A patient in her second trimester of pregnancy tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Ask the patient what she took and when she learned she was pregnant. This response is appropriate because the nurse needs to gather essential information to assess the potential risk to the fetus accurately. Knowing the medication, dosage, duration of exposure, and timing concerning pregnancy is crucial for determining the extent of harm, if any, to the fetus. Option B) Contact the patient’s provider to request an ultrasound is incorrect because an ultrasound cannot provide information about the past exposure to medications and its effects on the fetus. It is important to assess the historical context in this situation. Option C) Counsel the patient to consider termination of the pregnancy is inappropriate without gathering all relevant information first. It is essential to provide non-judgmental and evidence-based care to support the patient in making informed decisions. Option D) Suggest to the patient that she go to a high-risk pregnancy center is not the most appropriate initial action. While high-risk pregnancy centers may provide specialized care, the immediate focus should be on gathering information to assess the current situation accurately. Educationally, this question highlights the importance of thorough assessment, patient-centered care, and evidence-based practice in pharmacological management during pregnancy. It emphasizes the need for nurses to gather comprehensive data before making any recommendations or decisions regarding patient care, especially in sensitive situations like pregnancy.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Count the pills in the prescription bottle. This action is essential to determine if the patient is actually taking the prescribed medication as directed. Non-adherence to medication regimens is a common issue, especially among older adults, which can result in subtherapeutic drug levels. By counting the pills, the nurse can assess whether the patient is taking the medication as prescribed. Option A) Asking the patient about difficulty swallowing pills is not the most immediate action to take in this situation. While this information may be relevant, confirming medication adherence through pill count is more urgent. Option C) Notifying the provider to request more frequent dosing without confirming the patient's adherence could lead to unnecessary medication adjustments. Option D) Requesting an order for renal function tests is not the most appropriate action at this point, as the primary concern is determining the reason for the subtherapeutic drug level, which is more likely related to medication adherence than renal function. In an educational context, this scenario highlights the importance of thorough assessment and investigation when a patient presents with subtherapeutic drug levels. Nurses must prioritize actions that directly address potential causes of the issue, such as non-adherence, before considering other factors or interventions. Effective medication management is crucial in ensuring positive patient outcomes, especially in older adults who may face unique challenges in adhering to complex medication regimens.

Correct Answer: C

Rationale: IUDs are contraindicated in women at high risk for STDs, such as those with multiple sexual partners, due to increased infection risk (e.g., pelvic inflammatory disease). Monogamous women (options A and B) and those with unrelated conditions like rosacea (D) are not at higher risk, making option C the patient to advise against IUD use.

Correct Answer: A

Rationale: Transurethral alprostadil has fewer side effects (e.g., less priapism or fibrosis) compared to intracavernous injections, though both increase penile arterial flow. Intracavernous doses are lower (5-40 mcg vs. 125-1000 mcg transurethrally), and volume isn’t 0.1 mL, making option A the key distinction to explain.

Correct Answer: A

Rationale: The correct answer is A) extending the duration of local anesthetics. Alpha1-adrenergic agonists, such as epinephrine, produce vasoconstriction by acting on alpha1 receptors in blood vessels. When combined with local anesthetics, they help to constrict blood vessels at the site of administration, reducing blood flow and systemic absorption of the anesthetic. This constriction results in a slower systemic clearance of the anesthetic, prolonging its duration of action and enhancing its effectiveness. Option B) producing mydriasis to facilitate ophthalmic examinations is incorrect because this action is typically achieved by using drugs that act on the iris sphincter and dilator muscles, not through vasoconstriction. Option C) slowing the heart rate in tachycardic patients is incorrect because alpha1-adrenergic agonists primarily cause vasoconstriction and can actually lead to an increase in blood pressure and reflex tachycardia. Option D) treating hypotension is incorrect because while alpha1 agonists can increase blood pressure through vasoconstriction, they are not typically the first-line agents for treating hypotension, as other medications are more effective and have fewer side effects for this purpose. Understanding the specific actions and indications of alpha1-adrenergic agonists is crucial for pharmacology students and healthcare professionals to make informed decisions when managing patient care. By grasping the rationale behind their use in extending local anesthetics, learners can apply this knowledge in clinical scenarios to optimize patient outcomes.