The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse?

Correct Answer: A

Rationale: Sertraline, an SSRI, commonly causes sexual dysfunction, including delayed ejaculation, affecting up to 70% of patients due to increased serotonin levels impacting sexual response. This side effect can significantly affect quality of life, making it a valid concern warranting physician notification , as the doctor might adjust the dose or switch to a drug with fewer sexual side effects, like bupropion. Choice B minimizes the patient's experience, prioritizing depression over well-being, which could reduce compliance. Choice C assumes a drastic outcome (suicide) without evidence, escalating unnecessarily. Choice D inaccurately suggests spontaneous resolution, which is rare without intervention. The nurse's best action is to advocate for the patient by informing the physician, ensuring a tailored treatment plan, making choice A the most patient-centered and proactive response.

Correct Answer: D

Rationale: Aripiprazole, a partial dopamine agonist, balances receptor activity versus haloperidol's full block, reducing side effects like extrapyramidal symptoms, common in schizophrenia treatment. Compliance isn't directly tied to this switch. Efficacy or symptom reduction varies-side effect profile drives the change. Fewer side effects align with aripiprazole's design, improving tolerability.

Correct Answer: C

Rationale: When teaching a patient how to use sublingual nitroglycerin, it is essential to include the instruction that if the chest pain is not relieved after one tablet, they should call 911 immediately. This is because persistent chest pain could indicate a serious cardiac event, such as a heart attack, that requires immediate medical attention. It is not advisable to take multiple doses without consulting a healthcare provider, as this can lead to complications. The patient should seek emergency medical help if their symptoms are not relieved after taking one tablet of sublingual nitroglycerin.

Correct Answer: A

Rationale: Epinephrine is a potent agonist of adrenergic receptors, which are part of the sympathetic nervous system. It rapidly affects alpha and beta-adrenergic receptors, leading to increased heart rate, vasoconstriction, and bronchodilation. Muscarinic and cholinergic receptors are part of the parasympathetic nervous system and are not directly activated by epinephrine. Nicotinic receptors are found in the neuromuscular junction and autonomic ganglia but are not the primary target of epinephrine. The rapid action of epinephrine makes it a critical drug in emergencies such as anaphylaxis.

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.