Which medication is most appropriate for long-term management of cholesterol in patients with coronary artery disease?

Choice A rationale

Methadone is metabolized by the liver, and long-term use can lead to liver toxicity and elevated liver enzymes. It is crucial to monitor liver function tests (LFTs) such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to detect hepatic impairment. The normal range for ALT is typically 7 to 56 U/L, and for AST, it is 10 to 40 U/L.

Choice B rationale

Methadone can affect the cardiovascular system, leading to dose-dependent hypotension or hypertension. Regular blood pressure monitoring is essential to detect and manage these fluctuations, preventing complications like syncope or organ damage. The normal range for blood pressure is less than 120/80 mm Hg, and variations outside this range require careful clinical assessment.

Choice C rationale

A primary risk of methadone, an opioid, is respiratory depression, which can be life-threatening. This side effect is a major concern, especially when initiating treatment or adjusting the dose. Monitoring the patient's respiratory rate and oxygen saturation is essential for patient safety. A normal respiratory rate for an adult is 12 to 20 breaths per minute.

Choice D rationale

This choice is incorrect because monitoring liver function, blood pressure, and respiratory status are all essential aspects of care for a patient on methadone due to the drug's systemic effects and potential for adverse reactions. Therefore, none of the above is not a correct answer.

Choice A rationale

Lithium has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small. Regular blood tests are crucial to monitor serum lithium levels, typically ranging from 0.6 to 1.2 mEq/L, to ensure the dose is therapeutic and to prevent toxicity. This statement indicates a correct understanding of lithium therapy and does not require further teaching.

Choice B rationale

Tremors, nausea, and diarrhea are common early signs of lithium toxicity. The patient should be taught to recognize and report these symptoms to their healthcare provider. This statement demonstrates the patient's awareness of potential adverse effects and the importance of prompt reporting, which is a correct understanding of the medication. The nurse should reinforce this patient teaching.

Choice C rationale

Stopping lithium abruptly can lead to a relapse into a manic or depressive episode. Lithium is a mood stabilizer, and its effectiveness is dependent on consistent, long-term use. This statement indicates a significant misunderstanding of the medication's purpose and the chronicity of bipolar disorder, necessitating immediate and comprehensive further teaching. The patient's illness requires ongoing treatment.

Choice D rationale

This statement shows an understanding of the chronic nature of bipolar disorder and the need for long-term medication adherence to maintain mood stability. Continuing the medication even when feeling better is essential to prevent mood swings and relapse. This statement reflects a correct understanding of the treatment plan, and no further teaching is required.