An older male adult comes to a primary care setting, and his ...

[mia]

An older male adult comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which laboratory report can help to explain why this individual needs sildenafil?
 
  a. Serum potassium 4.5 mEq/L
  b. Prothrombin time 13 seconds
  c. Alanine transferase (ALT) 50 units/L
  d. Glycosylated hemoglobin (Hgb A1c) over 8

Question 2

A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge.
 
  a. Medication reconciliation
  b. Providing a list of community resources
  c. Contacting a durable medical equipment facility
  d. Educating the client on appropriate range-of-motion exercises

[Chou]

Answer to Question 1

D

Feedback
A Incorrect. The potassium level is within normal limits.
B Incorrect. The prothrombin time is within normal limits.
C Incorrect. The ALT is within normal limits.
D Correct. The Hgb A1c is an indicator of serum glucose control over the last 90 days. A Hgb A1c level over 8 indicates this older adult had poor glucose con-trol in that time frame. As a reliable indicator of hyperglycemia, it can indicate the reason this man experiences erectile dysfunction because hyperglycemia is associated with peripheral arterial disease. An erection occurs as the penile shaft becomes engorged with blood. This process can be impaired if the vessels are damaged from hyperglycemia because hyperglycemia damages the lining of blood vessels and leads to progressive occlusion of the damaged vessels. Many of the vessels involved in causing an erection are fine vessels and are among the first vessels occluded in arterial disease.

Answer to Question 2

A
Medication reconciliation is the most important intervention to complete before discharge. Me-dication discrepancies are the most prevalent adverse event after hospital discharge and the most challenging component of a successful hospital-to-home transition. Nurses' attention to an accu-rate prehospital medication list, medication reconciliation during hospitalization and at discharge, and patient and family education about medications are required to enhance safety. Educating the client on appropriate range-of-motion exercises, providing a list of community resources, and contacting a durable medical equipment facility are all important and should be completed as well, but medication reconciliation should be the priority.