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.
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ANS:
While reviewing discharge instructions, a patient asks the nurse why the oral dose of the opioid is so much higher than the IV dose was. Select the nurse's best response
a. "When patients go home, they need higher doses of medication." b. "The oral form of the drug passes through the liver, and a lot is metabolized before it can achieve the effect." c. "When the physician converted the dosages, there was an error in calculation." d. "The doses should be the same. The physician must think that your pain is not well controlled."