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Angina Pectoris
Angina Nursing Care Plan
To prepare for your NCLEX exam, you will need to review the high yield topics such as angina pectoris. Know what is important in an Angina Nursing Care Plan. Get started here. Can you answer the following questions:
Question A nurse is caring for a patient who reports chest pain that started while mowing the lawn. The pain is described as a pressing, squeezing sensation in the center of the chest that has lasted for more than 10 minutes. Which of the following actions should the nurse take first?
A. Administer sublingual nitroglycerin.
B. Perform a 12-lead electrocardiogram (ECG).
C. Provide reassurance to the patient.
D. Administer aspirin.
E. Call for a cardiac stress test.
Correct Answer: B. Perform a 12-lead electrocardiogram (ECG).
Rationale: The initial action in evaluating a patient with chest pain suggestive of angina or a possible myocardial infarction is to perform a 12-lead ECG. This allows for immediate assessment of cardiac rhythm and potential ischemic changes, guiding further management. Administering sublingual nitroglycerin and aspirin are also important steps but come after the initial assessment with an ECG. Reassurance and calling for a cardiac stress test are supportive measures or follow-up actions rather than immediate priorities.
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Question A patient with a history of stable angina reports experiencing chest pain more frequently, even at rest. Which type of angina is the patient most likely experiencing now?
A. Stable angina
B. Unstable angina
C. Variant (Prinzmetal’s) angina
D. Microvascular angina
E. Nocturnal angina
Correct Answer: B. Unstable angina
Rationale: Unstable angina is characterized by chest pain that occurs at rest or with minimal exertion and represents a worsening condition that could precede a myocardial infarction. Stable angina typically occurs with predictable levels of exertion and resolves with rest or nitroglycerin. Variant (Prinzmetal’s) angina occurs due to coronary artery spasm, often at rest, but is not necessarily indicative of worsening stable angina. Microvascular angina involves pain due to dysfunction of the coronary microvasculature without significant large coronary artery obstructions. Nocturnal angina occurs specifically during sleep.
Question When teaching a patient about the management of angina, which lifestyle modification should the nurse prioritize to help reduce the frequency of angina attacks?
A. Increase calcium intake.
B. Engage in regular, moderate exercise.
C. Sleep at least 8 hours per night.
D. Increase protein intake.
E. Practice deep breathing techniques.
Correct Answer: B. Engage in regular, moderate exercise.
Rationale: Regular, moderate exercise is crucial for patients with angina as it helps improve cardiovascular health, enhances blood flow to the heart, and can help reduce the frequency of angina attacks. While adequate sleep and stress management techniques like deep breathing are important for overall health, engaging in exercise directly addresses the root causes of angina by improving cardiac efficiency and reducing risk factors for coronary artery disease. Increasing calcium and protein intake may be beneficial for general health but do not directly affect angina frequency.
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Question A nurse is assessing a patient who complains of chest pain. Which characteristic of the pain would suggest that it is anginal pain rather than pain from a non-cardiac cause?
A. Sharp and localized to the left lower quadrant of the abdomen.
B. A dull ache that is relieved by antacids.
C. A crushing sensation that radiates to the left arm or neck.
D. Intermittent claudication that worsens with exercise.
E. Pain that intensifies with deep breathing.
Correct Answer: C. A crushing sensation that radiates to the left arm or neck.
Rationale: Anginal pain is typically described as a crushing, squeezing, or pressure-like sensation in the chest that may radiate to the left arm, neck, jaw, or back. This characteristic distinguishes it from non-cardiac causes of chest pain, such as gastrointestinal distress (which might be relieved by antacids), musculoskeletal pain (which might worsen with movement or breathing), or pain localized to other regions such as the abdomen. Intermittent claudication is associated with peripheral arterial disease and affects the limbs, not the chest.
Question A patient with stable angina is prescribed sublingual nitroglycerin. The nurse instructs the patient to take one tablet if chest pain occurs, but what additional key piece of information should the nurse include in the teaching?
A. Take a second tablet if pain persists after 15 minutes.
B. Lie down to avoid dizziness after taking the tablet.
C. Only take the medication on an empty stomach.
D. Take a maximum of four tablets at 5-minute intervals if pain persists.
E. Drink a full glass of water after taking the tablet.
Correct Answer: D. Take a maximum of four tablets at 5-minute intervals if pain persists.
Rationale: When using sublingual nitroglycerin for angina, the standard instruction is to take one tablet at the onset of symptoms and then, if pain persists, take another tablet 5 minutes later, up to a maximum of three doses in 15 minutes. If the pain does not resolve after three doses, it is a medical emergency that requires immediate attention. Lying down to avoid dizziness is practical advice but not the key piece of information regarding dosage and timing. Taking the medication on an empty stomach or with a full glass of water does not apply to sublingual nitroglycerin, as its absorption is not affected by food or fluid intake.
Cardiac rhythm
Question In educating a patient on recognizing the signs of angina versus a heart attack, the nurse explains that a key difference between angina and a heart attack is:
A. Angina pain typically lasts less than 5 minutes.
B. Angina can be relieved by rest and nitroglycerin, whereas heart attack pain cannot.
C. Heart attack symptoms always include vomiting, but angina does not.
D. Angina is always precipitated by physical exertion, while heart attacks can occur at rest.
E. Heart attacks are characterized by sharp pain, whereas angina is a dull ache.
Correct Answer: B. Angina can be relieved by rest and nitroglycerin, whereas heart attack pain cannot.
Rationale: A distinguishing feature between angina and a heart attack is that angina pain typically can be relieved by rest and nitroglycerin, reflecting its nature as a temporary decrease in blood flow to the heart. In contrast, the pain from a heart attack, which results from a more prolonged reduction in blood flow leading to myocardial damage, is not relieved by these measures. Vomiting can occur in both conditions but is not a definitive distinguishing symptom. Both angina and heart attacks can occur at rest or during exertion, and the nature of the pain (sharp versus dull) is not a reliable differentiator.
Defibrillation
Question A patient with known coronary artery disease (CAD) is on a regimen of medications including aspirin, a beta-blocker, and a statin. The nurse recognizes that the primary goal of this medication regimen in the context of angina is to:
A. Immediately relieve angina pain.
B. Prevent myocardial infarction.
C. Lower blood pressure to reduce cardiac workload.
D. Increase heart rate to improve myocardial oxygen supply.
E. Reduce cholesterol levels only.
Correct Answer: B. Prevent myocardial infarction.
Rationale: The primary goal of a comprehensive medication regimen that includes aspirin (an antiplatelet agent), beta-blockers (which reduce heart rate and blood pressure, decreasing myocardial oxygen demand), and statins (which lower cholesterol and stabilize plaque) in patients with coronary artery disease (CAD) is to prevent myocardial infarction. This is achieved by addressing the underlying pathophysiological mechanisms of CAD, thereby reducing the risk of acute events like heart attacks. While some components of the regimen, such as beta-blockers, also help relieve angina by reducing cardiac workload, the overarching objective is to prevent the progression of CAD to a myocardial infarction. Lowering blood pressure and reducing cholesterol are important but are part of the broader goal of preventing myocardial infarction rather than ends in themselves.
Question A nurse is providing discharge instructions to a patient who experienced unstable angina. Which statement by the patient indicates a need for further teaching?
A. “I will avoid strenuous exercise and heavy lifting.”
B. “I should report any chest pain that occurs at rest to my doctor immediately.”
C. “It’s okay to use over-the-counter NSAIDs for pain as I normally would.”
D. “I’ll make sure to take my prescribed medications as directed.”
E. “I understand the importance of keeping my follow-up appointments.”
Correct Answer: C. “It’s okay to use over-the-counter NSAIDs for pain as I normally would.”
Rationale: The statement about using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) as usual indicates a need for further teaching because NSAIDs can increase the risk of cardiovascular events in patients with coronary artery disease (CAD). They may also interfere with the antiplatelet effects of aspirin, a common medication prescribed to patients with unstable angina to prevent myocardial infarction. Avoiding strenuous exercise, reporting chest pain, taking prescribed medications, and keeping follow-up appointments are all appropriate actions for a patient with unstable angina. The patient’s misunderstanding about NSAIDs highlights the need for education on medication interactions and the importance of consulting healthcare providers before taking new or over-the-counter medications.
Question When assessing a patient with angina, which of the following findings would the nurse interpret as an indication of a more severe underlying cardiac condition?
A. Pain that is relieved after taking sublingual nitroglycerin.
B. Pain that occurs predictably with exertion and resolves with rest.
C. A decrease in the duration of anginal episodes over time.
D. Pain that occurs spontaneously at rest with no apparent trigger.
E. A consistent pattern of angina that has not changed in several months.
Correct Answer: D. Pain that occurs spontaneously at rest with no apparent trigger.
Rationale: Pain that occurs spontaneously at rest, without any apparent trigger, suggests a more severe form of angina, such as unstable angina or variant angina, and indicates a higher risk of acute coronary syndrome or myocardial infarction. This type of pain reflects significant underlying coronary artery disease and a greater instability of coronary plaques, which can lead to complete artery occlusion. In contrast, pain that is relieved by nitroglycerin, occurs predictably with exertion, or has a consistent pattern typically represents stable angina, which, while indicative of coronary artery disease, suggests a more stable condition. A decrease in the duration of anginal episodes does not necessarily indicate a more severe condition and might reflect the effectiveness of treatment or natural variability in angina presentation.
Question A nurse is educating a patient on the use of a nitroglycerin patch for chronic stable angina. Which instruction is most important for the nurse to emphasize to prevent tolerance to nitroglycerin?
A. Apply the patch to the same site every day.
B. Wear the patch for 24 hours a day without removing it.
C. Remove the patch for a certain period each day, usually for 8-12 hours, to ensure a nitrate-free interval.
D. Use additional sublingual nitroglycerin while wearing the patch for breakthrough pain.
E. Increase the patch dosage if angina episodes increase in frequency.
Correct Answer: C. Remove the patch for a certain period each day, usually for 8-12 hours, to ensure a nitrate-free interval.
Rationale: To prevent the development of tolerance to nitroglycerin, it is crucial to ensure a nitrate-free interval each day, typically for 8-12 hours, during which the patch is removed. This approach maintains the medication’s effectiveness in controlling angina symptoms over time. Applying the patch to the same site every day can lead to skin irritation but does not address tolerance. Wearing the patch continuously without a break increases the risk of developing tolerance, making the medication less effective. While using sublingual nitroglycerin for breakthrough pain is appropriate, it does not prevent tolerance to the patch. Increasing the dosage without a healthcare provider’s guidance can lead to adverse effects and does not address the issue of tolerance.
angina presentation
During an interview with a 49-year-old male with a BMI of 31, he reports left-sided chest pain and tightness for the past 4 weeks when he walks 10 minutes to his mailbox. The chest pain is always relieved within minutes after resting. He smokes one pack of cigarettes per day. He has been treated for hypertension in the past, although he has not been taking his blood pressure medication for the past 6 months. His older brother died of a myocardial infarction at 59 years old. His vitals on your assessment today are afebrile, pulse 85 beats per minute, blood pressure 150/93 mmHg, and respiratory rate 14 breaths per minute.
angina pectoris definition
Angina pectoris or “angina” is a condition caused by a decrease in blood flow to the heart muscle. The reduced blood flow results in chest pain and other symptoms. Symptoms typically are worse during exertion and cause shortness of breath, nausea, dizziness, and sweating. Angina is found in patients with coronary artery disease or atherosclerosis. This is the cause of angina in most patients. In a small number of patients, angina may be caused by vasospasm. Atherosclerotic plaques narrow the coronary arteries that supply the blood to the heart. When angina occurs, most patients report chest tightness and pain causing the patient to have to stop the activity. Patients may experience pain in the left arm and jaw. This may be mild to moderate or severe in some patients. When it occurs, patients may take sublingual nitroglycerine if it has been prescribed.
what triggers angina?
Angina may be classified as unstable or stable. Unstable angina is typically longer than 20 minutes in duration and occurs at rest, new onset or angina that occurs more often, angina of longer duration or has an unpredictable onset, or after a recent myocardial infarction. Stable angina usually occurs with activity or emotional stress. It is predictable and usually last a short time and is relieved by rest or medicine. The primary risk factors are smoking, high blood pressure, diabetes, and hyperlipidemia or high cholesterol. Other risk factors include family history, sedentary lifestyle, and age.
lifestyle changes for angina
Lifestyle modifications include weight management, exercise, dietary modifications, lipid control, and stopping smoking.
angina treatment guidelines
Medications prescribed by the health care provider may include antiplatelet therapy, statins, antihypertensives, oral hypoglycemics, or insulin therapy for diabetics. For episodes of angina and chronic anginal symptoms, patients may be prescribed sublingual nitroglycerin, beta-blockers, calcium channel blockers, or nitrates. In addition to lifestyle changes such as a healthy diet, regular exercise, quitting smoking, and medical interventions, procedures to open the arteries that are blocked may be recommended. This includes coronary artery bypass, percutaneous coronary intervention (PCI), angioplasty, and stenting. Additional treatment guidelines are provided by the American College of Cardiology and the American Heart Association.
nursing care plan for angina pectoris
Nursing considerations in patients who are hospitalized or being managed in the outpatient setting include close monitoring to prevent complications and provide support and education on how to manage and reduce the risk of complications. The nurse will assess the patient’s vital signs, risk factors, and pain level. Long-term management includes evaluating the patient’s lifestyle, habits, diet, and activity. Patients should be able to identify signs and symptoms of angina such as chest discomfort, shortness of breath, and changes in one’s condition that require medical intervention. Nurses should know and convey the indication for taking medications as prescribed and how to monitor for side effects and worsening of symptoms. Nurses should ensure that the patient knows the warning sign and when to seek medical treatment. Complications of angina occur in some patients and include myocardial infarction “heart attack”, stroke, heart failure, and cardiomyopathy.
Nursing cardiovascular care on the boards
The NCLEX is critical for aspiring nurses to become licensed and practice professionally. The NP exam certification is an advanced certification that tests clinical knowledge. These exams cover a wide range of topics related to nursing practice, including the assessment and management of cardiac conditions such as myocardial infarction, coronary artery disease, angina, atrial fibrillation, and ventricular tachycardia. Nurses must be familiar with the ECG and be able to interpret basic electrocardiographs and the different waves, including the P waves, PR interval, and T waves. If a patient presents with chest pain, the nurse must be able to prioritize their actions, obtain an accurate history, and assess the patient’s vital signs, including pulse rate, blood pressure, respiratory rate, and neck veins. Weight gain, blood urea nitrogen level, and potassium level may also be indicators of renal insufficiency, which may affect cardiac function and require prompt medical attention.
Cardiovascular drug and procedures
Nursing notes should reflect an understanding of the patient’s condition and must be thorough and accurate, including any signs, symptoms, and side effects of medication, such as nausea and vomiting, that may be associated with the administration of drugs. Patients taking, for example, warfarin sodium or IV furosemide must be assessed for the therapeutic effects of the drugs. Nurses must be familiar with the potential adverse side effects of these medications and take appropriate nursing actions to minimize them. The NCLEX asks about procedures. If a patient has recently undergone a coronary artery bypass graft (CABG) surgery, the nurse must monitor the patient’s cardiac output and blood flow, as well as listen for a friction rub or any abnormal sounds.
Cardiac acute care
Acute cardiac complications may be presented on the NCLEX and NP examination. If a patient has symptoms of cardiac tamponade, such as neck vein distention or narrowing pulse pressure, the nurse must immediately stabilize the patient and provide appropriate care. This may include administering oxygen, preparing for a pericardiocentesis procedure, or notifying the emergency department. In cases where ventricular tachycardia is present, the nurse must monitor the patient closely and prepare for defibrillation if necessary.
