A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing?

Correct Answer: D

Rationale: The 74-year-old professional golfer is likely experiencing Prinzmetal™s angina. This type of angina, also known as variant angina, typically occurs at rest and is due to coronary artery spasm, rather than the typical obstruction of blood flow seen in classic angina. The chest pain in Prinzmetal™s angina is often relieved by medications that dilate the blood vessels, such as nitroglycerin, as described by the patient. This distinguishes it from classic angina, which is typically triggered by exertion or emotional stress. Unstable angina, on the other hand, is characterized by chest pain that occurs unpredictably, even at rest and may signal an impending heart attack.

Correct Answer: A

Rationale: Metformin lowers blood glucose by reducing hepatic production and improving insulin sensitivity, best taken with meals to minimize GI upset (e.g., nausea), a common side effect, while aligning with food intake for glycemic control. Reporting muscle pain relates to rare lactic acidosis, not a primary instruction unless symptomatic. Avoiding carbohydrates is incorrect'diabetes management balances carbs, not eliminates them. Bedtime-only dosing ignores twice-daily norms. Taking it with meals enhances tolerance and efficacy, critical for adherence in type 2 diabetes, where metformin is first-line. This instruction reflects its pharmacokinetics and practical use, making A the key teaching point.

Correct Answer: D

Rationale: Mefenamic acid is not a phenylpropionic derivative. It is classified as a fenamate, structurally related to fenamic acid. The other options (A. ibuprofen, B. fenoprofen, C. naproxen) are all examples of phenylpropionic derivatives, commonly referred to as propionic acids. These drugs have similar chemical structures and mechanisms of action, making them a distinct group within the nonsteroidal anti-inflammatory drug (NSAID) class.

Correct Answer: D

Rationale: Post-appendectomy pain management often combines opioids like morphine with NSAIDs for synergy. Acetaminophen is an analgesic but not a true NSAID (lacks significant anti-inflammatory action). Celecoxib , a COX-2 inhibitor, is less common acutely due to cost and milder effect. Ibuprofen is effective but less potent parenterally. Ketorolac , a potent NSAID, is widely used postsurgically-available IV/IM, it reduces inflammation and pain, complementing morphine's central action. Naproxen (E) is oral, less ideal acutely. Ketorolac's rapid onset and efficacy in reducing opioid requirements make it standard. Its short-term use minimizes GI risks, aligning with surgical protocols, distinguishing it from other options for acute postoperative pain control.

Correct Answer: A

Rationale: Imipramine, a tricyclic antidepressant, is cardiotoxic in overdose, causing dysrhythmias (e.g., widened QRS) due to sodium channel blockade. The priority assessment is cardiac status to detect life-threatening arrhythmias, guiding urgent interventions like sodium bicarbonate. Liver and renal effects are secondary in acute overdose. Neurological issues like seizures occur but are less immediately lethal than cardiac collapse. The nurse focuses on cardiac monitoring, aligning with toxicology priorities, making A the critical assessment.