A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication?

Correct Answer: D

Rationale: Scheduled surgery would be a contraindication for taking garlic tablets because garlic has blood-thinning properties that could potentially increase the risk of bleeding during or after surgery. This can interfere with the blood's ability to clot properly, leading to excessive bleeding and other complications during the surgical procedure. It is important to inform healthcare providers about all supplements being taken, including garlic tablets, before undergoing any surgery to ensure patient safety.

Correct Answer: B

Rationale: Metformin (Glucophage) is a biguanide medication used to manage type 2 diabetes. While it is generally well-tolerated, one of its rare but serious adverse effects is lactic acidosis, a condition characterized by the buildup of lactic acid in the bloodstream. This can occur in patients with renal impairment or other risk factors. Hypoglycemia is uncommon with metformin alone, and GI distress, though common, is not life-threatening. Somnolence is not typically associated with metformin. Therefore, lactic acidosis is the most specific and serious adverse effect.

Correct Answer: D

Rationale: Scheduled surgery would be a contraindication for taking garlic tablets because garlic has blood-thinning properties that could potentially increase the risk of bleeding during or after surgery. This can interfere with the blood's ability to clot properly, leading to excessive bleeding and other complications during the surgical procedure. It is important to inform healthcare providers about all supplements being taken, including garlic tablets, before undergoing any surgery to ensure patient safety.

Correct Answer: D

Rationale: Diphenhydramine, a first-generation antihistamine, has anticholinergic effects, including urinary hesitancy , due to reduced bladder contractility. This can escalate to retention, a serious issue, especially in older adults or those with prostate issues, warranting physician reporting. Sedation is expected and manageable, not typically reported unless severe. Diarrhea isn't common; constipation is more likely. Projectile vomiting suggests a different pathology, not a typical antihistamine effect. The nurse teaches reporting urinary hesitancy as it's a significant anticholinergic complication requiring intervention, making choice D the priority symptom to monitor.

Correct Answer: D

Rationale: Phenytoin toxicity (ataxia, nystagmus) occurs despite a ‘normal' total plasma level (15 mg/L) due to nephrotic syndrome's hypoalbuminemia. Normally, phenytoin is 90% protein-bound, with 10% free (active). Low albumin increases the free fraction (e.g., to 20%), raising CNS exposure despite a therapeutic total level. Creatinine doesn't typically interfere with phenytoin assays; they're reliable unless specific lab issues exist. Furosemide doesn't alter the blood-brain barrier for phenytoin; no evidence supports this. Oestrogen in HRT doesn't directly enhance phenytoin's CNS toxicity; it may affect metabolism, but not here. Cerebrovascular events don't fit the drug-related context. The increased free fraction explains toxicity, necessitating free level monitoring in hypoalbuminemia.

Correct Answer: D

Rationale: Lanoxin (digoxin) is a medication commonly used to treat heart failure and arrhythmias. The order specifies the dosage and timing but does not indicate the route of administration. Since digoxin can be administered orally, intravenously, or intramuscularly, the nurse must clarify the route with the prescriber to ensure safe and accurate administration. Administering the medication via the wrong route could lead to serious complications, such as toxicity or ineffective treatment. Therefore, contacting the prescriber for clarification is the correct and safest action for the nurse to take.

Correct Answer: B

Rationale: Atropine is a mydriatic agent that dilates the pupil and can precipitate angle-closure glaucoma in patients with a narrow anterior chamber angle. Therefore, it is critical to inform the ophthalmologist if the patient has a history of angle-closure glaucoma. Cataracts (A), open-angle glaucoma (C), and macular degeneration (D) are not contraindications for the use of atropine.

Correct Answer: A

Rationale: Theophylline, a bronchodilator, treats COPD but has a narrow therapeutic range (10-20 mcg/mL). Monitoring theophylline levels prevents toxicity (e.g., seizures, tachycardia) or subtherapeutic dosing, ensuring efficacy. Sodium , glucose , and platelets aren't directly impacted. Blood level checks align with theophylline's pharmacokinetics'hepatic metabolism, variable clearance'critical in COPD where respiratory support hinges on precision. This focus prevents adverse outcomes, making A the key value to monitor for safe, effective therapy.

Correct Answer: B

Rationale: Protamine is the antidote for Heparin. Heparin is an anticoagulant medication that works by increasing the activity of antithrombin III, leading to the inhibition of clotting factors. In cases of excessive bleeding or overdose with Heparin, protamine can be administered to neutralize its anticoagulant effects. Protamine works by binding to heparin to form a stable complex, thereby reversing the anticoagulant activity of Heparin. It is important for healthcare providers to be familiar with the antidotes for various medications to manage potential complications effectively.