A nurse is instructing the mother of a child who has iron-deficiency anemia to increase iron in the child’s diet in addition to the prescribed iron supplement. Which of the following foods are high in iron and should be recommended by the nurse?

Choice A reason: Atorvastatin does not typically cause a change in urine color to dark yellow. While patients should report significant changes in urine color, such as dark brown (tea-colored) urine which could indicate myoglobinuria from rhabdomyolysis, dark yellow is not a recognized side effect of this specific HMG-CoA reductase inhibitor.

Choice B reason: While older statins with shorter half-lives were often recommended to be taken at night to align with peak endogenous cholesterol synthesis, atorvastatin has a long half-life and can be taken at any time of day. Consistency is helpful, but evening administration is not a strict clinical requirement.

Choice C reason: While it is true that grapefruit juice can inhibit the cytochrome P450 3A4 enzyme, leading to increased plasma concentrations of certain statins and potential toxicity, reporting muscle pain remains the absolute clinical priority because it serves as an early warning sign of potentially life-threatening rhabdomyolysis.

Choice D reason: Muscle pain or weakness, known as myalgia, is a critical side effect of statin therapy. It can progress to rhabdomyolysis, a severe condition characterized by the breakdown of skeletal muscle fibers and the release of myoglobin into the bloodstream, which can lead to acute renal failure and electrolyte imbalances.

Choice A reason: Sublingual nitroglycerin is designed for rapid absorption through the highly vascular oral mucosa. Placing the tablet under the tongue and allowing it to dissolve without chewing or swallowing ensures direct systemic entry, bypassing the hepatic first-pass effect, which provides rapid relief of ischemic chest pain.

Choice B reason: Nitroglycerin sublingual tablets are intended for immediate action. If they take 10 minutes to work, the administration technique is likely incorrect. These tablets should provide relief within 1 to 5 minutes; if no relief occurs after one dose, emergency protocols should be initiated.

Choice C reason: Headache is the most common side effect of nitrates due to systemic vasodilation, including dilation of cerebral vessels. It is generally expected and does not necessitate stopping the medication, although the nurse should advise the client that it may occur.

Choice D reason: Taking nitroglycerin prophylactically before physical activity or situations known to trigger angina is a valid clinical recommendation for many clients. Educating the client to take it prior to such events can help prevent the onset of ischemic pain by dilating coronary arteries beforehand.