Adams4e Tif Ch27

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 27Question 1Type: MCSA

The patient says to the nurse, "My doctor said I can't have fried chicken anymore because I have heart disease. I've eaten it all my life and am fine except for some indigestion lately." What is the best response by the nurse?

1. "Did your doctor mention exercise? That is the most important lifestyle change to slow the progression of your heart disease."

2. "Your indigestion is an indication that your body cannot tolerate fatty foods; this causes an increased workload for your heart."

3. "Fried chicken is actually okay, but you must be very careful with the type of fat that you fry the chicken in."

4. "Your indigestion could actually be chest pain caused by narrowed coronary arteries; you will need a low-fat diet."

Correct Answer: 4

Rationale 1: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats. Some patients experience angina pain in the midepigastrium, which is an indication of coronary artery disease (CAD) not an intolerance of fatty foods. Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD). The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

Rationale 2: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats. Some patients experience angina pain in the midepigastrium; which is an indication of coronary artery disease (CAD) not an intolerance of fatty foods. Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD). The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

Rationale 3: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats. Some patients experience angina pain in the midepigastrium; which is an indication of coronary artery disease (CAD) not an intolerance of fatty foods. Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD). The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

Rationale 4: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats. Some patients experience angina pain in the midepigastrium; which is an indication of coronary

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

artery disease (CAD) not an intolerance of fatty foods. Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD). The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 27-1

Question 2Type: MCMA

The nurse is conducting an education class about myocardial blood supply for patients with coronary artery disease (CAD). The nurse determines that learning has occurred when the patients make which statement(s).

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "The heart has right and left arteries that arise from the aorta."

2. "The coronary arteries carry blood away from the heart to the right atrium."

3. "Anastomoses are small arteries that supply blood to the heart."

4. "Coronary arteries primarily carry blood to the left ventricle."

5. "The right and left arteries have smaller branches that go around the heart."

Correct Answer: 1,3,5

Rationale 1: The myocardium receives blood from the right and left coronary arteries that arise from aortic sinuses at the base of the aorta. These divulge into smaller branches that encircle the heart. Numerous smaller vessels, known as anastomoses, serve as communication networks among the coronary arteries. The coronary veins, not arteries, carry blood to the right atrium. The coronary arteries supply blood to all areas of the heart, not primarily the left ventricle.






Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 27-2


The patient is being treated for angina. He asks the nurse if angina is the same thing as having a heart attack. What is the best response by the nurse?



1. "Severe emotional distress and panic can accompany angina."

2. "A heart attack, or myocardial infarction, means part of your heart has died."

3. "Actually, it depends on what type of angina you mean; there are several types."

4. "They are basically the same, but with angina, part of your heart dies."

5. "Angina is caused by insufficient oxygen to the myocardium."

Correct Answer: 1,2,5Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 1: Angina pectoris is acute chest pain caused by insufficient oxygen reaching a portion of the myocardium. Accompanying the discomfort is severe emotional distress, a feeling of panic with fear of impending death. A myocardial infarction indicates ischemia and necrosis have occurred to the affected part of the myocardium. Angina and myocardial infarction are different in that with myocardial infarction ischemia and necrosis occurs to a portion of the myocardium. There are several types of angina; however this response does not answer the patient's question.





Global Rationale:


Question 4Type: MCSA


The nurse is providing care to a patient who has experienced several episodes of angina. What is the primary outcome for this patient?

1. The patient will experience relief of chest pain with anticoagulant therapy.

2. The patient will experience relief of chest pain with nitrate therapy.

3. The patient will experience relief of chest pain with aspirin therapy.

4. The patient will experience relief of chest pain with therapeutic lifestyle changes.

Correct Answer: 2

Rationale 1: A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Anticoagulant therapy is used to prevent additional thrombi from forming post–myocardial infarction; it will not relieve angina pain. Therapeutic lifestyle changes are significant if the patient is to maintain a healthy heart, but they will not relieve chest pain; this is accomplished with medications. Aspirin therapy following an acute myocardial infarction dramatically reduces mortality due to its antiplatelet function; it will not relieve angina pain.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning


Learning Outcome: 27-4


The patient takes nitroglycerine (Nitrostat) for relief of occasional stable angina. The nurse would be most concerned about which statement made by the patient?

1. "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem."

2. "I'm going water skiing tomorrow; I hope my angina isn't a problem."

3. "I really don't like those little pills. I've heard about patches: can I try them?"

4. "My angina has been a little more frequent. Do I need a painkiller too?"

Correct Answer: 1

Rationale 1: A patient with erectile dysfunction is likely to use sildenafil (Viagra). Concurrent use of sildenafil (Viagra) and nitroglycerine (Nitrostat) may cause life-threatening hypotension and cardiovascular collapse. An activity like waterskiing could precipitate angina, however this can be prevented by taking nitroglycerine (Nitrostat) prior to the activity (prophylactic use). Occurrences of stable angina can change somewhat in frequency; however an analgesic is not indicated. Patches can be substituted for pills in many cases; this is a reasonable question, but not the primary concern at this time.




Global Rationale:




The nurse is preparing to administer nitroglycerine via the intravenous route. What must the nurse plan to do prior to administering this medication?

1. Use gloves to prevent self-administration.

2. Instruct the patient to avoid moving the arm in which the medication is infusing.

3. Cover the intravenous (IV) bottle to decrease light exposure.

4. Darken the room to decrease light exposure.

Correct Answer: 3

Rationale 1: For intravenous (IV) administration, cover the intravenous (IV) bottle to reduce degradation of nitrates due to light exposure. Wearing gloves is indicated when the nurse is administering nitroglycerine paste or ointment to prevent self-administration. Darkening the room is not as effective as covering the intravenous (IV) bottle in decreasing light exposure. Also, the patient might not want the room darkened. There is no reason for the patient to avoid arm movement during intravenous (IV) administration of nitroglycerine.





Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 27-5


The nurse has completed medication education with the patient who is receiving atenolol (Tenormin). The nurse determines that teaching is effective when the patient makes which statement?

1. "I must avoid grapefruit juice when I take this medicine."

2. "I must call my doctor if I want to stop this medicine."

3. "I must check my pulse before taking the medicine, and call the doctor if it is less than 50."

4. "I must take this medicine with food so it will be properly absorbed."

Correct Answer: 2

Rationale 1: When beta blockers are abruptly discontinued, adrenergic receptors are stimulated causing excitation. This could result in tachycardia or myocardial infarction (MI). Atenolol (Tenormin) may be taken with or without food. Atenolol (Tenormin) is not metabolized through the CYP 450 chromosome system, so grapefruit juice is not contraindicated. Patients should check their pulse prior to taking atenolol (Tenormin), but they should call the physician if the pulse is less than 60, not 50.



Rationale 4: When beta blockers are abruptly discontinued, adrenergic receptors are stimulated causing excitation. This could result in tachycardia or myocardial infarction (MI). Atenolol (Tenormin) may be taken with or without food. Atenolol (Tenormin) is not metabolized through the CYP 450 chromosome system, so grapefruit juice is not contraindicated. Patients should check their pulse prior to taking atenolol (Tenormin), but they should call the physician if the pulse is less than 60, not 50.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:



The patient is receiving diltiazem (Cardizem) and wants to know why he developed a headache after taking the medication. What is the best response by the nurse?

1. "Diltiazem (Cardizem) causes the blood vessels in your brain to widen; giving you the headache."

2. "Diltiazem (Cardizem) increases prostaglandin synthesis; giving you the headache."

3. "Diltiazem (Cardizem) releases Substance P, activating pain receptors in your brain and giving you the headache."

4. "Diltiazem (Cardizem) causes the blood vessels in your brain to narrow; giving you the headache."

Correct Answer: 1

Rationale 1: Side effects of diltiazem (Cardizem) are generally not serious and are related to vasodilation: headache, dizziness, and edema of the ankles and feet. Side effects of diltiazem (Cardizem) are related to vasodilation, not vasoconstriction. Diltiazem (Cardizem) does not alter prostaglandin synthesis. Diltiazem (Cardizem) does not lead to a release of Substance P.




Global Rationale:




The patient in the emergency department experienced an acute myocardial infarction (MI) 8 hours ago. The nurse is administering reteplase (Retavase) intravenously (IV). The patient asks the nurse what is being done. What is the best response by the nurse?

1. "This medicine is widening the arteries in your heart so they can get more oxygen."

2. "This medication is dissolving the clot that is causing your heart attack."

3. "This medicine is thinning your blood so more clots will not develop."

4. No response is indicated; the patient is past the time frame where thrombolytic therapy is effective.

Correct Answer: 2

Rationale 1: When treating myocardial infarction (MI), thrombolytic therapy is administered to dissolve clots obstructing the coronary arteries, thus restoring circulation to the myocardium. Thrombolytics dissolve clots in coronary arteries; they are not vasodilators. Thrombolytics are most effective when administered from 20 minutes to 12 hours after the onset of myocardial infarction (MI) symptoms; this patient is within the time frame. Thrombolytics dissolve clots in coronary arteries, they are not anticoagulants.





Global Rationale:



The patient receives reteplase (Retavase) intravenously (IV). The nurse assesses the patient for orientation and level of consciousness. The patient's wife asks the nurse why this is being done. What does the nurse indicate as the reason for the assessment?

1. The medication can alter fluid balance; this affects orientation and level of consciousness.

2. The medication can cause bleeding in the brain; this affects orientation and level of consciousness.

3. The medication causes hypoglycemia; this affects orientation and level of consciousness.

4. The medication decreases oxygen to the brain; this decreases orientation and level of consciousness.

Correct Answer: 2

Rationale 1: Cerebral hemorrhage is a concern with reteplase (Retavase) therapy; the nurse must assess for changes in mental and neurological status. Reteplase (Retavase) does not decrease oxygen to the brain. Reteplase (Retavase) does not cause hypoglycemia. Reteplase (Retavase) does not alter fluid balance in the body.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub:


Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-6


The nurse has completed medication education with the patient who is receiving nitroglycerine (Nitrostat) as therapy for angina. The nurse determines that teaching is effective when the patient makes which statement?

1. "I can keep taking tablets until the pain is gone, but I should not use more than five tablets."

2. "I can take one tablet every 5 minutes, but not more than three tablets in 15 minutes."

3. "I should call my doctor if my pain is not gone after 15 minutes of taking these tablets."

4. "I can take three tablets, one every 10 minutes, but not more than three tablets in 30 minutes."

Correct Answer: 2

Rationale 1: Patients must be instructed to take one nitroglycerine (Nitrostat) tablet (under the tongue) every 5 minutes until pain is relieved, or up to three doses. Nitroglycerine (Nitrostat) tablets should be taken every 5 minutes, not every 10 minutes. Patients should follow the time frame of taking a nitroglycerine (Nitrostat) tablet every 5 minutes and not exceed three tablets. Calling the physician is appropriate, but the patient must still know the protocol for taking nitroglycerine (Nitrostat) tablets.

Rationale 2: Patients must be instructed to take one nitroglycerine (Nitrostat) tablet (under the tongue) every 5 minutes until pain is relieved, or up to three doses. Nitroglycerine (Nitrostat) tablets should be taken every 5 minutes, not every 10 minutes. Patients should follow the timeframe of taking a nitroglycerine (Nitrostat) tablet every 5 minutes and not exceed three tablets. Calling the physician is appropriate, but the patient must still know the protocol for taking nitroglycerine (Nitrostat) tablets.



Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 27-6


The nurse is teaching a class on antianginal drugs to a group of patients who have experienced myocardial infarctions (MIs). The nurse determines that learning has occurred when a patient makes which statement?

1. "These medications decrease how much oxygen my heart needs."

2. "These medications thin my blood so my heart receives more oxygen."

3. "These medications increase the amount of oxygen my heart receives."

4. "These medications increase oxygen to my heart by increasing nitric oxide production."

Correct Answer: 1

Rationale 1: The primary means by which antianginal drugs terminate an acute angina episode, or decrease the frequency of angina episodes, is by reducing the myocardial demand for oxygen. Antianginal medications cannot increase the oxygen supply to the myocardium. Antianginal medications do not have an anticoagulant effect. Antianginal medications do not increase nitric acid production.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 27-5Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


The patient receives amlodipine (Norvasc) for treatment of angina. What is a primary assessment for the nurse?

1. A sudden weight loss of 5 pounds or more

2. Hypokalemia and hypernatremia

3. Marked increase in international normalized ration (INR) levels

4. A sudden weight gain of 2 pounds or more

Correct Answer: 4

Rationale 1: Calcium channel blockers may worsen heart failure. Assess for signs of fluid retention by obtaining daily weights. A sudden increase in weight of 2 pounds or more may indicate fluid retention. Calcium channel blockers do not affect the international normalized ration (INR) level. Calcium channel blockers can result in fluid retention, not fluid loss. Calcium channel blockers do not affect serum levels of potassium or sodium.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-6



The nurse has completed medication education with a post–myocardial infarction (MI) patient about nifedipine (Adalat). The nurse evaluates the education as effective when the patient makes which statement?

1. "I only need to take this medicine if I plan to do a strenuous activity."

2. "I will need to take this medicine until my stress test is normal."

3. "I only need to take this medicine when I experience chest pain."

4. "I will need to take this medicine for the rest of my life."

Correct Answer: 4

Rationale 1: Beta blockers reduce myocardial oxygen demand, which is critical for patients who have experienced a recent myocardial infarction (MI). Unless contraindicated, beta-blocker therapy continues for the remainder of the patient's life. Beta-blocker therapy must continue for the remainder of a patient's life, this is not based on the results of a test. Beta blockers are taken on a scheduled basis, not as needed (prn); this statement refers to nitrates. Beta blockers are not used prophylactically; this statement refers to nitrates.




Global Rationale:


Question 15Type: MCSAAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Which of the following would be the most likely reason that atherosclerotic plaque would be responsible for producing a myocardial infarction?

1. Atherosclerotic plaque builds up on the endocardium, preventing blood from leaving the atriums.

2. Atherosclerotic plaque results in a narrowing of 50% of the coronary arteries.

3. Atherosclerotic plaque impairs the ability of coronary arteries to constrict and dilate.

4. Atherosclerotic plaque causes a blockage that prevents blood from reaching the myocardium.

Correct Answer: 4

Rationale 1: Atherosclerotic plaque builds up inside of blood vessels that supply heart tissue oxygen-rich blood. When the blood flow is blocked, the myocardium is damaged. Atherosclerotic plaque does damage the elasticity of blood vessels, but this is less likely to produce a myocardial infarction. Atherosclerotic plaque can result in a myocardial infarction when blocked by 50%, but more likely it will not. Atherosclerotic plaque builds up in blood vessels, not in heart chambers. (p. 339)




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-1

Question 16Type: MCSAAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

The myocardium receives blood via coronary arteries that attach to

1. the aortic arch.

2. the superior vena cava.

3. the pulmonary vein.

4. the base of the aorta.

Correct Answer: 4

Rationale 1: The coronary arteries arise from the base of the heart.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-2


Which of the following most likely would be related to angina as opposed to a myocardial infarction?

1. Chest pain relieved by one sublingual nitroglycerin

2. Chest pain that radiates to the patient's back

3. Chest pain that occurred while the patient was eating breakfast

4. Chest pain accompanied by shortness of breath

Correct Answer: 1

Rationale 1: It is essential to recognize the difference between angina and myocardial infarction because the treatments are very different. Chest pain that is relieved by one sublingual nitroglycerin is most likely angina. Chest pain that is not relieved by nitroglycerin would most likely be from a myocardial infarction. Chest pain


related to angina is often experienced when the person is doing a strenuous activity. Eating is not strenuous. Chest pain that is radiating or is accompanied by shortness of breath can be from angina or a myocardial infarction.

Rationale 2: It is essential to recognize the difference between angina and myocardial infarction because the treatments are very different. Chest pain that is relieved by one sublingual nitroglycerin is most likely angina. Chest pain that is not relieved by nitroglycerin would most likely be from a myocardial infarction. Chest pain related to angina is often experienced when the person is doing a strenuous activity. Eating is not strenuous. Chest pain that is radiating or is accompanied by shortness of breath can be from angina or a myocardial infarction.



Global Rationale:

Cognitive Level: UnderstandingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 27-3


The primary pharmacologic goal in treating patients experiencing stable angina is to

1. increase venous blood flow to the right atrium.

2. eliminate blockages by using thrombolytics.

3. establish a regular exercise program and diet plan.

4. increase cardiac oxygen supply and reduce cardiac oxygen demand.

Correct Answer: 4

Rationale 1: The primary pharmacologic goals are to reduce oxygen demand of the heart and increase oxygen supply. Increasing the supply of venous blood to the right atrium might be beneficial, but is not a primary goal.


Eliminating blockages via thrombolytics would be attributed to myocardial infarctions, not to stable angina. Establishing a regular exercise program and diet plan would be important, but is not a pharmacologic goal.

Rationale 2: The primary pharmacologic goals are to reduce oxygen demand of the heart and increase oxygen supply. Increasing the supply of venous blood to the right atrium might be beneficial, but is not a primary goal. Eliminating blockages via thrombolytics would be attributed to myocardial infarctions, not to stable angina. Establishing a regular exercise program and diet plan would be important, but is not a pharmacologic goal.



Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 24-4


Which of the following reduce the hearts demand for oxygen by lowering heart rate?

1. Anticoagulants and beta-adrenergic blockers

2. Calcium channel blockers and anticoagulants

3. Organic nitrates and calcium channel blockers

4. Beta-adrenergic blockers and calcium channel blockers

Correct Answer: 4

Rationale 1: Beta blockers and some calcium channel blockers reduce cardiac demand by lowering heart rate. Organic nitrates dilate vessels, and anticoagulants prevent blood clots from forming.





Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-5


Which adverse effect listed below is common for patients taking topical nitroglycerin paste?

1. Rash

2. Shortness of breath

3. Headache

4. Ventricular tachycardia

Correct Answer: 3

Rationale 1: Nitroglycerin can dilate cerebral vessels, leading to headaches. Dysrhythmias, shortness of breath, and the development of a rash are not common.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Following a myocardial infarction, elevations in which of the following cardiac markers would be seen first, and are cardiac tissue—specific?

1. White blood cells

2. Troponin I

3. Myoglobin

4. Creatine kinase

Correct Answer: 2

Rationale 1: Of the cardiac markers listed, only troponin is cardiac-specific and will be elevated within 2–4 hours.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 27-3


Which myocardial infarction patient listed below would be a candidate for reteplase (Retavase) therapy?

1. 54-year-old female with type 2 diabetes

2. 45-year-old female with a 2-week-old cranial artery repair


3. 62-year-old with a recent hemorrhagic stroke

4. 70-year-old male with active GI bleed

Correct Answer: 1

Rationale 1: Contraindications for reteplase therapy include a history of CVA (stroke), recent surgical procedure, and active bleeding.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 27-7


Which of the following is indicated for the prevention of blood clots?

1. Captopril (Capoten)

2. Reteplase (Retavase)

3. Morphine

4. Abciximab (ReoPro)

Correct Answer: 4

Rationale 1: Abciximab is a glycoprotein IIb/IIIa inhibitor (antiplatelet agent) used to prevent blood clots. Captopril is an ACE inhibitor, morphine is used for analgesia, and reteplase is used to break up blood clots.





Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 27-7


A patient asks which conditions will cause his heart to need more oxygen. The nurse answers with which statement(s)?



1. "Increasing physical activity."

2. "Watching a television show."

3. "Emotional stress."

4. "Eating a meal."

5. "Listening to music."

Correct Answer: 1,3

Rationale 1: Increased physical activity requires more cardiac output, increasing the work of the heart and increasing myocardial oxygen demand.

Rationale 2: Watching a television show generally does not require more cardiac output.

Rationale 3: Emotional stress causes epinephrine release, increasing heart rate and contractility and increasing myocardial oxygen demand.

Rationale 4: Eating a meal generally does not require more cardiac output.

Rationale 5: Listening to music generally does not require more cardiac output.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 27.1


The nurse is preparing to teach a patient therapeutic lifestyle changes that can decrease the risk of coronary artery disease. The nurse plans to include which topics in the teaching?



1. Eliminating the consumption of alcohol

2. Eliminating foods high in cholesterol and saturated fats

3. Maintaining blood pressure within normal levels

4. Exercising and maintaining a healthy weight

5. Decreasing the number of cigarettes smoked


Rationale 1: It is not necessary to eliminate the consumption of alcohol. It is recommended that the patient decrease consumption to small or moderate amounts.

Rationale 2: It is recommended that patients eliminate foods high in cholesterol and saturated fats in order to decrease the risk of CAD.

Rationale 3: Keeping blood pressure within normal levels decreases the risk of CAD.

Rationale 4: Exercising and maintaining a healthy weight decrease the risk of CAD.

Rationale 5: The patient should be encouraged to eliminate tobacco products, not just decrease the number of cigarettes smoked.

Global Rationale:

Cognitive Level: Applying


Client Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 27-4


The nurse knows that the basic strategies of antianginal therapy are



1. decreased the oxygen consumption of the brain.

2. increased myocardial contractility.

3. increased blood flow to the peripheral blood vessels.

4. increased blood flow to the myocardium.

5. decreased myocardial oxygen demand.

Correct Answer: 4,5

Rationale 1: Angina is a mismatch between myocardial oxygen supply and oxygen demand. Decreasing brain oxygen consumption will not help correct this problem.

Rationale 2: Angina is a mismatch between myocardial oxygen supply and oxygen demand. Increasing contractility will increase myocardial oxygen supply, making the angina worse.

Rationale 3: Angina is a mismatch between myocardial oxygen supply and oxygen demand. Increasing blood flow to peripheral blood vessels does nothing to correct this imbalance.

Rationale 4: Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to increase oxygen supply by increasing blood flow to the coronary arteries.

Rationale 5: Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to decrease myocardial oxygen demand.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



The nurse is teaching a patient about the pharmacological management of angina. The nurse plans to include which points in the patient teaching?



1. The medications increase the heart rate.

2. The medications dilate the veins so that the heart receives less blood.

3. The medications cause the heart to contract with less force.

4. The medications increase blood pressure.

5. The medications increase the ability of the body to produce red blood cells.

Correct Answer: 2,3

Rationale 1: Medications used to treat angina decrease the heart rate.

Rationale 2: Medications that dilate the veins so that the heart receives less blood treat angina by decreasing preload.

Rationale 3: Medications that cause the heart to contract with less force reduce contractility and are useful in treating angina.

Rationale 4: Medications used to treat angina decrease blood pressure.

Rationale 5: Antianginal medications do not cause the body to produce more red blood cells.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 27-5



The nurse is caring for a patient who is recovering from a myocardial infarction (MI). The nurse anticipates that the patient will be prescribed which medications in order to reduce postÂ?MI mortality?



1. Aspirin

2. Beta blockers

3. Narcotic analgesics

4. ACE inhibitors

5. Antidysrhythmics


Rationale 1: Aspirin is often prescribed to reduce the risk of postÂ?MI mortality.

Rationale 2: Beta-blockers are often prescribed to reduce the risk of postÂ?MI mortality.

Rationale 3: Narcotic analgesics are not prescribed to reduce the risk of postÂ?MI mortality. They are administered to manage severe pain and anxiety associated with MIs.

Rationale 4: ACE inhibitors are prescribed to reduce the risk of postÂ?MI mortality.

Rationale 5: Antidysrhythmics are prescribed to treat postÂ?MI dysrhythmias, not to reduce the risk of postÂ?MI mortality.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 27.6


The nurse is reviewing the health history for a patient who may be a candidate for thrombolytic therapy for the treatment of an MI. The nurse knows that therapy is contraindicated in which circumstances?




1. Menses

2. A history of intracranial hemorrhage

3. Hemophilia

4. Liver disease

5. Peptic ulcer disease

Correct Answer: 2,3,4,5

Rationale 1: Menses is not a contraindication for thrombolytic therapy.

Rationale 2: A history of intracranial hemorrhage is a contraindication for thrombolytic therapy.

Rationale 3: Hemophilia, a clotting disorder, is a contraindication for thrombolytic therapy.

Rationale 4: Liver disease is a contraindication for thrombolytic therapy.

Rationale 5: Peptic ulcer disease is a contraindication for thrombolytic therapy.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 27-6


Adams4e Tif Ch27

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