A patient in the clinic develops sudden shortness of breath and ...

[fagboi]

A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness.
 
  The NP activates the emergency medical system and should anticipate that this patient will receive: a. intravenous alteplase.
  b. low-dose aspirin and warfarin.
  c. low-molecular-weight heparin (LMWH).
  d. unfractionated heparin (UFH) and warfarin.

Question 2

A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to:
 
  a. take the lowest recommended dose initially.
  b. monitor for hypertension while taking the drug.
  c. take the antihistamine with a decongestant for best effect.
  d. watch for symptoms of paradoxical excitation with this medication.

[smrerig]

Answer to Question 1

D
This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy. Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE. LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for treatment of massive PE.

Answer to Question 2

A
Antihistamines are more likely to cause excessive sedation, syncope, dizziness, confusion, and hypotension in elderly patients; a decrease in dose is usually necessary. Hypotension is likely; there is no need to monitor for hypertension. This patient does not have symptoms of congestion. Paradoxical excitation occurs in some young children but is not an identified risk in elderly patients.

[fagboi]

Excellent

[dantucker]

TYSM