A client who has chronic stable angina is being discharged. Which statement by the client indicates an understanding of the discharge teaching?

Choice A reason: Total cholesterol is not the best indicator of the effectiveness of simvastatin, a drug that lowers cholesterol levels and reduces the risk of cardiovascular disease. ¹ Total cholesterol includes both LDL and HDL (high density lipoprotein), which have opposite effects on the heart and blood vessels. ² The normal range of total cholesterol for adults is less than 200 mg/dL, but this does not reflect the balance between LDL and HDL.

Choice B reason: Blood pressure is not directly related to the effectiveness of simvastatin, although high blood pressure and high cholesterol are both risk factors for cardiovascular disease. ³ Simvastatin does not lower blood pressure, but it may prevent or slow down the development of atherosclerosis, which is the narrowing and hardening of the arteries due to plaque buildup. ¹ The normal range of blood pressure for adults is less than 120/80 mmHg.

Choice C reason: Serum triglycerides are another type of fat in the blood that can contribute to cardiovascular disease. ² Simvastatin can lower triglyceride levels, but this is not its main effect. ¹ The normal range of serum triglycerides for adults is less than 150 mg/dL.

Choice D reason: LDL is the main target of simvastatin therapy, as it is the "bad" cholesterol that can cause plaque buildup and damage the arteries. ¹ Simvastatin works by inhibiting an enzyme that produces LDL in the liver. The optimal level of LDL for adults is less than 100 mg/dL, and even lower for those with high risk of cardiovascular disease. ² A LDL level of 90 mg/dL indicates that the client's current dose of simvastatin has been effective.

Choice A reason: Increasing the intake of dietary fiber is not related to the instruction for carvedilol. Dietary fiber is beneficial for lowering cholesterol and blood sugar levels, but it does not affect the action or side effects of carvedilol. The client should follow a balanced diet that is low in sodium, fat, and cholesterol.

Choice B reason: This is the correct answer. Changing from a lying to sitting position slowly is an important instruction for carvedilol. Carvedilol is a beta-blocker that lowers the blood pressure and the heart rate. It can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. This can lead to dizziness, fainting, or falls. The client should change positions gradually and avoid sudden movements.

Choice C reason: Expecting weight gain of 6-8 pounds is not an instruction for carvedilol. Weight gain is not a common or expected side effect of carvedilol. It can indicate fluid retention, which can worsen the heart condition and the blood pressure. The client should monitor their weight regularly and report any significant changes to the health care provider.

Choice D reason: Taking the medication after eating breakfast is not an instruction for carvedilol. Carvedilol can be taken with or without food, depending on the client's preference and tolerance. The important thing is to take the medication at the same time every day and not to skip or double the doses.