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Chapter 37 – Cardiac Glycosides, Antianginal Drugs, & Antidysrhythmic Agents | NCLEX Style Questions with Answers and Rationales | A-Graded Pharmacology Exam Resource
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The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement
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
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
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
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
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
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
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?
The therapeutic range of digoxin is between 0.5 and 2 mg/mL. This patient's level is high, indicating toxicity.
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.
Rationale: Hypokalemia enhances digoxin’s effects on the myocardium, increasing the risk of toxicity.
Rationale: These are classic signs of digoxin toxicity and require immediate evaluation and possible withholding of the drug.
Rationale: If chest pain persists after 1 dose of SL nitroglycerin, the patient should call 911 — this may be a heart attack.
Rationale: Nitroglycerin causes vasodilation, often resulting in headache due to increased intracranial blood flow.
Rationale: Beta blockers reduce myocardial oxygen demand and are effective in preventing anginal episodes.
Rationale: Long-term amiodarone therapy can lead to life-threatening pulmonary fibrosis.
Rationale: Nitroglycerin is light- and heat-sensitive. It must be stored in the original dark glass container to maintain potency.
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?
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?
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
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
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
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
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?
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?
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
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
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?
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
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?
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
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?
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.
disease
ejection fraction without symptoms of HF)
(fatigue, SOB, edema, decreased physical activity)
symptoms of HF at rest
limit/avoid alcohol intake stop smoking decrease saturated fat intake mild exercise
flow and decreasing blood fluid volume
in patients who cannot tolerate an ACE inhibitor.
Metoprolol (Toprol XL, Lopressor) Bisoprolol (Zebeta)
Unstable (preinfarction) - occurs frequently w/progressive severity unrelated to activity; unpredicatable Variant (prinzmetal, vasospastic) - occurs during rest
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
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
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
before administration
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
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?
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.