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 blood pressure of 88/62 mm Hg indicates hypotension, which is a contraindication for nitrates and nitrites use. Nitrates and nitrites are vasodilators that can further lower blood pressure, potentially leading to severe hypotension and cardiovascular collapse in a patient with already low blood pressure. Therefore, caution should be exercised in administering nitrates and nitrites to a patient with hypotension. In this case, the presence of severe chest pain may be indicative of a myocardial infarction, which would typically warrant the consideration of nitroglycerin (a nitrate) administration for chest pain relief. However, in the presence of hypotension, alternative treatment options may need to be considered first to stabilize the blood pressure before nitrate administration.

Correct Answer: D

Rationale: The correct technique when administering topical nitroglycerin ointment is to remove the old ointment before applying the new ointment. This is to prevent any potential overdosing of the medication, as nitroglycerin can be rapidly absorbed through the skin. It is important to ensure that the previous application is fully removed before applying a new dose to prevent any accumulation of the medication.

Correct Answer: D

Rationale: Loop diuretics can cause excessive potassium excretion in the urine, leading to low potassium levels in the body (hypokalemia). Some manifestations of potassium deficiency (hypokalemia) include muscle weakness, which can range from mild to severe, and anorexia (loss of appetite). Other symptoms of hypokalemia may include fatigue, weakness, constipation, and even cardiac arrhythmias. It is important for healthcare providers to monitor patients on loop diuretics for signs of potassium deficiency to prevent complications.

Correct Answer: A

Rationale: Patients with peptic ulcers should stop taking NSAIDs. NSAIDs, which stands for nonsteroidal anti-inflammatory drugs, can worsen peptic ulcers by increasing the risk of gastrointestinal bleeding and ulcer formation. NSAIDs work by inhibiting prostaglandin synthesis, which can lead to a decrease in the protective mucus production in the stomach lining, allowing gastric acid to damage the mucosa and exacerbate peptic ulcers. Therefore, it is crucial for patients with peptic ulcers to avoid NSAIDs to prevent further damage to the gastrointestinal tract.

Correct Answer: D

Rationale: Phenazopyridine is a urinary analgesic commonly used to relieve the burning sensation and pain experienced during urination, typically caused by urinary tract infection or irritation. It works by acting as a local anesthetic on the lining of the urinary tract, providing relief from discomfort. Tolterodine and oxybutynin are used to treat overactive bladder by reducing bladder spasms and urge incontinence, whereas bethanechol is a direct-acting cholinergic agonist primarily used to stimulate bladder contractions in individuals with urinary retention. Thus, for the symptom of burning sensation and pain when urinating, phenazopyridine would be the most likely urinary analgesic to be ordered.