Question

section 4 pharmacology
critical thinking
multiple choice
read each critical - thinking item carefully and then select the one best response.

1. you and your partner are dispatched to a home on the east side of town for a possible heart attack. on arrival, you are met by a distressed wife who says her husband began having chest pain while mowing the lawn. after obtaining the patients vital signs, you begin to take a sample history. when you ask about medications, the patient begins listing off all of the medications he has been prescribed by his doctor. nitroglycerin would be contraindicated if the patient was currently taking which of the following medications?

a. albuterol
b. aspirin
c. oxygen
d. sildenafil

1. your patient is a 73 - year - old man who complains of severe chest pressure with trouble breathing while having dinner at a local diner. he has a small vial of nitroglycerin in his pocket but says that he has not taken any in several days and needs you to help him to get the vial open. after administering oxygen, what is the first thing that you should do?

a. obtain the patients blood pressure and ensure that his systolic pressure is not below 100 mm hg.
b. begin assisting the patients ventilations.
c. place him in the recovery position.
d. check his blood glucose level.

1. you are called to the beach for a 15 - year - old boy who is having trouble breathing. he tells you between gasps that he was stung by something and that his body feels “swollen.” just then, his mother runs up to you and puts an epipen into your hand. “here,” she says breathlessly. “this is his epipen. he needs this!” would you administer epinephrine to this patient?

a. yes. push the epipen firmly against the patients thigh for several seconds.
b. no. the epipen will make his condition worse.
c. yes. use the sublingual route.
d. no. his signs and symptoms contraindicate an epinephrine injection.

1. “i think shes drunk!” a bystander yells as you and your partner arrive on the scene of an unknown medical problem. you observe an approximately 45 - year - old woman stumbling between several cars in the parking lot of a grocery store. as you catch up to the woman, you ask her if she is diabetic. she nods clumsily and leans against one of the cars. you test her blood glucose and obtain a reading of 49 mg/dl. what should you do?

a. administer glucose gel orally.
b. contact medical control for further instructions.
c. restrain her onto the gurney and insert a nasopharyngeal airway.
d. wait for an als response so that glucose can be administered intravenously.

1. you are dispatched to the county fair for a 54 - year - old woman complaining of chest pain. you arrive to find her pressing on the center of her chest and note that she has pale, clammy skin. you ask if she has any cardiac history, and she tells you, “no, i just have arthritis, and my doctor says that i am prediabetic.” her vital signs are: pulse 112 beats/minute, respiratory rate 18 breaths/minute, blood pressure 94/62 mm hg, and oxygen saturation 99% on room air. would you give this patient aspirin?

a. no. nitroglycerin would be more appropriate.
b. yes. her signs and symptoms indicate a cardiac problem, and aspirin could help.
c. no. aspirin is contraindicated for arthritis.
d. yes. its analgesic properties may help with the discomfort.

Explanation:

1. Nitroglycerin and sildenafil interact dangerously, increasing the risk of severe hypotension. So nitroglycerin is contraindicated if the patient is taking sildenafil.
2. Before administering nitroglycerin, blood pressure must be checked to ensure systolic pressure is not below 100 mmHg to avoid severe hypotension.
3. The boy has signs of an allergic reaction (stung and swelling), and an Epi - Pen (epinephrine) is appropriate for anaphylaxis. It is administered via intramuscular injection in the thigh.
4. A blood glucose reading of 49 mg/dL indicates severe hypoglycemia. Oral glucose gel is the appropriate first - line treatment.
5. The woman has chest pain, pale and clammy skin, and an elevated heart rate. These are signs of a possible cardiac problem, and aspirin can help by inhibiting platelet aggregation.

Answer:

1. D. Sildenafil
2. A. Obtain the patient's blood pressure and ensure that his systolic pressure is not below 100 mm Hg.
3. A. Yes. Push the EpiPen firmly against the patient's thigh for several seconds.
4. A. Administer glucose gel orally.
5. B. Yes. Her signs and symptoms indicate a cardiac problem, and aspirin could help.