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 D

Explanation

A. "I can season food with ketchup.": Ketchup is high in sodium, which can increase blood pressure and counteract dietary management of hypertension. Using it regularly would not align with a low-sodium meal plan.

B. "I can have canned soup.": Most canned soups contain high levels of sodium, making them unsuitable for clients aiming to reduce salt intake for hypertension control. Fresh or low-sodium alternatives are recommended.

C. "I can have a bologna sandwich.": Bologna is a processed meat with high sodium and saturated fat content, which can exacerbate hypertension and cardiovascular risk. It is not appropriate for a heart-healthy diet.

D. "I can season food with vinegar.": Vinegar adds flavor without adding sodium, making it a safe seasoning option for clients managing hypertension. Using vinegar helps maintain taste while adhering to dietary restrictions.

A. Dextrose 5% in water B. Dextrose 5% in 0.45% sodium chloride C. Lactated Ringer's D. 0.9% sodium chloride

Correct Answer is D

Explanation

A. Dextrose 5% in water: D5W contains glucose, which can cause red blood cells to swell and hemolyze during transfusion. Hemolysis increases the risk of acute transfusion reactions and reduces the effectiveness of the transfused cells. This solution is therefore unsafe to use as a carrier fluid for blood products.

B. Dextrose 5% in 0.45% sodium chloride: The presence of dextrose again creates a risk of hemolysis because glucose alters the osmotic stability of transfused RBCs. The hypotonic component further increases the likelihood of cell rupture during administration. This makes the solution incompatible with packed RBC transfusion.

C. Lactated Ringer's: LR contains calcium, which can bind with the anticoagulant citrate in stored blood products. This can cause clot formation within the infusion line or blood bag, creating a serious safety risk. For this reason, LR should not be used when administering packed RBCs.

D. 0.9% sodium chloride: Normal saline is isotonic and does not interact with the anticoagulants in stored blood, making it the safest and recommended solution for RBC transfusions. It maintains cell integrity and prevents clotting, ensuring the transfusion can be delivered effectively and without complications.

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