Which of the following client findings should the nurse identify as a contraindication to the administration of simvastatin? Select all that apply.

Blood pressure

Creatinine kinase

BUN

Prescription for diltiazem

Client report of muscle ache

Answer and Explanation

Correct Answer : B,D,E

A. Blood pressure: The blood pressure reading of 140/90 mm Hg does not interfere with simvastatin therapy and does not increase the risk of adverse reactions. Statins do not significantly affect blood pressure, and hypertension alone is not a contraindication. This finding does not prevent safe administration of the medication.

B. Creatinine kinase: The creatine kinase level of 200 units/L is above the normal range and indicates possible muscle injury. Elevated CK increases concern for statin-associated myopathy, which can progress to rhabdomyolysis if the medication is continued. Withholding simvastatin until further evaluation protects the client from worsening muscle damage.

C. BUN: The BUN level of 15 mg/dL is normal and does not indicate renal impairment or dehydration. Simvastatin is not contraindicated in clients with normal kidney function. Because this value shows stable renal status, it does not affect the safety of initiating statin therapy.

D. Prescription for diltiazem: Diltiazem inhibits CYP3A4, the enzyme responsible for metabolizing simvastatin, and can significantly raise simvastatin levels. Higher serum concentrations increase the risk of severe myopathy and rhabdomyolysis. This drug interaction requires reconsideration of simvastatin dosing or alternative therapy.

E. Client report of muscle aches: Muscle pain is an early sign of statin-related myopathy and warrants immediate attention before giving another dose. Continuing the medication may worsen muscle breakdown and contribute to elevated CK levels. Holding the statin until the cause of the symptoms is evaluated promotes client safety.

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Correct Answer is C

Explanation

A. Administer an antiemetic after each meal: Antiemetics may be prescribed if nausea is present, but routine administration after every meal is unnecessary and could mask symptoms. Medication should be given based on the client’s needs rather than a fixed schedule.

B. Season foods with spices: Strong spices can irritate the gastrointestinal tract or worsen oral lesions in clients with AIDS. Mild seasoning is preferable to enhance flavor without causing discomfort or reducing appetite.

C. Provide a high-calorie diet: A high-calorie diet helps address malnutrition by supplying additional energy and nutrients needed to maintain weight and support immune function. Small, frequent, nutrient-dense meals can improve intake and promote overall health.

D. Encourage three large meals daily: Large meals may be overwhelming for clients with malnutrition, fatigue, or gastrointestinal symptoms. Smaller, more frequent meals are better tolerated and more effective in meeting caloric and nutritional needs.

A. Obtain a radial pulse. B. Maintain direct pressure over the site. C. Reinforce the dressing over the site. D. Check whether the bleeding has stopped.

Correct Answer is B

Explanation

A. Obtain a radial pulse.: Assessing the radial pulse does not help control active bleeding and does not address the immediate risk associated with hemophilia. Circulatory checks may be useful later, but they do not stop hemorrhage. The priority is to control bleeding before moving to assessment tasks.

B. Maintain direct pressure over the site.: Clients with hemophilia have impaired clotting and require sustained direct pressure to help slow bleeding. Continuous pressure supports platelet plug formation and reduces blood loss from even minor injuries. This action directly targets the immediate threat and is the most effective next step.

C. Reinforce the dressing over the site.: Adding more dressing does not exert the pressure needed to stop bleeding in hemophilia. Reinforcement may absorb more blood but will not help form a clot or reduce active bleeding. This delays the correct intervention and can allow further blood loss.

D. Check whether the bleeding has stopped.: Checking too soon interrupts clot formation, which is especially fragile in clients with clotting disorders. Lifting the dressing to inspect can dislodge early clots and worsen hemorrhage. Bleeding must be controlled first through sustained, uninterrupted pressure.

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Which of the following client findings should the nurse identify as a contraindication to the administration of simvastatin? Select all that apply.

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Naxlex Comprehensive Predictor Exams

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Explanation

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