Nitrates

Every question here, with the answer

1. A client with angina has an order for sublingual nitroglycerin for chest pain. Before giving it, the nurse finds a blood pressure of 84/50 mm Hg. What should the nurse do?

   1. Apply a nitrate patch instead.
   2. Give the dose and recheck blood pressure in 5 minutes.
   3. Give the dose with a glass of water.
   4. Hold the dose and notify the health care provider.

   Answer: Hold the dose and notify the health care provider.

   Nitrates should not be given when systolic blood pressure is less than 90 mm Hg, and the provider is notified. Giving any nitrate, including a patch, would lower the pressure further, and patches are not used for acute chest pain.

2. A client with a prescription for sublingual nitroglycerin asks what to do if chest pain does not go away. Which instruction is correct?

   1. Take one tablet every 5 minutes for up to three doses; if pain continues, call 911.
   2. Apply an extra nitrate patch for fast relief.
   3. Take three tablets at once, then wait an hour.
   4. Take one tablet every hour until the pain stops.

   Answer: Take one tablet every 5 minutes for up to three doses; if pain continues, call 911.

   The client takes one sublingual nitrate every 5 minutes for three doses if pain persists, and calls 911 if chest pain continues. Patches are not used for acute chest pain, and the other timings are not the teaching.

3. A client on nitroglycerin tells the nurse he also takes sildenafil for erectile dysfunction. Why is this combination dangerous?

   1. It makes the nitrate ineffective against chest pain.
   2. It causes severe hyperkalemia.
   3. It causes the nitrate patch to fall off.
   4. It can cause severe hypotension and cardiac decompensation.

   Answer: It can cause severe hypotension and cardiac decompensation.

   Nitrates should not be taken with PDE inhibitors such as sildenafil because they can cause severe hypotension and cardiac decompensation. The other effects are not described in the section.

4. A nurse is teaching a client who will use a nitroglycerin patch. Which instructions should the nurse include? Select all that apply.

   1. Apply the patch once daily as a maintenance medication.
   2. Remove the patch for 10 to 12 hours before placing a new one.
   3. Use the patch to treat sudden chest pain.
   4. Avoid hairy areas when applying the patch.
   5. Rotate application sites.

   Answer: Apply the patch once daily as a maintenance medication., Remove the patch for 10 to 12 hours before placing a new one., Avoid hairy areas when applying the patch., Rotate application sites.

   Patches are applied once daily for maintenance, placed away from hairy areas, removed for 10–12 hours to prevent tolerance, and rotated to prevent skin irritation. The client should not use patches for acute chest pain.

5. An older adult is starting isosorbide mononitrate. Which teaching points are appropriate? Select all that apply.

   1. Headache means the drug must be stopped immediately.
   2. If you feel faint from low blood pressure, lie on your back with legs elevated and call your provider.
   3. Rise slowly from a lying or sitting position.
   4. Acetaminophen may help relieve headaches from the drug.
   5. Take erectile dysfunction medications only in the evening.

   Answer: If you feel faint from low blood pressure, lie on your back with legs elevated and call your provider., Rise slowly from a lying or sitting position., Acetaminophen may help relieve headaches from the drug.

   Older clients are at higher risk for postural hypotension and should rise slowly, headaches can be relieved with acetaminophen, and low blood pressure is managed by lying flat with legs elevated and notifying the provider. Erectile dysfunction drugs should not be taken with nitrates at any time, and the section does not say to stop the drug for headache.

6. A client asks where to keep their sublingual nitroglycerin tablets. What should the nurse teach?

   1. In the refrigerator in a plastic bag.
   2. In the original amber glass bottle, away from light, in a dry place.
   3. In a clear container on a sunny windowsill so they are easy to find.
   4. In a pill organizer in the bathroom.

   Answer: In the original amber glass bottle, away from light, in a dry place.

   Sublingual nitrates are stored away from light in a dry place in the original amber glass bottle. A bathroom is humid, and clear containers or plastic bags do not protect from light or moisture as described.