1 A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? Show
a To relieve exertional angina c To prevent the occurrence of angina 2 A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a The intravenous form is given by IV push injection. c Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. 3 Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a "I can take this drug to stop an attack of angina." a "I can take this drug to stop an attack of angina." 4 While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a Hypertension d Asthma 5 A 68-year-old man has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." 6 The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a A glass of wine a, c, e 7. The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose? 3 tablets per dose (150 mg per dose) Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin
patch? A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." Correct A nitroglycerin patch should be applied to a nonhairy, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain. Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient? A. It is the blood volume within the heart. Preload is determined by the amount of blood in the ventricle just before contraction. Which statement by the patient demonstrates a need for further education regarding nitroglycerin? D. "I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient? C. It is the pressure against which the heart must pump. Afterload is determined by the pressure in the aorta just before systole. Which nitrate preparation or dosage form has the longest duration of action? D. Transdermal nitroglycerin patch The transdermal patch has an 8- to 12-hour duration of action, compared with 0.5 to 6 hours for the other choices. In order to prevent the development of tolerance, the nurse instructs the patient to perform which action? C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. Tolerance can be prevented by maintaining an 8-hour nitrate-free period each day. What is included in the priority
assessment before administering isosorbide mononitrate (Imdur)? C. Blood pressure Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering. The patient asks how nitroglycerin should be stored while traveling. What is
the nurse's best response? B. "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. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag. Patient teaching regarding sublingual nitroglycerin should include which statement? D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness." Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve. Which statement indicates that the patient understands discharge teaching about nitroglycerin? B. "I will need to keep the nitroglycerin stored in the bottle it comes in." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months in order to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just before engaging in activity that is known to cause chest pain. A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response? C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." When applying nitroglycerin ointment, the nurse should
perform which action? B. Apply the ointment to a nonhairy part of the upper torso. Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin. Rubbing would increase absorption and risks of side effects. 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 best action? B. 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 minutes while changing the rate of the intravenous nitroglycerin infusion. It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)? D. Erectile dysfunction medications Concurrent administration of erectile dysfunction medications such as sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension. When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis? C. Bronchial asthma Noncardioselective beta blockers should be used with caution in patients with bronchial asthma since any level of blockade of beta2-receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone. Which are common side effects of nitroglycerin? (Select all that apply.) B. Flushing When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.) A. Blood pressure What 3 instructions should be given to a patient taking transdermal nitroglycerine?For transdermal dosage form (skin patch): Adults—Apply one patch once a day in the morning. Leave the patch in place for a total of 12 to 14 hours. Children—Use and dose must be determined by your doctor.
What are the precautions of nitroglycerin?Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue or between the cheek and gum, and let it dissolve. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.
Which patient instruction will help prevent tolerance to nitrate therapy?One of the ways to prevent tolerance is to change the dosing of regular nitrate therapy to guarantee a nitrate-free interval. For example, if patients take nitrate patches, the recommendation is only to wear them for 12 hours to allow a nitrate-free interval of 8–12 hours. This minimises the risk of tolerance.
Why is a patient who is using transdermal nitroglycerin patch instructed to remove the patch at bedtime and apply a new one in the morning?Since continuous 24-hour plasma concentrations of nitroglycerin do not appear to be desirable, alternative approaches to therapy are needed. A simple method to minimise tolerance with transdermal nitroglycerin patches is to remove the patch at bedtime and reapply a new patch in the morning.
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Which instruction does the nurse provide a patient who is prescribed nitroglycerin patches in order to prevent the development of tolerance to nitrates?
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