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Chapter 37 – Cardiac Glycosides,
Antianginal Drugs, &
Antidysrhythmic Agents | NCLEX-
Style Questions with Answers and
Rationales | A-Graded Pharmacology
Exam Resource
The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement
by the patient indicates understanding of the teaching? ✔✔✔answer✔✔✔"I should
rotate sites when changing the patch to prevent skin irritation." Patients should be taught to rotate application sites when using the transdermal nitroglycerin. Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider. The nurse is teaching a patient about sublingual nitroglycerin administration. What information will
the nurse include when teaching this patient? ✔✔✔answer✔✔✔Take the first tablet
while sitting or lying down. Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down. If pain is not better or has worsened 5 minutes after the first dose, patients should call
- The tablets must dissolve under the tongue and should not be swallowed. A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the
patient to perform which action? ✔✔✔answer✔✔✔Take acetaminophen as needed.
Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain.
A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse
anticipate in a patient receiving this medication? ✔✔✔answer✔✔✔Pounding headache
The pounding headache is related to vasodilation of the cerebral vessels. A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that
nitroglycerin is administered by this route for which reason? ✔✔✔answer✔✔✔To
increase absorption Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed. A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patient's regimen. The nurse will explain that verapamil
is given for which purpose? ✔✔✔answer✔✔✔To relax coronary arteries
Verapamil is a calcium channel blocker and is used to relax coronary artery spasm in patients with variant angina. A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will
✔✔✔answer✔✔✔switch to diltiazem (Cardizem).
Hypotension is a common effect of calcium channel blockers and is more common with nifedipine. It is less common with diltiazem, so the provider may order that drug. The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take?
✔✔✔answer✔✔✔Notify the provider of digoxin toxicity.
The therapeutic range of digoxin is between 0.5 and 2 mg/mL. This patient's level is high, indicating toxicity.
- A nurse is preparing to administer digoxin. Which of the following is the most important assessment prior to administration? A. Respiratory rate B. Blood glucose level C. Apical pulse for one full minute D. Capillary refill time
✔✔✔answer✔✔✔: C
Rationale: Always check the apical pulse before giving digoxin. Hold the dose and notify the provider if the heart rate is <60 bpm in adults.
- A patient is receiving digoxin for heart failure. Which electrolyte imbalance increases the risk of digoxin toxicity? A. Hypernatremia B. Hypokalemia C. Hypermagnesemia D. Hypocalcemia
✔✔✔answer✔✔✔: B
Rationale: Hypokalemia enhances digoxin’s effects on the myocardium, increasing the risk of toxicity.
- The patient on digoxin reports nausea, blurred vision, and yellow halos. What is the nurse's best response? A. Encourage fluid intake B. Administer antiemetics C. Hold the next dose and notify the provider D. Reassure the patient that side effects are temporary
✔✔✔answer✔✔✔: C
Rationale: These are classic signs of digoxin toxicity and require immediate evaluation and possible withholding of the drug.
- A patient with angina is prescribed nitroglycerin sublingually. What instruction is most important to provide? A. "Swallow the tablet with a full glass of water." B. "If pain is not relieved in 5 minutes, call emergency services." C. "Take the medication only after meals." D. "Apply the tablet to your inner cheek."
✔✔✔answer✔✔✔: B
Rationale: If chest pain persists after 1 dose of SL nitroglycerin, the patient should call 911 — this may be a heart attack.
- What is a common side effect of nitroglycerin? A. Dry mouth B. Constipation C. Headache D. Blurred vision
✔✔✔answer✔✔✔: C
Rationale: Nitroglycerin causes vasodilation, often resulting in headache due to increased intracranial blood flow.
- Which drug class is commonly used as first-line treatment for chronic stable angina? A. Beta blockers B. Cardiac glycosides C. Anticoagulants D. Loop diuretics
✔✔✔answer✔✔✔: A
Rationale: Beta blockers reduce myocardial oxygen demand and are effective in preventing anginal episodes.
- The nurse is caring for a patient on amiodarone. What is a serious adverse effect to monitor for? A. Constipation B. Pulmonary toxicity C. Muscle cramps D. Increased appetite
✔✔✔answer✔✔✔: B
Rationale: Long-term amiodarone therapy can lead to life-threatening pulmonary fibrosis.
- A nurse is educating a patient on how to store sublingual nitroglycerin. What statement indicates correct understanding? A. "I will keep it in a clear pill organizer." B. "I’ll store it in my bathroom cabinet." C. "I’ll keep it in its original dark container, tightly sealed." D. "I’ll put the pills in my wallet for easy access."
✔✔✔answer✔✔✔: C
Rationale: Nitroglycerin is light- and heat-sensitive. It must be stored in the original dark glass container to maintain potency.
- What lab value should be monitored regularly in a patient on digoxin therapy?
The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action?
✔✔✔answer✔✔✔Administer ordered dose of digoxin.
Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range. When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor?
(Select all that apply) ✔✔✔answer✔✔✔- Continuous blood pressure
- Presence of chest pain Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored. Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium
channel blocker? ✔✔✔answer✔✔✔Absence of chest pain
The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased. The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will
cause the nurse to take action? ✔✔✔answer✔✔✔Chest pain
The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Which statement made by the patient demonstrates a need for further instruction regarding the use
of nitroglycerin? ✔✔✔answer✔✔✔"I can take up to five tablets at 3-minute intervals for
chest pain if necessary."
Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse
include in the patient's teaching plan? ✔✔✔answer✔✔✔"Apply the patch to a non-hairy
area of the upper torso or arm." A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's
best response? ✔✔✔answer✔✔✔"It's best to keep it in its original container away from
heat and light." Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. Which assessment finding will alert the nurse to suspect early digitalis toxicity?
✔✔✔answer✔✔✔Loss of appetite with slight bradycardia
Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia. A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which action will the nurse take?
✔✔✔answer✔✔✔Evaluate digoxin levels.
Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient's digoxin levels. A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given
concurrently to treat this condition? ✔✔✔answer✔✔✔Warfarin (Coumadin)
Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboemboli, warfarin is given concurrently.
The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which
medication? ✔✔✔answer✔✔✔Potassium
If a patient is taking digoxin and a potassium-wasting diuretic such as thiazide, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity The nurse administers a dose of digoxin (Lanoxin) to a patient who has heart failure and returns to the room later to reassess the patient. Which finding indicates that the medication is effective?
✔✔✔answer✔✔✔Decreased dyspnea
The patient should show improvement in breathing and oxygenation. A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which
reason? ✔✔✔answer✔✔✔To provide cardioprotective effects
Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive heart failure for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses. A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction?
✔✔✔answer✔✔✔Avoid extremes in weather.
Avoiding extreme weather conditions is important to help prevent anginal attacks. Patients should be instructed to avoid strenuous exercise; avoid alcohol, which can enhance hypotensive effects of nitrates; and use nitroglycerin at the first sign of pain. A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory
rate of 16 breaths/min. What is the nurse's priority action? ✔✔✔answer✔✔✔Decrease
the intravenous nitroglycerin by 10 mcg/min.
Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion. What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment?
✔✔✔answer✔✔✔Apply the ointment to a non-hairy part of the upper torso.
Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch.
Right-Sided Heart Failure ✔✔✔answer✔✔✔Blood backs up in periphery
Left-Sided Heart Failure ✔✔✔answer✔✔✔Blood backs up in lungs
Stage 1 Heart Failure ✔✔✔answer✔✔✔High risk for HR without symptoms or structural
disease
Stage 2 Heart Failure ✔✔✔answer✔✔✔Some levels of cardiac changes (decrease
ejection fraction without symptoms of HF)
Stage 3 Heart Failure ✔✔✔answer✔✔✔Structural heart disease with symptoms of HF
(fatigue, SOB, edema, decreased physical activity)
Stage 4 Heart Failure ✔✔✔answer✔✔✔Severe structural heart disease & marked
symptoms of HF at rest
Nonpharmacologic treatment for HF ✔✔✔answer✔✔✔limit salt intake
limit/avoid alcohol intake stop smoking decrease saturated fat intake mild exercise
ACE Inhibitors ✔✔✔answer✔✔✔- Dilate venules and arterioles, improving renal blood
flow and decreasing blood fluid volume
- Decrease release of aldosterone
ARB's ✔✔✔answer✔✔✔Valsartan (Diovan) and candesartan (Atacand) approved for HF
in patients who cannot tolerate an ACE inhibitor.
Diuretics ✔✔✔answer✔✔✔First-line drug treatment for reducing fluid volume
- Spironolactone (Aldactone) Blocks production of aldosterone; improves heart rate variability; decreases myocardial fibrosis cardioprotective effect of blocking aldosterone in the heart and blood vessels to promote cardiac remodeling
Beta Blockers ✔✔✔answer✔✔✔Carvedilol (Coreg)
Metoprolol (Toprol XL, Lopressor) Bisoprolol (Zebeta)
Angina (types) ✔✔✔answer✔✔✔Classic (stable) - occurs w/predictable stress or exertion
Unstable (preinfarction) - occurs frequently w/progressive severity unrelated to activity; unpredicatable Variant (prinzmetal, vasospastic) - occurs during rest
Types of Antianginal Drugs ✔✔✔answer✔✔✔NITRATES: reduction of venous tone,
decreased workload of the heart, vasodilation BETA BLOCKERS: decrease the workload of the heart and decrease oxygen demands CALCIUM CHANNEL BLOCKERS: decrease the workload of the heart and decrease oxygen demands
Antidysrhythmic Drugs ✔✔✔answer✔✔✔Class I - Sodium channel blockers
Class II - Beta-adrenergic blockers (reduce calcium entry, decrease conduction) Class III - prolong repolarization Class IV - calcium channel blockers A patient has angina pectoris. The patient's BP is 100/60 mm Hg. The nurse administers nitroglycerin 0.4 mg sublingual (SL). It is most important for the nurse to assess the patient for the development of
✔✔✔answer✔✔✔hypotension
A side effect of nitroglycerin is hypotension owing to the vasodilation of blood vessels A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse
implement? (Select all that apply.) ✔✔✔answer✔✔✔- Checking the apical pulse rate
before administration
- Monitoring the patient's serum digoxin level
- Instructing patient to report pulse rate less than 60 A patient is ordered to receive digoxin (Lanoxin) to treat congestive heart failure. The nurse is most
concerned about which assessment finding? ✔✔✔answer✔✔✔Heart rate 56 beats/min
A baseline pulse rate for the patient should be obtained for future comparisons. Apical pulse should be taken for a full minute and should be greater than 60 beats/min. The prescriber should be notified if the patient's pulse is less than 60 beats per minute A nurse is preparing to administer digoxin (Digitalis) to a patient. Which laboratory result is the nurse
most concerned about? ✔✔✔answer✔✔✔Potassium 3.0 mEq/L
A low serum potassium level enhances the action of digoxin and can cause digitalis toxicity When administering antianginal drugs, the nurses identifies which as the most common response?
✔✔✔answer✔✔✔Hypotension
The most common side effect of antianginal drugs is hypotension
Carbonic anhydrase inhibitors are primarily used to decrease IOP in patients with open-angle (chronic) glaucoma. Thiazides and loop diuretics are used to treat hypertension and peripheral edema. Potassium-sparing diuretics are used as mild diuretics in combination with other diuretics.
