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Author Question: A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the pain ... (Read 106 times)

EY67

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on: Jul 23, 2018
A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the pain intensifies.
 
  The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:
  a. an angiotensin-converting enzyme (ACE) inhibitor.
  b. intravenous nitroglycerin and a beta blocker.
  c. ranolazine (Ranexa) and quinidine.
  d. supplemental oxygen and intravenous morphine.

Question 2

A nurse is reviewing a patient's medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____.
 
  a. level of gemfibrozil; increased
  b. level of gemfibrozil; reduced
  c. anticoagulant effects; increased
  d. anticoagulant effects; reduced


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missalyssa26

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Reply #1 on: Jul 23, 2018
Answer to Question 1

ANS: B
This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.

Answer to Question 2

ANS: C
Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may need to be reduced.


EY67

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Reply #2 on: Jul 23, 2018
Both answers were spot on, thank you once again


missalyssa26

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Reply #3 on: Jul 23, 2018
Great! Please up vote :D


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