A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil. He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate?

The correct answer is c. 2,525 mL.

Choice A reason:

1,350 mL is calculated by considering only the lactated Ringer’s IV intake. The calculation is as follows:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL. This option does not include the intake from cefazolin, packed RBCs, sodium chloride boluses, or famotidine.

Choice B reason:

1,600 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.

Choice C reason:

2,525 mL is the correct total intake. The detailed calculation is:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL.
• Cefazolin in 100 mL of 0.9% sodium chloride: 100 mL.
• Two units of packed RBCs: 275 mL + 250 mL = 525 mL.
• Two IV bolus infusions of 250 mL of 6.0% sodium chloride: 250 mL + 250 mL = 500 mL.
• Famotidine in 50 mL of 0.9% sodium chloride: 50 mL.

Adding these together: 1,350 mL + 100 mL + 525 mL + 500 mL + 50 mL = 2,525 mL.

Choice D reason:

2,100 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.

Choice A reason: This is incorrect because orally administered decongestants do not have an immediate onset. They take longer to act than nasal sprays because they have to be absorbed through the gastrointestinal tract. Nasal sprays act directly on the nasal mucosa and have a faster onset.

Choice B reason: This is correct because orally administered decongestants do not cause rebound congestion. Rebound congestion is a condition in which the nasal passages become more swollen and congested after the effect of the nasal spray wears off. This can lead to overuse and dependence on the nasal spray. Orally administered decongestants do not have this effect because they act systemically and not locally.

Choice C reason: This is incorrect because orally administered decongestants do not have a shorter duration. They have a longer duration than nasal sprays because they are metabolized more slowly by the liver. Nasal sprays have a shorter duration because they are eliminated more quickly by the nasal mucosa.

Choice D reason: This is incorrect because orally administered decongestants are not more potent than nasal sprays. They have a similar potency, but they have a different mechanism of action. Orally administered decongestants act on the alpha-adrenergic receptors in the blood vessels, causing vasoconstriction and reducing congestion. Nasal sprays act on the beta-adrenergic receptors in the bronchial smooth muscle, causing bronchodilation and improving airflow.