Pharmacology Nitro / Angina #2

Question

Which is the priority information for the nurse to obtain from a patient presenting to the emergency department with substernal chest pain of 8/10, diaphoresis, and a room air oxygen of 90%?

Answers

  1. A thorough medication history
    • Rationale:

      This answer is correct because when phosphodiesterase-5 enzyme inhibitors are taken with nitroglycerin, the blood pressure can drop so significantly, the treatment could be deadly. Therefore, the nurse should obtain a careful medication history before administering nitroglycerin in a patient experiencing angina or symptoms of myocardial infarction. The nurse should specifically ask if the patient takes phosphodiesterase-5 enzyme inhibitors, to make sure all efforts have been made to not have a potentially deadly adverse medic

  2. Insurance coverage information
    • Rationale:

      This answer is not correct because even though this information should be obtained eventually, it is not the priority information the nurse should ask. Insurance coverage is insignificant when a patient is experiencing a life-threatening emergency, such as acute angina.

  3. Social history, including alcohol use
    • Rationale:

      This answer is not correct because although social history should be obtained in a complete assessment, it is not a priority to be assessed in this instance. Since emergency treatment with nitroglycerin is standard for this condition, immediate medication history needs to be obtained, in case the patient is taking phosphodiesterase-5 enzyme inhibitors. If so, the healthcare provider should be notified immediately due to the risk of an unsafe drop in blood pressure when these medications are taken.

  4. Use of supplemental oxygen in the home
    • Rationale:

      This answer is not correct because knowing if the patient takes supplemental oxygen at home is not as important as the medication history due to the need to know if the patient takes phosphodiesterase-5 enzyme inhibitors. Furthermore, the oxygen saturation is 90% and very stable in this patient.

Overview

A thorough medical history, including home medications is essential when admitting a patient with clinical manifestation of myocardial infarction. This assessment information could significantly affect the welfare of the patient.

Explanation

Learning Outcomes

Phosphodiesterase-5 enzyme inhibitors, such as the brand-name medications of Viagra and Cilias, treat erectile dysfunction through vasodilation. When taken with nitroglycerin, the blood pressure can drop so significantly, the treatment could be deadly. Therefore, the nurse should obtain a careful medication history before administering nitroglycerin in a patient experiencing angina or symptoms of myocardial infarction. The nurse should specifically ask if the patient takes phosphodiesterase-5 enzyme inhibitors, to make sure all efforts have been made to not have a potentially deadly adverse medication reaction.

Test Taking Tip

Understanding the severe side effects of nitroglycerin with phosphodiesterase-5 enzyme inhibitors is important to consider if a patient has chest pain. Therefore, a thorough medication history is imperative.

Video Rationale