The nurse understands that to reduce tolerance to nitrates in a ...

[kodithompson]

The nurse understands that to reduce tolerance to nitrates in a patient with stable angina, the patient should be dosed with
 
  a. SL nitroglycerin prn.
  b. sustained-release oral tablets on an intermittent schedule.
  c. transdermal nitroglycerin patches q 24 hours.
  d. nitroglycerin ointment q 8 hours.

Question 2

A patient presents to the emergency department (ED) with complaints of dull chest pain. He rates the pain as a 6 on a scale of 0 to 10.
 
  His vital signs (V/S) are: R20, BP162/90, P112, T97.8. Prior to administration of a nitrate drug, which information would be most important for the nurse to obtain?
  a. Has the patient experienced any dizziness, nausea, or vomiting?
  b. Has the patient used any alcohol or drugs for erectile dysfunction recently?
  c. Has the patient taken any drugs within the past 12 hours?
  d. Has the patient had a previous heart attack?

[Liamb2179]

Answer to Question 1

ANS: B
Tolerance is most likely to develop with high-dose therapy and uninterrupted therapy. To prevent tolerance, nitroglycerin and other nitrates should be used in the lowest effective dosages, and long-acting formulation (eg, patches, sustained-release preparations) should be used on an intermittent schedule that allows at least 8 drug-free hours each day, usually during the night.
SL nitroglycerin is not used for stable angina; it is a prn agent for acute angina.
Transdermal patches should be used q 12 hours, not q 24 hours.
Nitroglycerin ointment is not indicated around the clock, because tolerance will develop; a period of at least 8 drug free-hours is necessary to prevent this.

Answer to Question 2

ANS: B
Nitroglycerin can intensify the effects of other hypotensive agents, including drugs that have vasodilating effects, such as drugs for erectile dysfunction. Patients should also be instructed to avoid alcohol.
Asking the patient about dizziness, nausea, and vomiting may be pertinent, but is not most important for impending chest pain.
This response is not as specific regarding the erectile dysfunction drugs so it is not the most important question to ask given the other options to choose from in the list of answers
This is an important issue but not as important as answer 2 which asks about the alcohol or erectile dysfunction drugs.

[kodithompson]

Thank you!

[Liamb2179]

Always glad to help...