Which serum levels should be monitored when the client is taking a statin drug?

Complete blood count

Cardiac enzymes

Blood urea nitrogen

Liver enzymes

Answer and Explanation

The Correct Answer is D

A. Complete blood count: While a complete blood count (CBC) provides information about red and white blood cells and platelets, statin therapy is not typically associated with hematologic toxicity. Routine CBC monitoring is not required for patients on statins unless there are specific clinical concerns or comorbid conditions.

B. Cardiac enzymes: Cardiac enzymes such as troponin and CK-MB are used to detect myocardial injury. Statins do not usually cause acute cardiac injury, so monitoring these enzymes is not part of routine statin therapy. However, CK (creatine kinase) may be monitored if myopathy or muscle pain develops.

C. Blood urea nitrogen: Blood urea nitrogen (BUN) assesses renal function. Statins are metabolized primarily by the liver, not the kidneys, and do not typically affect BUN. Monitoring BUN is not routinely required unless the patient has preexisting kidney disease or is taking nephrotoxic medications concurrently.

D. Liver enzymes: Statins can cause hepatotoxicity and elevate liver transaminases (ALT and AST). Monitoring liver enzyme levels before starting therapy and periodically afterward is recommended to detect hepatocellular injury early and ensure safe use of the medication.

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Correct Answer is A

Explanation

A. Pacemaker spikes before each QRS complex: In a properly functioning ventricular pacemaker, the electrical stimulus is delivered to the ventricles, which appears as a sharp vertical spike on the ECG immediately before the QRS complex. This indicates that the pacemaker is successfully initiating ventricular depolarization and maintaining an adequate heart rate.

B. Pacemaker spikes with each T wave: A pacemaker spike occurring during the T wave is abnormal and dangerous because it can fall during ventricular repolarization, increasing the risk of inducing ventricular fibrillation. This is known as “R-on-T” phenomenon and requires immediate assessment and adjustment of pacemaker settings.

C. Pacemaker spikes before each P wave: Spikes before the P wave indicate atrial pacing. While this would be appropriate for an atrial pacemaker, it is not normal for a ventricular pacemaker. Ventricular pacemakers specifically target ventricular depolarization and would not appropriately spike before atrial activity.

D. Pacemaker spikes after each QRS complex: Spikes occurring after the QRS complex indicate delayed or inappropriate firing of the pacemaker. This may mean the pacemaker is malfunctioning, as ventricular depolarization has already occurred, and the extra stimulus does not contribute to effective cardiac output.

A. The client should be observed for manifestations of hemorrhage. B. Warfarin is compatible with heparin. C. Warfarin can be administered along with NSAIDS. D. The client's aPTT should be monitored.

Correct Answer is A

Explanation

A. The client should be observed for manifestations of hemorrhage: Warfarin is an anticoagulant that inhibits vitamin K–dependent clotting factors, increasing the risk of bleeding. Prior to administration, the nurse must assess for signs of hemorrhage, such as bruising, hematuria, melena, or gum bleeding, and educate the client about early warning signs to ensure safety.

B. Warfarin is compatible with heparin: While warfarin and heparin may be used concurrently during initiation of anticoagulation therapy, they are not inherently “compatible” for long-term combined administration. Heparin is usually discontinued once warfarin reaches therapeutic INR levels, and concurrent use requires careful monitoring.

C. Warfarin can be administered along with NSAIDs: NSAIDs increase the risk of gastrointestinal bleeding and can potentiate warfarin’s anticoagulant effect. Co-administration is generally avoided unless necessary, and if used, the client requires close monitoring for bleeding complications.

D. The client's aPTT should be monitored: aPTT is used to monitor unfractionated heparin therapy, not warfarin. Warfarin’s anticoagulant effect is monitored via the international normalized ratio (INR) or prothrombin time (PT), making aPTT monitoring inappropriate.

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Which serum levels should be monitored when the client is taking a statin drug?

Nursing Test Bank

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Correct Answer is A

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