A patient who has begun using transdermal nitroglycerin for ...

[cdr_15]

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:
 
  a. digoxin (Lanoxin) to slow the heart rate.
  b. immediate discontinuation of the nitroglycerin.
  c. periods of rest when the heart rate increases.
  d. verapamil as an adjunct to nitroglycerin therapy.

Question 2

A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, Nitroglycerin:
 
  a. dilates coronary arteries to increase blood flow to the heart.
  b. increases the oxygen supply to the cardiac muscle.
  c. increases ventricular filling to improve cardiac output.
  d. promotes vasodilation, which reduces preload and oxygen demand.

[carolinefletcherr]

Answer to Question 1

ANS: D
Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.

Answer to Question 2

ANS: D
Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain.

[cdr_15]

Excellent

[zacnyjessica]

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