A nurse is caring for a client who is taking lovastatin and has a new prescription for ezetimibe to lower cholesterol levels.
Which of the following laboratory values should the nurse monitor?

Calcium.

Creatinine clearance.

Thyroid stimulating hormone (TSH).

Alanine aminotransferase (ALT).

Answer and Explanation

The Correct Answer is D

Choice A rationale

Calcium levels are primarily regulated by parathyroid hormone and calcitonin and are essential for bone health and muscle function. Neither lovastatin nor ezetimibe directly impacts calcium metabolism to a degree that requires routine monitoring of serum calcium levels. Calcium monitoring is not a primary concern for these lipid-lowering medications.

Choice B rationale

Creatinine clearance is a measure of renal function, reflecting the kidney's ability to filter waste products from the blood. While some medications can affect kidney function, lovastatin and ezetimibe do not typically have significant nephrotoxic effects that necessitate routine monitoring of creatinine clearance unless pre-existing renal impairment is present.

Choice C rationale

Thyroid stimulating hormone (TSH) is produced by the pituitary gland and regulates thyroid hormone production. There is no direct pharmacological mechanism by which lovastatin or ezetimibe would significantly alter thyroid function or TSH levels. Therefore, TSH monitoring is not a standard requirement for these lipid-lowering therapies.

Choice D rationale

Both lovastatin (a statin) and ezetimibe can, albeit rarely, cause liver dysfunction, including elevated liver enzymes. Alanine aminotransferase (ALT) is a specific indicator of hepatocellular injury. Monitoring ALT is crucial to detect potential drug-induced hepatotoxicity, particularly with combination therapy, ensuring early intervention if liver damage occurs. Normal ALT is typically 7-55 U/L.

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Correct Answer is C

Explanation

Choice A rationale

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can exacerbate gastric ulcers by inhibiting prostaglandin synthesis, which normally protects the gastric mucosa. Continuing ibuprofen would counteract the therapeutic effects of esomeprazole, a proton pump inhibitor, and increase the risk of gastrointestinal bleeding and ulcer perforation.

Choice B rationale

Esomeprazole delayed-release capsules contain enteric-coated pellets to protect the active ingredient from gastric acid degradation, allowing absorption in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach and reduced bioavailability, thereby diminishing its therapeutic efficacy.

Choice C rationale

Esomeprazole is a proton pump inhibitor that irreversibly binds to and inhibits the H+/K+-ATPase pump in gastric parietal cells, thereby reducing gastric acid secretion. Taking it 60 minutes before a meal ensures that peak plasma concentrations coincide with the maximal activity of these pumps, which are stimulated by food intake, optimizing its acid-suppressing effect.

Choice D rationale

While some medications can cause insomnia, it is not a commonly reported adverse effect of esomeprazole. Common adverse effects of proton pump inhibitors typically include headache, nausea, diarrhea, abdominal pain, and flatulence, reflecting their primary actions on the gastrointestinal system and potential systemic effects.

A. Sodium bicarbonate. B. Magnesium sulfate. C. Calcium gluconate. D. Potassium chloride.

Correct Answer is C

Explanation

Choice A rationale

Sodium bicarbonate is used to treat metabolic acidosis or certain drug overdoses, but it does not directly address hypocalcemia, which is the underlying cause of a positive Trousseau's sign. Its primary action is to increase systemic pH, not calcium levels.

Choice B rationale

Magnesium sulfate is administered for magnesium deficiencies, pre-eclampsia, or certain arrhythmias. While magnesium deficiency can sometimes exacerbate hypocalcemia, it is not the primary treatment for Trousseau's sign, which specifically indicates low calcium.

Choice C rationale

Calcium gluconate is the appropriate medication to administer for a positive Trousseau's sign, as this sign indicates hypocalcemia (low serum calcium levels). Calcium gluconate directly replenishes calcium, correcting the neuromuscular excitability caused by insufficient extracellular calcium.

Choice D rationale

Potassium chloride is given to treat hypokalemia (low potassium levels). While electrolyte imbalances can be complex, a positive Trousseau's sign is specifically indicative of hypocalcemia, not hypokalemia, and potassium administration would not resolve the underlying issue.

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A nurse is caring for a client who is taking lovastatin and has a new prescription for ezetimibe to lower cholesterol levels. Which of the following laboratory values should the nurse monitor?

Nursing Test Bank

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A nurse is caring for a client who is taking lovastatin and has a new prescription for ezetimibe to lower cholesterol levels.
Which of the following laboratory values should the nurse monitor?