Unstable Angina

Question 1

Which type of angina increases in frequency, duration, and severity as the time progresses?
1 Unstable angina
2 Prinzmetal’s angina
3 Microvascular angina
4 Chronic stable angina

Answer 1

ANS:1
Unstable angina is a chronic stable angina that increases in frequency, duration, and severity as the time progresses. Prinzmetal’s angina occurs primarily at rest and is triggered by smoking and increased levels of substances, such as histamine and epinephrine. Microvascular angina is triggered by activities of daily life and exertion. Chronic stable angina is provoked by exertion and relieved by rest.

Question 2

The nurse is caring for a patient who complains of a squeezing, heavy, choking sensation when performing physical activity. What would be the priority nursing action in this situation?
1 Instruct the patient to take aspirin if the pain occurs again.
2 Instruct the patient to take acetaminophen if the pain persists.
3 Instruct the patient to lie down and rest until the pain is relieved.
4 Instruct the patient to get an electrocardiogram (ECG) immediately.

Answer 2

ANS: 3
The symptoms described by the patient may be due to angina. The patient should be advised to lie down until the pain disappears because stable angina is due to exertion and can be relieved by resting. The patient should be advised to take aspirin to decrease the incidence of atherosclerosis. The patient may be instructed to take acetaminophen only if the patient experiences headache or any other muscle pain. The patient must be advised to get an electrocardiogram (ECG) in order to rule out the presence of any heart disease.

Question 3

What instruction should the nurse provide a patient who shows an ST segment depression in the electrocardiogram (ECG) to help relieve symptoms of pain between the shoulder blades?
1 Eat a full meal until you are satisfied.
2 Perform vigorous exercise to relieve the pain.
3 Take nitroglycerine immediately after any strenuous activity.
4Abstain from any kind of sexual activity until it’s deemed safe by a cardiologist

Answer 3

ANS: 4
The patient should abstain from sexual activity, which increases the cardiac workload and promotes sympathetic stimulation because it may precipitate angina. The patient should not eat a full meal or perform vigorous exercise to avoid increasing the cardiac workload that could precipitate an angina attack. Patients with stable angina should take nitroglycerin tablets before performing strenuous physical activity, rather than after, in order to prevent the occurrence of anginal attack.

Question 4

Which instructions should the nurse provide to a patient who is on nitroglycerin therapy? Select all that apply
1 “Place the nitroglycerin tablet under the tongue.”
2 “Change your position slowly after taking the medicine.”
3 “Store nitroglycerin tablets in a warm and bright environment.”
4 “Replace nitroglycerin tablets annually once the bottle is opened.”
5 “Discard nitroglycerin tablets if they do not cause a tingling sensation.”

Answer 4

ANS: 1,2,5
Nitroglycerin tablets should be placed under the tongue and allowed to dissolve. Nitroglycerin causes orthostatic hypotension on administration, so the patient should be advised to change position slowly. Nitroglycerin should cause a tingling sensation when administered; if there is not a tingling sensation, the medication should be discarded. The patient should be instructed to store nitroglycerin away from light and heat to protect it from degradation. Once the nitroglycerin bottle is opened, the tablets lose their potency and need to be replaced every six months.

Question 5

Which nursing intervention will be beneficial in patients with angina?
1 Position the patient upright and supply oxygen.
2 Rest the patient in recumbent position during attack.
3 Encourage the patient to perform isometric exercises.
4 Include a salt-rich diet to prevent orthostatic hypotension.

Answer 5

ANS. 1
A patient with angina should be placed in an upright position and supplied oxygen to provide comfort and to attain an appropriate amount of oxygen in blood unless contraindicated. A recumbent positioning of the patient may precipitate the attack. Isometric exercises are stressful and may exacerbate the symptoms by increasing the cardiac workload. Salt and saturated fat foods are restricted in the patient to prevent further complications.

Question 6

A patient with angina is prescribed a calcium channel blocker (CCB). Upon reviewing the medication history, the nurse finds that the patient is on digoxin. Which intervention by the nurse helps in ensuring safe care?
1 Monitor for QT prolongation
2 Monitor for increase in weight
3 Monitor for decrease in blood pressure
4 Monitor for increase in serum digoxin levels

Answer 6

ANS: 4
CCB directly acts on cardiac and vascular smooth muscles and promotes smooth muscle relaxation and vasodilation of coronary and systemic arteries, thereby increasing the blood flow. The nurse should closely monitor the serum digoxin levels for toxicity because CCB potentiates the action of digoxin by increasing serum digoxin levels. QT wave prolongation should be monitored upon administration of sodium current inhibitors. Weight should be monitored in patients taking beta blockers. Long-acting nitrates such as isosorbide dinitrate and isosorbide mononitrate can cause hypotension, resulting in orthostatic hypotension

Question 7

Which drugs are used in the dual antiplatelet therapy after a stent placement? Select all that apply.
1 Aspirin
2 Losartan
3 Captopril
4 Ticagrelor
5 Ranolazine

Answer 7

ANS: 1, 4
Aspirin is an antiplatelet drug that helps prevent thrombosis around the stent. Ticagrelor is also an antiplatelet drug and helps prevent clotting around the stent, thus maintaining its patency. Captopril is an angiotensin-converting enzyme inhibitor used to treat high risk chronic stable angina. Losartan is an angiotensin II receptor blocker used in patients who are intolerant of angiotensin-converting enzyme (ACE) inhibitors. Ranolazine is a sodium current inhibitor, used to treat chronic angina refractory to other medications.

Question 8

A patient with sudden stabbing pain in the chest, arms, and shoulders at unusual times of the day and night is on short-acting nitrates. Which intervention helps promote better care management in the patient?
1 Monitor for QT interval prolongation.
2 Monitor for decrease in the heart rate.
3 Monitor for decrease in blood pressure.
4 Monitor for decreased ejection fraction

Answer 8

ANS: 3
The patient has symptoms of unstable angina. The patient on short-acting nitrates such as nitroglycerin may experience orthostatic hypotension, so the blood pressure of the patient should be monitored regularly and the patient asked to make slow movements. A patient on fluoxetine must undergo monitoring for QT interval prolongation because this medication prolongs the QT interval. The patient on beta-adrenergic blockers may experience bradycardia and should be monitored for a decrease in the heart rate. The patients with heart failure should be monitored for ejection fraction.

Question 9

Which medication is responsible for the condition of a patient prescribed medications to treat stable angina and with a history of asthma who is admitted to the emergency department complaining of severe chest pain and breathlessness?
1 Short acting nitrates
2 Beta adrenergic blocker
3 Calcium channel blocker
4 Angiotensin II receptor blocker

Answer 9

ANS:2
The patient with a history of asthma should avoid beta-adrenergic blockers because they can cause bronchoconstriction, resulting in increased breathlessness. Short-acting nitrates are the first line treatment for a patient with angina and can be used safely in asthma patients. Calcium channel blockers are used in patients if β-blockers are contraindicated, poorly tolerated, or do not control anginal symptoms. Angiotensin II receptor blockers can be given to the patient safely, because they have no harmful effects on the respiratory system.

Question 10

A client diagnosed with stable angina is undergoing a 12-lead electrocardiogram. Which of the following results is not expected?

1. ST segment depression
2. ST segment elevation
3. T-wave flattening
4. T-wave inversion

Answer 10

ANS: 2
During an episode of angina, T-wave flattening or inversions and ST segment depression may be seen on the electrocardiogram due to subendocardial ischemia(Non-STEMI). ST segment elevation is seen with impending or acute myocardial infarction.

Question 11

A client is scheduled for a cardiac angiogram. Which of the following should the nurse instruct the client about this diagnostic test?

1. It is noninvasive.
2. Contrast dye is injected.
3. Clients can move about after the procedure.
4. General anesthesia is used.

Answer 11

ANS: 2
A cardiac angiogram is a procedure that visualizes the structures of the heart and vessels. This is an invasive procedure; however, it does not need general anesthesia. The client is awake during the procedure. A contrast dye is injected, and the client may feel a warm sensation. The client must maintain bed rest with the leg straight for up to 4 to 6 hours after the catheter is removed.

Question 12

.When planning the care of a client diagnosed with stable angina, which of the following would be considered a goal of treatment?

1. Decrease in ischemia and episodes of angina
2. Prevent myocardial infection
3. Reduction of risk factors
4. Reduction of stress by education

Answer 12

ANS: 1
The primary goal for the treatment of stable angina is to improve the quality of life by decreasing episodes of angina and ischemia. The second goal is to increase the quantity of life by preventing progression to myocardial infarction and death. Reduction of risk factors and education are both parts of a treatment plan.

Question 13

.A client tells the nurse that using nitroglycerin tablets causes a tingling sensation and a headache. The nurse knows that this is:

1. an emergency.
2. an allergic reaction.
3. evidence of toxicity.
4. expected.

Answer 13

ANS: 4
Nitroglycerin tablets will cause a tingling sensation and can cause feelings of the heart pounding, as well as flushing and headache. These symptoms are not an emergency, an allergic reaction, or evidence of toxicity. These symptoms are expected with nitroglycerin tablets.

Question 14

A nurse is considering contraindications to fibrinolytic therapy. Which of the following patients is an appropriate candidate for fibrinolytic therapy?

1. A patent with a peptic ulcer disease
2. A patient with a history of hemorrhagic stroke
3. A patient with a history of a motor vehicle accident 1 year ago
4. A patient with inflammatory bowel disease

Answer 14

ANS: 3
Contraindications to fibrinolytic therapy include active internal bleeding, active inflammatory bowel disease, active peptic ulcer disease, active pericarditis, defective homeostasis, gastrointestinal/genitourinary bleeding for less than 6 months, history of hemorrhagic stroke, known bleeding disorders, neurologic procedure within the past 2 months, recent surgery or trauma within 2 months, pregnancy, suspected aortic dissection, and uncontrolled hypertension.

Question 15

1. The nurse is assessing the pain of a client experiencing angina. Which of the following should be included in this assessment? (Select all that apply.)
2. Precipitating event
3. Quality
4. Radiation
5. Severity
6. Timing
7. Medication

Answer 15

ANS: 1, 2, 3, 4, 5
The memory aid PQRST can be used to assess a client experiencing symptoms of angina, and it includes precipitating event, quality, radiation, severity, and timing. Medication is not a part of this assessment.

Question 16

A client is diagnosed with angina after describing the type of pain she experiences. Which of the following are characteristics of anginal pain? (Select all that apply.)

1. Pressure
2. Heavy
3. Squeezing
4. Stabbing
5. Sharp
6. Demonstrates a clenched fist over the sternum

Answer 16

ANS: 1, 2, 3, 6
Angina pain is typically described as pressure, heavy, squeezing, and it is demonstrated by placing a clenched fist over the sternum. This hand posture is referred to as Levines sign which is the universal sign for angina. Angina pain is not stabbing or sharp.

Question 17

A client is experiencing a sudden onset of chest pain. Which of the following will the nurse do to manage this chest pain?

1. Administer intravenous morphine as prescribed.
2. Provide oxygen.
3. Insert an indwelling urinary catheter.
4. Position the client on the left side.
5. Administer nitroglycerin as prescribed.
6. Administer aspirin as prescribed.

Answer 17

ANS: 1, 2, 5, 6
The emergency management of chest pain follows the memory aid MONA; that is, morphine, oxygen, nitroglycerin, and aspirin. An indwelling urinary catheter and positioning the client on the left side are not interventions for the emergency management of chest pain.

Question 18

What should a person with unstable angina avoid?

a. Walking outside
b. Eating red meat
c. Swimming in warm pool
d. Shoveling snow

Answer 18

ANS: D

The person with angina should avoid exposure to cold, heavy exercise, eating heavy meals, and emotional stress.

Question 19

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include:

a. substernal pain that radiates down the left arm.
b. epigastric pain that radiates to the jaw.
c. indigestion, nausea, and eructation.
d. fatigue, shortness of breath, and dyspnea.

Answer 19

ANS: A

The pain often radiates down the left inner arm to the little finger and also upward to the shoulder and jaw.

Question 20

A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following?

a. Complete occlusion of a coronary artery
b. Fatty streak within the intima of a coronary artery
c. Partial occlusion of a coronary artery with a thrombus
d. Vasospasm of a coronary artery

Answer 20

ANS: C
In unstable angina, some blood continues to flow through the affected coronary artery; however, flow is diminished related to partial occlusion. The pain in unstable angina is more severe, may occur at rest, and requires more frequent nitrate therapy.

Question 21

A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated?

a. ACE inhibitors and diuretics
b. Morphine sulfate and oxygen
c. Nitroglycerin, oxygen, and beta-blockers
d. Statins, bile acid, and nicotinic acid

Answer 21

ANS: C

Conservative intervention for the patient experiencing angina includes nitrates, beta-blockers, and oxygen.

Question 22

The nurse recognizes indications of unstable angina if a patient experiences what symptoms?
1 Dyspnea, hyperglycemia, and polyuria
2 Nausea, sweating, and shortness of breath
3 Peripheral edema and decreased urinary output
4 Confusion, dysrhythmias, and difficulty breathing

Answer 22

ANS: 2
A patient experiencing fatigue, indigestion, and shortness of breath may experiencing an unstable anginal attack. A patient experiencing dyspnea, hyperglycemia and polyuria may have diabetes. A patient with peripheral edema and a decreased urine output may have right ventricular dysfunction or heart failure due to UA or coronary artery disease. Altered mental status (confusion), difficulty in breathing, dizziness, and dysrhythmias are observed in elder patients with UA.

Question 23

A patient with chest pain due to coronary artery spasms does not respond to intravenous heparin administration. The nurse anticipates that the patient will receive a prescription for which treatment?
1 Antiplatelet and statins therapy
2Percutaneous coronary intervention
3Dual antiplatelet therapy and heparin
4Transmyocardial laser revascularization

Answer 23

ANS: 2
A patient with chest pain due to coronary artery spasms that are unresponsive to intravenous heparin administration would receive percutaneous coronary intervention (PCI). PCI can help open the blockage when thrombolytic therapy fails. Antiplatelet and statins therapy improves vein graft patency in a patient who has undergone CABG involving the saphenous vein. Dual antiplatelet therapy and heparin will help a patient with ongoing angina and negative cardiac markers. Transmyocardial laser revascularization is used for a patient with advanced coronary artery disease and persistent angina even after maximum medical therapy.

Question 24

The nurse explains the difference between exertional angina and unstable angina is that unstable angina occurs:

a. on heavy exertion.
b. when the blood pressure increases sharply.
c. when the body reacts to high stress levels.
d. unpredictably, even in sleep.

Answer 24

ANS: D
Unstable angina attacks are unpredictable and do not follow a pattern as do stable angina attacks. Unstable angina can progress into a myocardial infarction (MI) and a medical emergency.

Question 25

The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium, which is brought on by which factors? (Select all that apply.)

a. Exertion
b. Emotional excitement
c. Eating heavy meals
d. Exposure to cold
e. Allergic reaction

Answer 25

ANS: A, B, C, D

Angina is not brought on by allergy.

Question 26

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?

a. It is important not to suddenly stop taking the atenolol.
b. Atenolol will increase the strength of my heart muscle.
c. I can expect to feel short of breath when taking atenolol.
d. Atenolol will improve the blood flow to my coronary arteries.

Answer 26

ANS: A
Patients who have been taking b-blockers can develop intense and frequent angina if the medication is suddenly discontinued. Atenolol (Tenormin) decreases myocardial contractility. Shortness of breath that occurs when taking b-blockers for angina may be due to bronchospasm and should be reported to the health care provider. Atenolol works by decreasing myocardial oxygen demand, not by increasing blood flow to the coronary arteries.

Question 27

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if

a. the patient is restless and agitated.
b. the blood pressure is 190/110 mm Hg.
c. the patient complains about feeling anxious.
d. the cardiac monitor shows a heart rate of 45.

Answer 27

ANS: D
Patients taking b-blockers should be monitored for bradycardia. Because this category of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be side effects.

Question 28

Nursing management of the patient with angina is directed toward

a. immediate administration of antiplatelet therapy.
b. assessment of history of previous anginal episodes.
c. assessment and documentation of chest pain episodes.
d. administration of prophylactic lidocaine for ventricular ectopy.

Answer 28

ANS: C
Nursing interventions focus on early identification of myocardial ischemia, control of chest pain, recognition of complications, maintenance of a calm environment, and patient and family education. It is important to document the characteristics of the pain and the patients heart rate and rhythm, blood pressure, respirations, temperature, skin color, peripheral pulses, urine output, mentation, and overall tissue perfusion.

Question 29

A patient with diagnosis of CAD with chest pain is admitted into the critical care unit. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead ECG reveals nonspecific ST segment elevation. This patient probably has

a. silent ischemia.
b. stable angina.
c. unstable angina.
d. Prinzmetal angina.

Answer 29

ANS: C
Unstable angina usually is more intense than stable angina, may awaken the person from sleep, or may necessitate more than nitrates for pain relief. A change in the level or frequency of symptoms requires immediate medical evaluation. Severe angina that persists for more than 5 minutes, worsens in intensity, and is not relieved by one nitroglycerin tablet is a medical emergency. Stable angina is predictable and caused by similar precipitating factors each time; typically, it is exercise induced. Patients become used to the pattern of this type of angina and may describe it as my usual chest pain. Pain control should be achieved within 5 minutes of rest and by taking sublingual nitroglycerin. Silent ischemia describes a situation in which objective evidence of ischemia is observed on an electrocardiographic monitor but the person does not complain of anginal symptoms. Variant unstable angina, or Prinzmetal angina, is caused by a dynamic obstruction from intense vasoconstriction of a coronary artery. Spasm can occur with or without atherosclerotic lesions. Variant angina commonly occurs when the individual is at rest, and it is often cyclic, occurring at the same time every day.

Question 30

The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder?
1 Unstable angina
2 Acute coronary syndrome (ACS)
3 ST-segment-elevation myocardial infarction (STEMI)
4 Non–ST-segment-elevation myocardial infarction (NSTEMI)

Answer 30

ANS 2
The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once-stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as a STEMI.