A nurse is teaching a class about risk factors for heart disease. Which of the following risk factors is modifiable? (Select all that apply)

Choice A reason: Anxiety typically causes peripheral vasoconstriction, not vasodilation, due to sympathetic nervous system activation. This “fight-or-flight” response increases catecholamine release, constricting peripheral blood vessels to redirect blood to vital organs. Vasodilation is more associated with relaxation or heat dissipation, not the heightened arousal state of anxiety, making this incorrect.

Choice B reason: Hyperventilation is a common finding in anxiety, as the sympathetic nervous system stimulates rapid, shallow breathing to increase oxygen supply during perceived stress. This can lower carbon dioxide levels, causing respiratory alkalosis, dizziness, or tingling. It reflects the body’s attempt to prepare for action, making it a hallmark physiological response in anxiety.

Choice C reason: Bradycardia, or slowed heart rate, is not typical in anxiety. Anxiety activates the sympathetic nervous system, increasing heart rate (tachycardia) to enhance blood flow to muscles and organs. Bradycardia is more associated with parasympathetic dominance, such as in relaxation or vagal stimulation, making it an incorrect finding for anxiety.

Choice D reason: Drowsiness is not expected in anxiety, which is characterized by heightened alertness and arousal due to sympathetic activation. Anxiety typically causes restlessness, difficulty concentrating, or insomnia, as the body remains in a hypervigilant state. Drowsiness may occur in other conditions, like depression, but is not a primary feature of anxiety.

Choice A reason: Atorvastatin, a statin, inhibits HMG-CoA reductase, reducing cholesterol synthesis in the liver. It can elevate liver enzymes (ALT, AST), indicating hepatotoxicity. Baseline liver function tests are essential to assess hepatic health before starting therapy, ensuring no pre-existing liver damage and monitoring for drug-induced liver injury during treatment.

Choice B reason: Thyroid function tests assess thyroid hormone levels, relevant for conditions like hypothyroidism, which can elevate lipids. Atorvastatin does not directly affect thyroid function or metabolism, so these tests are not routinely required before starting therapy unless thyroid disease is suspected as a contributor to hyperlipidemia.

Choice C reason: Renal function tests monitor kidney health, critical for drugs cleared renally. Atorvastatin is primarily metabolized by the liver via cytochrome P450 3A4, not excreted by kidneys. While statins may rarely cause rhabdomyolysis affecting kidneys, baseline renal tests are not mandatory unless renal disease is suspected.

Choice D reason: Blood glucose tests are relevant for diabetes management. Atorvastatin may slightly increase glucose levels, but this is a minor, long-term effect. Baseline glucose testing is not required unless diabetes is suspected. Liver function is the primary concern due to the drug’s hepatic metabolism and potential hepatotoxicity.