A nurse is planning care for a client who has asthma and a prescription for methylprednisolone.
Which of the following laboratory values should the nurse monitor while the client is receiving this medication?
Aspartate aminotransferase (AST).
Fibrin split products.
BUN.
Glucose.
The Correct Answer is D
Choice A rationale
Aspartate aminotransferase (AST) is an enzyme primarily found in the liver, heart, and muscle. Elevated levels can indicate hepatocellular damage or cardiac muscle injury. While some medications can affect liver function, AST is not a primary monitoring parameter for methylprednisolone, which is a corticosteroid, unless specific hepatotoxicity is suspected or pre-existing liver conditions exist. Normal AST levels are typically 10-40 U/L.
Choice B rationale
Fibrin split products (FSPs) are indicators of fibrinolysis, the breakdown of fibrin clots. Elevated FSPs suggest active clotting and subsequent clot degradation, often seen in disseminated intravascular coagulation (DIC). Methylprednisolone, a corticosteroid, does not directly impact fibrinolysis or coagulation to warrant routine monitoring of FSPs as a primary concern. This test is not routinely indicated.
Choice C rationale
Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from the waste product urea. Elevated BUN can indicate kidney dysfunction or dehydration. While corticosteroids can influence fluid balance, BUN is not a specific or primary laboratory value monitored for the direct effects of methylprednisolone therapy unless a pre-existing renal impairment is present. Normal BUN levels are typically 7-20 mg/dL.
Choice D rationale
Methylprednisolone, a glucocorticoid, significantly impacts carbohydrate metabolism by promoting gluconeogenesis and glycogenolysis, leading to increased blood glucose levels. This can induce hyperglycemia and even steroid-induced diabetes, particularly in predisposed individuals. Therefore, close monitoring of blood glucose is crucial to prevent and manage this common adverse effect. Normal fasting glucose is typically 70-99 mg/dL.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Gastrointestinal reflux, or GERD, is a condition where stomach acid flows back into the esophagus. While triptans can sometimes cause mild gastrointestinal upset, GERD itself is not a contraindication to sumatriptan use. The mechanism of action of sumatriptan involves serotonin receptor agonism, which does not significantly exacerbate or directly interact with the pathophysiology of gastrointestinal reflux disease.
Choice B rationale
Angina pectoris is chest pain caused by reduced blood flow to the heart muscle, often due to coronary artery disease. Sumatriptan causes vasoconstriction by acting on serotonin 5-HT1B/1D receptors. This generalized vasoconstrictive effect can lead to coronary artery spasm and worsen myocardial ischemia, making it a significant contraindication in patients with cardiovascular conditions like angina pectoris or a history of myocardial infarction.
Choice C rationale
Routine acetylsalicylic acid (aspirin) use is common for its antiplatelet and analgesic properties. There is no known direct contraindication to sumatriptan use in patients taking routine acetylsalicylic acid. While both medications can affect platelet function, their mechanisms of action and indications are distinct, and concurrent use is generally considered safe if no other contraindications exist.
Choice D rationale
Eczema is an inflammatory skin condition characterized by dry, itchy patches. Eczema is a dermatological condition and does not have any physiological or pharmacological interaction with sumatriptan's mechanism of action, which primarily involves vasoconstriction in the cerebral vasculature and inhibition of trigeminal nerve activity. Therefore, eczema is not a contraindication to sumatriptan therapy.
Correct Answer is D
Explanation
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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