A provider has ordered oral voriconazole [Vfend] which is an azole medication for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes anticoagulant medication Warfarin. The nurse will contact the provider to discuss which possibility?

Using a different antifungal agent

Reducing the dose of voriconazole

Administering intravenous voriconazole

Increasing the dose of Warfarin

Answer and Explanation

The Correct Answer is A

Choice A reason:
Using a different antifungal agent might be necessary due to the potential interaction between voriconazole and warfarin. Voriconazole can increase the anticoagulant effects of warfarin, leading to an increased risk of bleeding. Therefore, selecting an alternative antifungal that does not interact with warfarin could be the safest option for the patient.
Choice B reason:
Reducing the dose of voriconazole may not adequately address the drug interaction issue. Voriconazole can significantly affect warfarin metabolism even at lower doses, leading to potential complications. Therefore, this choice is less likely to be recommended.
Choice C reason:
Administering intravenous voriconazole does not change its interaction with warfarin. The method of administration does not alter the drug's effect on warfarin metabolism, making this option inappropriate for managing the drug interaction.
Choice D reason:
Increasing the dose of warfarin is not a viable option as voriconazole increases warfarin's anticoagulant effect. This would further elevate the risk of bleeding and is not recommended. Thus, this option is incorrect.

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Correct Answer is C

Explanation

Choice A reason:
Hypotension is not the likely cause of chest pain that does not improve after sublingual Nitroglycerin in a patient with a history of atherosclerosis. While hypotension can cause symptoms, the description of chest pain at rest that does not respond to Nitroglycerin suggests a more severe cardiac issue.

Choice B reason:
Stable angina typically occurs with exertion and is relieved by rest or Nitroglycerin. Chest pain consistent at rest that does not improve with Nitroglycerin suggests unstable angina, which is a more serious condition and requires immediate medical attention.

Choice C reason:
Unstable angina is the correct answer. It occurs when chest pain happens at rest and is not relieved by Nitroglycerin, indicating that the blood flow to the heart is severely restricted. This condition is a medical emergency as it can lead to a myocardial infarction.

Choice D reason:
Coronary vasodilation would typically relieve chest pain by increasing blood flow to the heart. The pain described is more consistent with unstable angina, where there is a significant reduction in blood flow to the heart that does not respond to vasodilation.

A. True B. False

Correct Answer is True

Explanation

Choice A reason:

True is the correct answer. Cardiac cells can endure ischemic conditions for approximately 20 minutes before irreversible injury occurs. Beyond this period, the lack of oxygen and nutrients leads to cell death and permanent damage to the heart tissue. This understanding is crucial in acute cardiac care, where timely intervention can prevent irreversible damage.

Choice B reason:

False is incorrect because it does not align with the known tolerance period of cardiac cells to ischemic conditions. The 20-minute window is critical for initiating interventions that can save heart tissue from permanent damage.

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Naxlex Comprehensive Predictor Exams

A patient with a history of atherosclerosis complains of chest pain that is consistent at rest. The pain does not improve after sublingual Nitroglycerin. The likely cause of this pain is:

Correct Answer is C

Explanation

Cardiac cells can withstand ischemic conditions for 20 minutes before irreversible cell injury occurs:

Correct Answer is True

Explanation

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