TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 51-55
Chapter 51: Drugs for Angina Pectoris
MULTIPLE CHOICE
1. A nurse is providing teaching for a patient with stable angina who will begin taking
nitroglycerin. Which statement by the patient indicates understanding of the teaching?
a. “I should not participate in aerobic exercise while taking this drug.”
b. “I should take aspirin daily to reduce my need for nitroglycerin.”
c. “If I take nitroglycerin before exertion, I can reduce the chance of an anginal
attack.”
d. “I take nitroglycerin to increase the amount of oxygen to my heart.”
ANS: C
Nitroglycerin can be taken before stressful events or exertion to reduce the chance of
an attack of angina. Aerobic exercise is an important part of nondrug therapy to
reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to
prevent coronary thrombus formation, but it does not reduce the need for
nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase
the amount of oxygen available to the heart.
DIF: Cognitive Level: Application REF: Organic Nitrates | Nitroglycerin |
Mechanism of Antianginal Effects | Summary of Treatment Measures | Drugs
Used to Prevent Myocardial Infarction and Death | Antiplatelet Drugs
TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
2. A nurse is discussing the difference between stable and variant angina with a group of
nursing students. Which statement by a student indicates the need for further teaching?
a. “Beta blockers are effective in stable angina but not in variant angina.”
b. “In both types of angina, prophylactic treatment is possible.”
c. “Variant angina is primarily treated with vasodilators to increase oxygen supply.”
d. “Variant angina is the result of increased oxygen demand by the heart.”
ANS: D
Variant angina is caused by coronary artery spasm, which reduces the oxygen supply
to the heart. Beta blockers are not effective in variant angina but are useful with stable
angina. Medications may be given to prevent anginal attacks in both types of angina.
, Vasodilators are used in variant angina to relieve coronary artery spasm and increase
the oxygen supply to the heart.
DIF: Cognitive Level: Analysis REF: Angina Pectoris: Pathophysiology
and Treatment Strategy | Chronic Stable Angina | Variant Angina TOP:
Nursing Process: Planning MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the
pain intensifies. The nurse notes that the patient has a heart rate of 76 beats per minute
and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient’s
lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate
providing:
a. an angiotensin-converting enzyme (ACE) inhibitor.
b. intravenous nitroglycerin and a beta blocker.
c. ranolazine (Ranexa) and quinidine.
d. supplemental oxygen and intravenous morphine.
ANS: B
This patient has unstable angina, and the next step, when pain is unrelieved by
sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE
inhibitors should be given to patients with persistent hypertension if they have left
ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line
angina drug, but it should not be given with quinidine because of the risk of
increasing the QT interval. Supplemental oxygen is indicated if cyanosis or
respiratory distress is present. IV morphine may be given if the pain is unrelieved by
nitroglycerin.
DIF: Cognitive Level: Application REF: Unstable Angina | Ranolazine | Drug
Interactions TOP: Nursing Process: Diagnosis MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
4. A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse
correctly states, “Nitroglycerin:
a. dilates coronary arteries to increase blood flow to the heart.”
b. increases the oxygen supply to the cardiac muscle.”
c. increases ventricular filling to improve cardiac output.”
d. promotes vasodilation, which reduces preload and oxygen demand.”
ANS: D
Nitroglycerin dilates the veins, which reduces venous return to the heart, which in
turn decreases ventricular filling. The resulting decrease in preload reduces the
oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or
oxygen supply to the heart. An increase in ventricular filling would increase oxygen
demand and result in increased anginal pain.
5. A hospitalized patient complains of acute chest pain. The nurse administers a 0.3 mg
sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs
remain stable. What is the nurse’s next step?
a. Apply a nitroglycerin transdermal patch.
b. Continue dosing at 10-minute intervals.
c. Give a second dose of nitroglycerin in 5 minutes.
d. Request an order for intravenous nitroglycerin.
ANS: C
An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in
this case, the patient should take another dose in 5 minutes. Transdermal delivery
systems are not useful for terminating an ongoing attack. Dosing at 10-minute
intervals is incorrect. If the patient fails to respond or if the pain intensifies,
intravenous nitroglycerin may be indicated.
DIF: Cognitive Level: Application REF: Nitroglycerin | Preparations and
Routes of Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
6. A patient who has begun using transdermal nitroglycerin for angina reports occasional
periods of tachycardia. The nurse will expect the prescriber to order:
a. digoxin (Lanoxin) to slow the heart rate.
b. immediate discontinuation of the nitroglycerin.
c. periods of rest when the heart rate increases.
d. verapamil as an adjunct to nitroglycerin therapy.
ANS: D
Nitroglycerin lowers blood pressure by reducing venous return and dilating the
arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex
tachycardia, which can increase cardiac demand and negate the therapeutic effects of
nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow
the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not
indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of
the tachycardia.
DIF: Cognitive Level: Application REF: Nitroglycerin | Adverse
Effects | Reflex Tachycardia TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
, 7. A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes
are increasing in frequency and usually occur when the patient walks the dog. The patient
reports needing almost daily doses of the nitroglycerin and states that one tablet usually
provides complete relief. What will the nurse do?
a. Contact the provider to suggest ordering a transdermal patch for this patient.
b. Question the patient about consumption of grapefruit juice.
c. Suggest that the patient limit walking the dog to shorter distances less frequently.
d. Suggest that the patient take two tablets of nitroglycerin each time, because the
symptoms are increasing in frequency.
ANS: A
Transdermal patches are good for sustained prophylaxis for anginal attacks and are
especially useful when patients have a regular pattern of attacks. Grapefruit juice does
not affect the metabolism of nitroglycerin. Patients with angina should be encouraged
to increase, not decrease, exercise. Taking two tablets is not recommended when one
is effective.
DIF: Cognitive Level: Application REF: Nitroglycerin | Transdermal
Delivery Systems TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
8. A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart
in the treatment of anginal pain. The nurse tells the student that beta blockers:
a. dilate arterioles to improve myocardial circulation.
b. improve cardiac contractility, which makes the heart more efficient.
c. increase arterial pressure to improve cardiac afterload.
d. increase the time the heart is in diastole.
ANS: D
Beta blockers increase the time the heart is in diastole, which increases the time
during which blood flows through the myocardial vessels, allowing more oxygen to
reach the heart. Beta blockers do not dilate arterioles. They do not increase cardiac
contractility; they decrease it, which reduces the cardiac oxygen demand. They do not
increase arterial pressure, which would increase the cardiac oxygen demand.
DIF: Cognitive Level: Comprehension REF: Beta Blockers TOP:
Nursing Process: Planning MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
9. A patient with stable exertional angina has been receiving a beta blocker. Before giving
the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an
appropriate nursing action?
a. Administer the drug as ordered, because this is a desired effect.
b. Withhold the dose and notify the provider of the heart rate.
c. Request an order for a lower dose of the medication.
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