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: 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: 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: D

Rationale: Barbiturates (e.g., phenobarbital) cause serious adverse effects-respiratory depression, dependence-limiting use versus safer options like benzos, per pharmacology. Cost isn't higher. Allergies aren't notable. They're effective but risky. Side effects drive rarity, a safety shift.

Correct Answer: B

Rationale: When treating a patient with renal failure, it is important to avoid NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) as pain medications. NSAIDs can worsen renal function and may cause further damage to the kidneys. They can also lead to complications such as fluid retention, elevated blood pressure, and electrolyte imbalances in patients with renal failure. Instead, other types of pain medications such as opioids and nonopioids (e.g., acetaminophen) may be considered for pain management in patients with renal failure. Short-acting analgesics should also be utilized cautiously in this population, considering the potential clearance and metabolism issues due to decreased renal function.

Correct Answer: D

Rationale: Vancomycin's rapid infusion causes red man syndrome (fever, chills, redness) is discontinue . Anticholinesterase is irrelevant. Corticosteroids treat severe reactions, not initial step. Intubation is excessive. Slowing infusion (E) is preventive, not reactive. Stopping vancomycin halts histamine release, resolving symptoms.

Correct Answer: D

Rationale: In severe renal failure, the clearance of digoxin is reduced, requiring smaller maintenance doses to avoid toxicity.

Correct Answer: D

Rationale: The correct teaching for a patient taking oral nitrofurantoin is to rinse the mouth after taking the medication to avoid staining the teeth. Nitrofurantoin can cause a harmless but noticeable side effect of staining the teeth, so it is important for the patient to rinse their mouth thoroughly after each dose to reduce the risk of this happening. The other options provided are not accurate teachings related to nitrofurantoin.

Correct Answer: A

Rationale: Digoxin is a medication commonly prescribed to patients with heart conditions, such as heart failure and certain types of irregular heartbeats. It primarily works by slowing down the heart rate and increasing the strength of the heart's contractions. This is why patients taking digoxin are typically taught to monitor their own pulse regularly to ensure it stays within a safe range.