GTN has its major effect on effort angina by:

Correct Answer: C

Rationale: Glyceryl trinitrate (GTN) relieves effort angina primarily by reducing preload (venodilation) and afterload (arterial dilation), decreasing myocardial oxygen demand, a true and major mechanism. It doesn't primarily reduce coronary vasospasm (more relevant in variant angina), nor significantly affect the renin-angiotensin system in this context. While it causes some coronary vasodilation, this is secondary to systemic effects on demand reduction. It doesn't cause systemic vasoconstriction (opposite effect). The preload/afterload reduction is the cornerstone of GTN's efficacy in stable angina, improving oxygen supply-demand balance, a critical concept in ischemic heart disease management.

Correct Answer: B

Rationale: Furosemide (Lasix) belongs to the sulfonamide drug class. Patients with allergies to sulfonamides may experience cross-reactivity and have an increased risk of allergic reactions to furosemide. Therefore, it is essential for the nurse to assess the patient for any allergies to sulfonamides before administering furosemide to prevent potential adverse reactions.

Correct Answer: C

Rationale: Protamine sulfate is the antidote for heparin overdose. Heparin is a commonly used anticoagulant medication that works by inhibiting the activity of thrombin and preventing blood clot formation. In the case of an overdose leading to excessive bleeding, protamine sulfate can be administered to neutralize the effects of heparin. Protamine sulfate forms a complex with heparin, therefore reversing its anticoagulant effects and helping to stop the bleeding. This antidote is especially useful in situations where immediate reversal of heparin's effects is necessary to prevent serious complications.

Correct Answer: C

Rationale: The correct instruction for the nurse to give the client regarding discontinuing a beta blocker is that it should NOT be abruptly stopped; the dose should be tapered down. Suddenly stopping a beta blocker can lead to rebound hypertension, angina, and even heart attack in some cases. Tapering down the dose helps the body adjust gradually and reduces the risk of adverse effects associated with abrupt discontinuation. It is important for the client to follow the healthcare provider's guidance on how to safely decrease the dose of the beta blocker.

Correct Answer: D

Rationale: Metformin is a medication commonly used to treat type 2 diabetes. It exerts its action through multiple mechanisms, as outlined below: