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 ["A","C","E"]

Explanation

A. Potassium: Spironolactone is a potassium-sparing diuretic. The client’s potassium level of 5.2 mEq/L is above normal, increasing the risk of hyperkalemia. Administering spironolactone in this context is contraindicated until potassium is corrected.

B. BUN: Although the BUN is elevated, indicating possible dehydration or renal impairment, it is not an absolute contraindication. Careful monitoring and dose adjustment may be necessary, but it does not automatically preclude spironolactone use.

C. Allergy: The client has a sulfonamide allergy. Spironolactone contains a sulfonamide group, which can trigger hypersensitivity reactions. This allergy is a clear contraindication to administering the medication.

D. Respiratory rate: The respiratory rate is within a reasonable range and does not affect the safety or efficacy of spironolactone. It is not a contraindication.

E. Creatinine: The elevated creatinine (1.7 mg/dL) indicates impaired renal function. Spironolactone can worsen hyperkalemia and fluid retention in clients with kidney dysfunction, making significant renal impairment a contraindication for its use.

A. "I will hold pressure to the site after the procedure." B. "You will need to fast for 2 hours before the procedure." C. "You will not receive a local anesthetic agent for this procedure." D. "You will have the bone marrow taken from your femur."

Correct Answer is A

Explanation

A. "I will hold pressure to the site after the procedure.": Firm pressure is required after a bone marrow aspiration to reduce bleeding because the needle penetrates highly vascular bone tissue. Applying pressure also helps prevent hematoma formation at the puncture site.

B. "You will need to fast for 2 hours before the procedure.": Fasting is not required because the procedure is performed using local anesthesia and does not involve sedation in most cases. Clients can eat normally without affecting the accuracy or safety of the aspiration.

C. "You will not receive a local anesthetic agent for this procedure.": A local anesthetic is routinely administered to numb the skin and periosteum to reduce discomfort during needle insertion. Although pressure or brief sharp pain may still occur, anesthesia is an essential part of the procedure.

D. "You will have the bone marrow taken from your femur.": The posterior iliac crest is the preferred site in adults because it provides easy access and yields adequate marrow safely. The femur is rarely used except in certain pediatric situations or special circumstances.

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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.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a new prescription for spironolactone. Which of the following client findings should the nurse identify as a contraindication to the administration of spironolactone? Select the 3 findings the nurse should identify as a contraindication.

Correct Answer is ["A","C","E"]

Explanation

A nurse is reinforcing teaching with a client who is to undergo a bone marrow aspiration. Which of the following statements should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse is caring for a client who has dysphagia following a stroke. The nurse should recommend a referral to which of the following members of the interdisciplinary team?

A nurse is reinforcing teaching with a client who has anemia and has a prescription for ferrous sulfate. Which of the following foods should the nurse recommend that the client consume to increase the absorption of this medication?

A nurse is reinforcing teaching with a client who is to begin taking lansoprazole. Which of the following statements by the client indicates an understanding of the teaching?

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