A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?

Correct Answer: A

Rationale: A patient arriving in the emergency department with severe chest pain and a history of episodic chest pain over the past week may be experiencing a myocardial infarction or other serious cardiac event. Nitrates and nitrites are commonly used to manage chest pain in such situations because they help dilate blood vessels, improve blood flow to the heart, and reduce the workload on the heart.

Correct Answer: B

Rationale: In patients with renal failure, NSAIDs (Nonsteroidal anti-inflammatory drugs) should be avoided as they can further impair kidney function and potentially cause kidney damage. NSAIDs can lead to acute kidney injury and worsen existing renal conditions by affecting prostaglandin synthesis in the kidneys, leading to decreased renal blood flow. It is essential to choose pain medications that do not rely on the kidneys for metabolism or excretion, such as nonopioid analgesics or certain types of opioids that are safe for use in renal impairment. It is advisable to consult with a healthcare provider for proper pain management in patients with renal failure.

Correct Answer: D

Rationale: Metformin is commonly used in the treatment of Type 2 diabetes. It works by helping to control blood sugar levels by decreasing glucose production in the liver and improving insulin sensitivity in the muscles. Therefore, the therapeutic use of metformin is in the maintenance of a person's blood glucose levels. While metformin can sometimes be associated with minor effects like gastrointestinal disturbances, it is not used to increase heart rate or decrease gastrointestinal secretions.

Correct Answer: B

Rationale: Omeprazole is a proton pump inhibitor commonly used to reduce stomach acid production. One of the side effects of omeprazole is a change in stomach pH. By inhibiting the proton pumps in the stomach lining, omeprazole reduces the production of acid, leading to an increase in the pH level of the stomach. This change in stomach pH can affect the overall balance of acidity in the stomach and may result in various gastrointestinal symptoms such as bloating, gas, or changes in digestion. It is important for individuals taking omeprazole to be aware of this potential side effect and consult their healthcare provider if they experience any unusual symptoms.

Correct Answer: B

Rationale: Phenytoin is an anticonvulsant medication commonly used in the treatment of seizures, including tonic-clonic (grand mal) seizures, complex partial seizures, and seizures occurring during neurosurgery. It works by stabilizing the excitable cell membranes in the brain, thereby reducing abnormal electrical activity that can lead to seizures. Phenytoin is not used as an antidiabetic, mood stabilizer, or antianxiety agent.