The nurse is having difficulty hearing his patient’s apical pulse with his stethoscope. Which action will help the nurse hear the heartbeat more clearly?

Choice A reason: This is an incorrect choice because release of prostaglandins lowers the patient’s heart rate and blood pressure is not a reason why acute pain is particularly dangerous for a patient having a heart attack. Prostaglandins are inflammatory mediators that are involved in pain perception and modulation, but they do not have a direct effect on the heart rate and blood pressure. In fact, some prostaglandins may have a protective role in the cardiovascular system by preventing platelet aggregation and vasodilation.

Choice B reason: This is an incorrect choice because release of substance P narrows the airways and leads to hypoxemia is not a reason why acute pain is particularly dangerous for a patient having a heart attack. Substance P is a neuropeptide that is involved in pain transmission and modulation, but it does not have a significant effect on the airways or the oxygen level. Substance P may cause bronchoconstriction in some patients with asthma or chronic obstructive pulmonary disease, but this is not a common or serious complication of acute pain.

Choice C reason: This is an incorrect choice because release of endorphins causes dangerous elevation of blood pressure is not a reason why acute pain is particularly dangerous for a patient having a heart attack. Endorphins are endogenous opioids that are involved in pain inhibition and modulation, but they do not have a major effect on the blood pressure. Endorphins may cause a slight increase in blood pressure by activating the opioid receptors in the brainstem, but this is not a significant or harmful response to acute pain.

Choice D reason: This is the correct choice because stimulation of the sympathetic nervous system will increase cardiac workload is a reason why acute pain is particularly dangerous for a patient having a heart attack. The sympathetic nervous system is part of the autonomic nervous system that is responsible for the fight-or-flight response, which is triggered by acute pain. The sympathetic nervous system will increase the heart rate, blood pressure, and cardiac contractility, which will increase the oxygen demand and consumption of the heart. This will worsen the ischemia and injury of the myocardium, and may lead to arrhythmias, heart failure, or cardiac arrest.

Choice A reason: This is incorrect. The patient frequently using an alcohol-based sanitizer for hand hygiene does not pose a risk for poisoning. Alcohol-based sanitizers are safe and effective for reducing the transmission of germs.

Choice B reason: This is correct. The patient taking acetaminophen 1000 mg every 4 hours around the clock poses a risk for poisoning. Acetaminophen is a common over-the-counter pain reliever that can cause liver damage or failure if taken in excess or for a prolonged period of time. The maximum daily dose of acetaminophen for adults is 4000 mg.

Choice C reason: This is incorrect. The patient taking alprazolam 0.25 mg every 8 hours does not pose a risk for poisoning. Alprazolam is a prescription medication that belongs to the benzodiazepine class of drugs. It is used to treat anxiety and panic disorders. It can cause side effects such as drowsiness, dizziness, or dependence, but not poisoning.

Choice D reason: This is incorrect. The patient rinsing with a fluoride mouthwash after brushing the teeth does not pose a risk for poisoning. Fluoride is a mineral that helps prevent tooth decay and strengthen the enamel. It is added to many dental products and public water supplies. It can cause mild stomach upset if swallowed in large amounts, but not poisoning.