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Case Study

a. Nitroglycerin dilates coronary arteries, which increases oxygen delivery to the heart tissue, thereby reducing chest pain.
c. A history of asthma is a contraindication to taking aspirin.

Review Questions

b. Morphine is a potent opioid agonist and can cause respiratory depression and failure. It is very important to monitor the client frequently (reassess at least every 5–10 minutes) when using morphine to control chest pain.
c. Nitroglycerin is a vasodilator, and vasodilation causes the blood pressure to drop.
a. Adenosine has a very short half-life and should be administered as a rapid IV bolus directly into a vein over 1–2 seconds, followed by a rapid saline flush.
c. The nurse should ask whether the client is taking any medications for erectile dysfunction because the use of nitroglycerin is contraindicated in clients who are taking a phosphodiesterase inhibitor such as tadalafil or sildenafil.
a. Stable angina occurs during exercise or exertion and improves with rest. Stable angina presents when the heart needs more oxygen but the supply of oxygen is restricted. Once the heart does not need increased oxygen, the angina subsides.
b. The ordered dose of diltiazem is 0.25 mg/kg, and 176 l b ÷ 2.2 k g = 80 k g , so 0.25 m g / k g × 80 k g = 20 m g .
a. The therapeutic effects of epinephrine include bronchodilation, increased heart rate, and increased blood pressure.
b. Dopamine causes vasospasm and can lead to necrosis, sloughing, and potentially gangrene if extravasation into the tissue occurs at the IV site.
d. Prolonged use of procainamide may lead to a positive antinuclear antibody test; if this occurs, the risk–benefit ratio of procainamide use should be reassessed.
a. Epinephrine is administered intramuscularly for the client in anaphylaxis who does not have ventricular fibrillation, pulseless ventricular tachycardia, asystole, or pulseless electrical activity.

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