MSN Exam for Angina Pectoris

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1) What are the anti-aginal actions of organic nitrates?

  1. Increase O2 consumption; redistribution of coronary flow to infarct areas; relief of coronary spasm; improve perfusion to other organs
  2. Decrease O2 consumption; redistribution of coronary flow to ischemic areas; relief of coronary spasm; improve perfusion
  3. Decrease O2 consumption; redistribution of coronary flow to infarct areas; relief of coronary spasm; improve perfusion

2) What are the anti-aginal actions of organic nitrates?

  1. Increase O2 consumption; redistribution of coronary flow to infarct areas; relief of coronary spasm; improve perfusion to other organs
  2. Decrease O2 consumption; redistribution of coronary flow to ischemic areas; relief of coronary spasm; improve perfusion
  3. Decrease O2 consumption; redistribution of coronary flow to infarct areas; relief of coronary spasm; improve perfusion

3) An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting:

  1. 2 to 5 g of a simple carbohydrate.
  2. 10 to 15 g of a simple carbohydrate
  3. 18 to 20 g of a simple carbohydrate.
  4. 25 to 30 g of a simple carbohydrate

4) Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?

  1. Angina pectoris
  2. Cardiomyopathy
  3. Left-sided heart failure
  4. Right-sided heart failure

5) A patient with stable angina is more likely to experience chest pain when the heart needs extra oxygen. During which of the following situations does the heart need extra oxygen?

  1. Smoking a cigarette
  2. Eating and digesting a heavy meal
  3. Running up the stairs or other physical activity
  4. All of the above

6) Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication?

  1. angina pectoris
  2. atherosclerosis
  3. atheroma
  4. ischemia

7) What are the effects of organic nitrates?

  1. Vasodilation; dilation of large veins results in decreased after-load and decreased cardiac output
  2. Vasodilation; dilation of large veins results in decreased pre-load and decreased cardiac output
  3. Vasodilation; dilation of large veins results in decreased pre-load and decreased blood pressure

8) Angina (angina pectoris) is a type of temporary chest pain, pressure or discomfort.

  1. True
  2. False

9) What is the mechanism by which organic nitrates exert their effects?

  1. Increased PKG which causes relaxation of smooth muscle
  2. Increased PKG which causes relaxation of large veins and arteries
  3. Decreased PKG which causes relaxation of smooth muscle

10) A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the following instructions does the nurse include in the teaching?

  1. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.”
  2. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”
  3. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.”
  4. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.

11) To enhance the percutaneous absorption of nitroglycerine ointment, it would be MOST important for the nurse to select a site that is

  1. muscular.
  2. near the heart.
  3. non-hairy.
  4. over a bony prominence.

12) What causes unstable angina?

  1. Atherosclerosis which ruptures, thrombus forms on top, often leading to complete occlusion
  2. Atherosclerosis which reduces O2 to tissue
  3. Atherosclerosis which ruptures, thrombus forms on top, always followed by breaking up and embolus formation leading to complete occlusion and infarction

13) What are the effects of organic nitrates?

  1. Vasodilation; dilation of large veins results in decreased after-load and decreased cardiac output
  2. Vasodilation; dilation of large veins results in decreased pre-load and decreased cardiac output
  3. Vasodilation; dilation of large veins results in decreased pre-load and decreased blood pressure

14) What causes unstable angina?

  1. Atherosclerosis which ruptures, thrombus forms on top, often leading to complete occlusion
  2. Atherosclerosis which reduces O2 to tissue
  3. Atherosclerosis which ruptures, thrombus forms on top, always followed by breaking up and embolus formation leading to complete occlusion and infarction

15) What are the drug therapy targets for angina treatment?

  1. Decrease heart rate; increase activation of RAAS system
  2. Increase cardiac output; decrease body fluid volume
  3. Improve myocardial perfusion; reduce metabolic demand
Answers and Rationales
  1. B. Decrease O2 consumption; redistribution of coronary flow to ischemic areas; relief of coronary spasm; improve perfusion 
  2. B. Decrease O2 consumption; redistribution of coronary flow to ischemic areas; relief of coronary spasm; improve perfusion
  3. B. 10 to 15 g of a simple carbohydrate . To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
  4. D. Right-sided heart failure. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output.
  5. D. All of the above. The heart needs extra oxygen when someone smokes a cigarette, eats a heavy meal, runs up the stairs or engages in other physical activity. Someone with stable angina is more likely to experience chest pain during any of these activities.
  6. A. angina pectoris . Angina pectoris is a symptom of myocardial ischemia.Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens. Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels. Ischemia is insufficient tissue oxygenation and may occur in any part of the body.
  7. B. Vasodilation; dilation of large veins results in decreased pre-load and decreased cardiac output 
  8. A. True
  9. A. Increased PKG which causes relaxation of smooth muscle 
  10. D. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved. Angina pectoris is caused by myocardial ischemia related to decreased coronary blood supply. Giving nitroglycerine will produce coronary vasodilation that improves the coronary blood flow in 3 – 5 mins. If the chest pain is unrelieved, after three tablets, there is a possibility of acute coronary occlusion that requires immediate medical attention.
  11. C. non-hairy. Nitroglycerine: used in treatment of angina pectoris to reduce ischemia and relieve pain by decreasing myocardial oxygen consumption; dilates veins and arteries. Side effects: throbbing headache, flushing, hypotension, tachycardia. Nursing responsibilities: teach appropriate administration, storage, expected pain relief, side effects. Ointment applied to skin; sites rotated to avoid skin irritaion. Prolonged effect up to 24 hours.
  12. A. Atherosclerosis which ruptures, thrombus forms on top, often leading to complete occlusion
  13. B. Vasodilation; dilation of large veins results in decreased pre-load and decreased cardiac output 
  14. A. Atherosclerosis which ruptures, thrombus forms on top, often leading to complete occlusion
  15. C. Improve myocardial perfusion; reduce metabolic demand 

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