A 69-year-old man with exercise-induced angina presents to his primary care physician for follow-up. The angina is worsening and is now present at rest. The patient is not taking any medications. Isosorbide dinitrate sublingual is prescribed for the patient. Which of the following interactions must the physician warn this patient about?

Correct Answer: C

Rationale: Isosorbide dinitrate, a nitrate, treats angina by dilating vessels, but its interaction with sildenafil causes severe hypotension. Both enhance cGMP, leading to profound vasodilation, a life-threatening risk. Cold extremities or hot extremities may occur as minor effects but aren't primary concerns. Tinnitus and vertigo (E) aren't linked. Given his age and potential for erectile dysfunction treatment, warning about sildenafil is critical. Nitrates' rapid action relieves rest angina, but this interaction demands patient education to prevent catastrophic blood pressure drops, distinguishing it from less severe side effects.

Correct Answer: B

Rationale: Focal complex partial seizures impair consciousness, causing confusion, unresponsiveness, and a blank stare, lasting minutes with slow recovery, as described. Simple partial seizures preserve awareness with focal symptoms. Tonic-clonic seizures feature convulsions. Absence seizures are brief (seconds) with rapid recovery. Myoclonic seizures involve jerks. The prolonged duration and impaired consciousness align with complex partial seizures' temporal lobe origin and EEG findings, distinguishing it here.

Correct Answer: A

Rationale: Aspirin, an acidic drug, ionizes in the small intestine's alkaline pH, reducing absorption as ionized forms cross membranes less easily than non-ionized. Absorption increases in the stomach's acid pH. Ionization directly affects rate. It absorbs mainly in the stomach and intestine, not beyond. Decreased absorption reflects pH impact, a pharmacokinetic rule.

Correct Answer: A

Rationale: Regular insulin is the only type of insulin that can be given intravenously (IV) due to its short onset of action. When administered IV, regular insulin can act quickly to control blood sugar levels in emergency situations such as diabetic ketoacidosis (DKA) or hyperglycemic crises. Other types of insulin, such as NPH, long-acting, or rapid-acting insulins, are not suitable for IV administration as they have different pharmacokinetic properties and are designed for subcutaneous use.

Correct Answer: D

Rationale: Dextromethorphan (DM), a cough suppressant, can cause dizziness, hallucinations, and confusion, especially with alcohol, which amplifies CNS depression . Dialysis isn't standard for DM overdose; it's not an opioid , though it acts centrally; and addiction isn't the acute issue. The nurse considers dizziness as a key adverse effect, worsened by beer, guiding a response to seek medical help.