Chapter 35: Antianginal and Vasodilating Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. When caring for a client with angina, the nurse instructs the client to place the nitroglycerin tablet between the cheek and the gums. Which form of nitroglycerin is the nurse administering? a. Sublingual b. Transdermal c. Buccal d. Translingual Answer: C Rationale: The nurse is administering the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the client to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the client to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, transdermal, and translingual routes. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the skin. In the translingual route, a spray is directed under or onto the tongue. Question format: Multiple Choice Chapter: 35 Learning Objective: 2 Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 450, Nitrates—Stopping a Pain Attack 2. A client is being discharged after being treated with nitroglycerin for an acute anginal attack. The nurse should include which instruction when providing the client with discharge instructions concerning how to properly administer nitroglycerin ointment at home? a. Apply a thick layer of the ointment. b. Rub the ointment onto the skin. c. Use an applicator for applying the ointment. d. Apply on the same site during every application. Answer: C Rationale: The nurse should instruct the client to use an applicator to apply a thin layer of the nitroglycerin ointment. The ointment should not come in contact with the skin of the person applying it, as it gets easily absorbed. The nurse must instruct the client not to rub the ointment while applying as it delivers large amounts of the drug into the system. The client should not apply the ointment on the same site during every application. The application site should be rotated to prevent inflammation of the area. Question format: Multiple Choice Chapter: 35 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 450, Administering Nitroglycerin Ointment 3. The nurse is preparing to teach discharge instructions to a client with angina. Which instruction should the nurse prioritize giving the client when teaching about the prescribed oral nitroglycerin? a. Store the nitroglycerin capsules in a plastic container. b. Place the nitroglycerin capsules along with other tablets. c. Recap the container tightly after taking out the capsules. d. Do not store nitroglycerin in a dark container. Answer: C Rationale: The nurse should instruct the client to recap the container tightly after taking out the nitroglycerin capsule. This is to ensure that the potency of nitroglycerin is not lost on exposure to air. Nitroglycerin should be stored in a dark container and protected from direct light exposure. The nurse should instruct the client to never store nitroglycerin under bright sunlight or in a plastic container. Nitroglycerin deteriorates when stored in plastic containers and on exposure to air and light. The nurse should instruct the client not to store nitroglycerin along with other drugs, as it loses its potency. Question format: Multiple Choice Chapter: 35 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 452, General Instructions 4. A client arrives at the urgent care center reporting chest pain and is diagnosed with angina pectoris. Which drug would the nurse expect to be prescribed? a. Nicardipine b. Hydralazine c. Minoxidil d. Nimodipine Answer: A Rationale: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an antianginal drug. Hydralazine and minoxidil are vasodilators primarily used to treat hypertension. Nimodipine is a calcium channel blocker used to treat subarachnoid hemorrhage. Question format: Multiple Choice Chapter: 35 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 454, Summary Drug Table 5. A nurse is assessing a client with angina who has received diltiazem. Which finding should the nurse prioritize and notify the health care provider for further instructions? a. Systolic pressure is 110 mm Hg b. Significant weight loss c. Lightheadedness d. Pulse rate is 45 beats per minute Answer: D Rationale: The nurse should withhold the drug and notify the health care provider when the client's pulse rate is 45 beats per minute. When calcium channel blockers are administered, there may be a fall in the pulse rate. When the pulse rate falls below 50 beats per minute, the nurse should notify the health care provider. When the systolic pressure falls below 90 mm Hg, the nurse should notify the primary health care provider. Weight gain, and not weight loss, occurs with the use of calcium channel blockers. The nurse should report weight gain. Lightheadedness is a common central nervous system adverse reaction occurring after taking the drug, and the nurse should instruct the client to lie down until the symptoms pass. Question format: Multiple Choice Chapter: 35 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 450, Ongoing Assessment 6. A client receiving amlodipine for angina is now reporting dizziness. Which intervention should the nurse prioritize to help alleviate the condition? a. Apply a cold cloth over the forehead. b. Instruct the client to lie down. c. Instruct the client to drink more water. d. Reduce the dosage of amlodipine.