Intervention-Pharmacology for Nurses: Practical Applications

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Chapter 23: Anti-Anginal Drugs Test, Nitroglycerin, Patient, Blood Pressure, Intervention

The key terms in this Pharmacology course include Anti-anginal drugs Test, Nitroglycerin, Patient, Blood Pressure, Chest, Heart Rate, Respiratory Rate, Isosorbide Mononitrate, Sustained-Release Tablet, Priority Nursing Intervention, Angina Pain, Acute Chest Pain, Adverse Effects, Nitroglycerin Sublingual Tablets

Before administering isosorbide mononitrate sustained-release tablet to a patient, what is the priority nursing intervention?

Remind the patient to take the tablet before meals.

Emphasize that the patient should swallow the tablet whole.

Obtain a blood pressure reading.

Advise the patient that Tylenol is used to treat headache.

Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

The patient states to the nurse, “My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?” Which statement by the nurse explains preload to this patient?

“It is the blood return to the heart.”

“It is the oxygen demand of the heart.”

“It is dilation of arteries and veins throughout the body.”

“It is the pressure against which the heart must pump.”

Preload is determined by the amount of blood in the ventricle just before contraction.

The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin sublingual tablets. Which instructions would the nurse include?

Chew or swallow the tablet for the quickest effect.

Keep the tablets locked in a safe place until you need them.

Sit or lie down before taking medication.

Take five tablets every 3 minutes for chest pain.

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. Intervention

A patient receiving IV nitroglycerin at 20 mcg/min and now 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 priority nursing action?

Assess the patient’s lung sounds.

Recheck the patient’s vital signs in 1 hour.

Notify the health care provider.

Decrease the IV 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 IV nitroglycerin infusion. Before notifying a provider, follow standing orders or protocol.

A patient who is taking nitroglycerin sublingual tablets is complaining of flushing and headaches. What is the nurse’s best response?

“Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin.”

“Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place.”

“These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin.”

“Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication.”

Headache, flushing of the face, dizziness, and fainting are the most common adverse effects of nitroglycerin and the headache generally subsides after the start of therapy.

For a patient receiving IV nitroglycerin, what are the priority nursing interventions? (Select all that apply.)

Check the heart rate.

Measure intake and output.

Auscultate lung sounds.

Monitor blood pressure.

Assess for worsening chest pain.

IV nitroglycerin can cause sudden and severe hypotension, worsening of chest pain, and significant changes in heart rate (<60 beats/min or >100 beats/min).

Which instruction would be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?

“If you get chest pain, apply a second patch next to the first patch.”

“Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder.”

“Make sure to rub a lotion or cream on the skin before putting on a new patch.”

“If you get a headache, remove the patch for 4 hours and then reapply.”

A nitroglycerin patch should be applied to a clean, residue-free, hairless, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and if headache occurs, the patient should not change the patch removal schedule to avoid these headaches. Sublingual nitroglycerin should be used to treat chest pain.