A nurse is preparing to administer topiramate 25 mg PO capsules BID to a client who has difficulty swallowing. Which of the following actions should the nurse take?

Simvastatin is an HMG-CoA reductase inhibitorused to treat dyslipidemia by reducing hepatic cholesterol synthesis. While effective for cardiovascular prophylaxis, it carries risks of hepatotoxicityand myopathy. Clinical monitoring focuses on liver function tests and markers of muscle integrity to detect early signs of statin-inducedorgan injury.

Rationale:

A.Decreased creatine kinase (CK) is not a finding of clinical concern; however, increased CK would be highly significant. Elevated CK levels indicate muscle breakdown or rhabdomyolysis, which is a rare but severe side effect of statin therapy. A low or normal CK level suggests that the medication is not currently causing significant damage to the client's skeletal muscle tissue.

B.Increased alkaline phosphatase is a marker of potential liver injury or biliary obstruction and must be reported to the provider immediately. Since simvastatin is processed by the liver, it can cause asymptomatic elevations in liver enzymes or, in rare cases, drug-induced hepatitis. The nurse must monitor for jaundice and upper quadrant pain when these laboratory values are elevated.

C.Increased HDL is a positive therapeutic outcome of simvastatin therapy and does not need to be reported as an adverse finding. High-density lipoprotein is the "good" cholesterol that aids in the transport of cholesterol away from the arteries. An increase in this value indicates that the medication and lifestyle changes are successfully reducing the client's overall cardiovascular risk profile.

D.Decreased HbA1c is generally a favorable finding, as it indicates improved long-term glucose control. Statins have actually been associated with a slight increase in HbA1c and blood glucose levels in some patients, potentially increasing the risk of diabetes. Therefore, a decrease would not be considered a medication-related adverse effect that requires urgent notification to the healthcare provider.

Active tuberculosis is an infectious disease caused by Mycobacterium tuberculosisrequiring combination chemotherapyto eradicate persistent bacilli and prevent multidrug resistance. Standard regimens utilize bactericidalagents like isoniazid and rifampin to achieve sterilization of infected tissues and prevent clinical relapse.

Rationale:

A.Monthly monitoring of kidney function is not a standard requirement for primary tuberculosis medications like isoniazid or rifampin, which are primarily hepatotoxic. While some aminoglycosides used for resistant cases affect renal status, the main concern for most patients is liver enzyme elevation. The nurse should focus on monitoring hepatic function and signs of jaundice instead of routine renal labs.

B.Taking two or more medications is essential because Mycobacterium tuberculosisis highly prone to developing resistance if treated with monotherapy. Using a combination, such as the RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) regimen, ensures that different bacterial populations and metabolic states are targeted simultaneously. This strategy is the cornerstone of preventing the emergence of multidrug-resistant tuberculosis strains during the long course of treatment.

C.Treatment for active tuberculosis typically lasts 6 to 9 months, rather than 3 years, for drug-susceptible cases. Extending therapy to 3 years is not standard practice and could lead to significant toxicity and non-compliance issues. The nurse must provide an accurate timeline to the client to ensure they understand the necessity of completing the entire several-month course.

D.Tuberculin skin tests are used for screening and diagnosis but are not useful for monitoring treatment progress in a patient already diagnosed with active disease. Once a skin test is positive, it will likely remain positive regardless of treatment success. Progress is instead monitored through sputum cultures, chest radiographs, and clinical improvement in symptoms like cough and fever.