

BUN

c.

Creatinine

d.

Electrolyte levels

e.

CBC

ANS: A, B, C, D, E

Premedication assessment for ranolazine (Ranexa) includes assessment of results of electrocardiography; renal function tests such as BUN, serum creatinine, and electrolyte levels; and CBC. These results will serve as a baseline for future comparison.

DIF: Cognitive Level: Application REF: p. 414 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

23. The nurse is performing a head to toe assessment on a resident in a long term care facility with a history of angina pectoris. When assessing peripheral perfusion, the nurse will perform which intervention(s)? (Select all that apply.)

a.

Count heart rate and describe rhythm.

b.

Note any loss of hair on lower legs.

c.

Auscultate blood pressure.

d.

Check pedal pulses.

e.

Assess pupil reaction.

ANS: B, D

Peripheral perfusion assessment includes noting loss of hair on lower legs, denoting decreased circulation. When assessing peripheral perfusion, the pedal pulses in the lower extremities are assessed in conjunction with skin color and temperature. Heart rate and rhythm are components of assessment of the cardiovascular system, but not associated with peripheral tissue perfusion. Pupil reaction is considered a neurologic assessment.

DIF: Cognitive Level: Application REF: p. 406 OBJ: 1

TOP: Nursing Process Step: Assessment, Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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