The nurse is reviewing a patient's laboratory test results and current medications and notes that the patient's prothrombin time is prolonged. The nurse checks the patient's medication list. What vitamin or mineral might be contributing to this?

Correct Answer: D

Rationale: Vitamin E can interfere with vitamin K-dependent clotting factors, leading to prolonged prothrombin time and increased bleeding risk. Vitamin A (A), selenium (B), and vitamin D (C) do not typically affect coagulation. The nurse should assess for excessive vitamin E supplementation or dietary intake.

Correct Answer: C

Rationale: Morphine, a potent opioid analgesic, is primarily used to manage moderate to severe pain, but its established clinical applications extend beyond analgesia. One well-documented use is in treating pulmonary congestion, particularly in acute pulmonary edema associated with heart failure. Morphine reduces preload by causing vasodilation, alleviating dyspnea and anxiety in these patients, though the exact mechanism is multifaceted and includes central effects on respiration. Managing generalized anxiety disorders is not a standard use, as anxiolytics like benzodiazepines are preferred. While morphine can relieve pain, its use in biliary colic is contraindicated because it causes sphincter of Oddi constriction, potentially worsening the condition. It is not a treatment for ACE inhibitor-induced cough, which is better managed with antitussives or drug discontinuation. Suppression of ethanol withdrawal is also not an established role, as benzodiazepines are the standard. Thus, pulmonary congestion stands out as a recognized therapeutic use.

Correct Answer: C

Rationale: Levetiracetam treats post-stroke focal seizures by modulating SV2A, offering efficacy, minimal hepatic metabolism, and low interaction risk, ideal for an elderly patient with likely polypharmacy. Phenytoin, a sodium channel blocker, controls seizures but has nonlinear kinetics and P450 induction, risking toxicity. Oxcarbazepine, similar to carbamazepine, has hyponatremia risks, concerning in the elderly. Phenobarbital sedates and interacts via P450. Levetiracetam's safety, renal clearance, and effectiveness in stroke-related epilepsy, per guidelines, make it the most appropriate here.

Correct Answer: D

Rationale: Valproic acid is metabolized in the liver, and patients with liver disease may have impaired liver function, which can lead to reduced metabolism of the drug and potential toxicity. Therefore, a patient with a history of liver disease starting therapy with valproic acid would be a cause for concern for the nurse. Monitoring of liver function tests would be crucial in this patient population to ensure the medication is being safely metabolized.

Correct Answer: D

Rationale: Hypocalcemia causes muscle spasms (tetany)-nerve hyperexcitability, per classic signs-unlike bruising (coagulation), hypertension (not direct), or wasting (chronic). Spasms dominate, per assessment.