Simvastatin has been prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply)
Reduce servings of raw vegetables and fruit.
Drug interactions are rare with antilipemic agents.
Report the occurrence of muscle pain immediately.
Report abnormal or unusual bleeding or yellow discoloration of the skin.
Limit fluid intake to prevent fluid overload.
Correct Answer : C,D
Choice A reason: Reducing raw vegetables and fruit is not necessary with simvastatin. Dietary vitamin K may affect warfarin, but statins are unaffected by fruits or vegetables, except grapefruit, which inhibits CYP3A4, increasing simvastatin levels. A balanced diet supports cardiovascular health, making this instruction incorrect.
Choice B reason: Drug interactions are not rare with simvastatin, a statin metabolized by CYP3A4. Inhibitors like grapefruit juice or antifungals increase simvastatin levels, risking toxicity, while inducers reduce efficacy. Patients must be educated about potential interactions, making this statement incorrect and misleading for safe statin use.
Choice C reason: Reporting muscle pain immediately is critical with simvastatin, as it may indicate myopathy or rare rhabdomyolysis. Statins disrupt muscle cell membranes, causing pain or weakness. Early reporting allows monitoring of creatine kinase levels and prevents progression to severe muscle damage, ensuring patient safety.
Choice D reason: Reporting bleeding or yellow skin (jaundice) is essential, as simvastatin can cause hepatotoxicity, elevating liver enzymes, or rare bleeding due to drug interactions. Jaundice indicates liver dysfunction, and bleeding may result from interactions with anticoagulants, necessitating prompt reporting to adjust therapy or monitor liver function.
Choice E reason: Limiting fluid intake is not required with simvastatin. Fluid overload is unrelated to statins, which affect cholesterol synthesis, not fluid balance. Adequate hydration supports general health, and no evidence suggests fluid restriction is necessary, making this instruction irrelevant and potentially harmful.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Griseofulvin is an antifungal used for dermatophyte infections like ringworm. It disrupts fungal mitosis by binding to keratin. It is not used for systemic infections and has minimal nephrotoxicity, as it is primarily metabolized by the liver, with side effects like rash or hepatotoxicity.
Choice B reason: Fluconazole treats systemic fungal infections like candidiasis by inhibiting ergosterol synthesis. It is generally well-tolerated and not significantly nephrotoxic, as it is excreted primarily via the kidneys unchanged. Its main side effects include hepatotoxicity and gastrointestinal upset, not kidney damage.
Choice C reason: Amphotericin B is used for severe systemic fungal infections, binding to ergosterol in fungal membranes, causing cell lysis. It is highly nephrotoxic, damaging renal tubular cells and reducing glomerular filtration rate, often requiring careful monitoring of kidney function and hydration to mitigate toxicity during treatment.
Choice D reason: Terbinafine treats dermatophyte infections like onychomycosis by inhibiting squalene epoxidase. It is not typically used for systemic infections and has low nephrotoxicity risk. Its primary side effects include hepatotoxicity and gastrointestinal issues, with minimal impact on renal function compared to amphotericin B.
Correct Answer is A
Explanation
Choice A reason: Garlic can enhance warfarin’s anticoagulant effect by inhibiting platelet aggregation and potentially increasing INR, raising bleeding risk. Its sulfur compounds may also induce hepatic enzymes, affecting warfarin metabolism. Patients on warfarin should avoid high garlic intake to maintain stable anticoagulation and prevent hemorrhage.
Choice B reason: Acetaminophen has no significant interaction with garlic. Acetaminophen is metabolized by the liver, primarily via glucuronidation, and garlic’s effects on platelet function or enzymes do not notably affect its pharmacokinetics or analgesic efficacy, making this an unlikely interaction concern.
Choice C reason: Phenytoin, an anticonvulsant, is metabolized by hepatic CYP450 enzymes, but garlic’s weak enzyme induction does not significantly alter phenytoin levels. Garlic’s primary interaction is with anticoagulants like warfarin, not anticonvulsants, making this drug less relevant for garlic-related concerns.
Choice D reason: Digoxin has no major interaction with garlic. Digoxin’s pharmacokinetics are primarily renal, and garlic’s effects on platelets or minor enzyme induction do not significantly alter digoxin levels or cardiac effects. Warfarin’s bleeding risk is more impacted by garlic’s antiplatelet properties.
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