Methylergonovine (Methergine) is prescribed to a patient who is having postpartum bleeding. Prior to giving the medication, the nurse contacts the physician who prescribed the medication if which of the following condition is documented in the patient’s chart?

Correct Answer: C

Rationale: Methylergonovine (Methergine) is contraindicated in patients with ischemic heart disease because it can cause vasoconstriction, increasing the risk of myocardial infarction or other cardiac complications. Hypotension is not a contraindication, and uterine atony is the indication for the medication. Acute gastroenteritis is unrelated to the use of methylergonovine. Therefore, ischemic heart disease is the condition that requires the nurse to contact the physician.

Correct Answer: C

Rationale: Methylergonovine (Methergine) is contraindicated in patients with ischemic heart disease because it can cause vasoconstriction, increasing the risk of myocardial infarction or other cardiac complications. Hypotension is not a contraindication, and uterine atony is the indication for the medication. Acute gastroenteritis is unrelated to the use of methylergonovine. Therefore, ischemic heart disease is the condition that requires the nurse to contact the physician.

Correct Answer: D

Rationale: Long QT syndrome predisposes patients to torsades de pointes, so pain management must avoid QT-prolonging drugs. Amitriptyline, a TCA, extends QT via sodium channel blockade, risking arrhythmias. Fentanyl, an opioid, has minimal QT impact and relieves severe pain but carries respiratory depression risks, less ideal for shingles' neuropathic pain. Acyclovir treats shingles' viral cause, not pain directly. Diazepam addresses anxiety, not pain. Gabapentin, an anticonvulsant, targets neuropathic pain (common in postherpetic neuralgia) by modulating calcium channels, with no significant QT prolongation, making it safe and effective here. Its efficacy in nerve pain, lack of cardiac risk, and suitability for chronic management post-shingles distinguish it as the best option.

Correct Answer: A

Rationale: Herpes simplex virus requires antiviral therapy, and acyclovir inhibits viral DNA replication, reducing symptom duration and severity, making it the standard treatment. Zidovudine targets HIV, not HSV. Nystatin is antifungal, ineffective against viruses. Metronidazole treats bacterial/protozoal infections. Acyclovir's specificity for HSV, backed by clinical guidelines, ensures targeted therapy, making A the most likely drug ordered for effective management.

Correct Answer: B

Rationale: Drugs that act simultaneously on a mixed group of receptors with an agonist action on one set and with an antagonist action on the other are termed as mixed agonist-antagonists. These drugs can have a dual effect on different types of receptors within the same system. They can elicit both agonist-like responses at one receptor and antagonist-like responses at another receptor, leading to a mixed overall effect on the system. This unique property makes them different from pure agonists, pure antagonists, or partial agonists which typically have a unidirectional effect on receptors.