A patient with a known history of angina was walking his dog and developed chest pain.

The patient immediately stops walking and sits down.

He continues to experience chest pain when sitting down.
When should he call 911?

Choice A rationale

While a dry cough is a common side effect of ACE inhibitors, it should not be simply dismissed. The cough is caused by the accumulation of bradykinin, a substance that is normally degraded by the enzyme that ACE inhibitors block. This cough can be very bothersome to patients, and in some cases, can progress and may warrant a change in medication.

Choice B rationale

Increasing fluid intake is a supportive measure for many types of coughs, but it does not address the underlying pharmacological cause of an ACE inhibitor-induced cough. The cough is a direct result of bradykinin accumulation in the lungs, and simply drinking more water will not reduce this level or resolve the cough. The appropriate action involves addressing the root cause.

Choice C rationale

The cough associated with ACE inhibitors is a known side effect that occurs due to the accumulation of bradykinin. This side effect is often a significant reason for discontinuation. The most appropriate nursing action is to report the finding to the healthcare provider so they can evaluate the patient and consider alternative therapies, such as an angiotensin II receptor blocker (ARB), which does not affect bradykinin levels.

Choice D rationale

Discontinuing the medication immediately is not the appropriate action. While a cough can be bothersome, it is not a life-threatening emergency. Abruptly stopping the medication, especially in a patient with a history of hypertension or heart failure, could lead to a sudden and dangerous increase in blood pressure or a worsening of their underlying condition. The decision to discontinue or change medication must be made by the healthcare provider.

Choice A rationale

Radioactive iodine (RAI) therapy involves the administration of a radioactive isotope of iodine, I-131, which is selectively taken up by the thyroid gland to destroy overactive thyroid cells. Since the patient's body contains radioactive material, they must follow strict precautions to prevent radiation exposure to others. This includes avoiding close contact with pregnant women and young children for several days to weeks, as they are more susceptible to the harmful effects of radiation.

Choice B rationale

This is incorrect. Patients are generally advised to stop taking antithyroid medications, such as methimazole or propylthiouracil, several days before RAI therapy. These drugs prevent the thyroid gland from utilizing iodine, which would interfere with the uptake of the radioactive iodine, rendering the treatment ineffective. The goal is to maximize the absorption of the radioactive iodine by the thyroid gland.

Choice C rationale

This is incorrect. A patient preparing for radioactive iodine therapy must follow a low-iodine diet for one to two weeks before the treatment. High-iodine foods would saturate the thyroid gland with non-radioactive iodine, competing with the radioactive iodine for uptake and significantly reducing the efficacy of the therapy. Limiting iodine intake ensures the thyroid is "hungry" for the radioactive isotope.

Choice D rationale

While increasing fluid intake is generally a healthy practice, it is not a primary safety instruction for radioactive iodine therapy. The main instruction is to drink fluids and urinate frequently after the procedure. This helps to flush any unabsorbed radioactive iodine from the body more quickly, reducing radiation exposure to other parts of the body, particularly the bladder.