While a patient is receiving a statin, the nurse knows to monitor the patient closely for the development of which problem?

Choice A reason: Salmeterol is a long-acting beta-2 agonist (LABA) used for maintenance therapy in asthma and COPD. It binds to beta-2 receptors, causing prolonged bronchodilation (up to 12 hours). Its slow onset makes it unsuitable for acute bronchospasm, where rapid-acting agents are needed to quickly relax airway smooth muscle.

Choice B reason: Fluticasone is an inhaled corticosteroid that reduces airway inflammation by inhibiting cytokine production and immune responses. It has no bronchodilatory effects and is not used for acute bronchospasm. Its role is in long-term asthma control, preventing exacerbations by reducing chronic inflammation, not providing immediate relief.

Choice C reason: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly binds to beta-2 receptors on airway smooth muscle, stimulating adenyl cyclase to increase cyclic AMP, leading to bronchodilation within minutes. This makes it ideal for acute bronchospasm in asthma, providing quick relief of symptoms like wheezing and shortness of breath.

Choice D reason: Montelukast is a leukotriene receptor antagonist that blocks leukotriene D4 receptors, reducing inflammation and bronchoconstriction. It is used for maintenance therapy in asthma, not for acute bronchospasm, as its onset is too slow (hours to days) to provide immediate relief during an acute asthma attack.

Choice A reason: Intravenous heparin has an immediate onset, as it rapidly enhances antithrombin activity, inhibiting thrombin and factor Xa, preventing clot formation. This quick action makes it ideal for acute conditions like pulmonary embolism, providing instant anticoagulation, with effects measurable by aPTT within minutes of administration.

Choice B reason: A 5- to 10-minute onset is too slow for IV heparin, which acts immediately upon entering the bloodstream. Subcutaneous heparin has a delayed onset (20-60 minutes), but IV delivery ensures rapid anticoagulant effects, making this timeframe incorrect for IV administration.

Choice C reason: A 20-minute onset is inaccurate for IV heparin. Its immediate binding to antithrombin provides instant anticoagulation, unlike oral anticoagulants like warfarin, which take days. The 20-minute timeframe may apply to subcutaneous heparin, not IV, which acts within seconds to minutes.

Choice D reason: A 1-hour onset is incorrect for IV heparin, which provides immediate anticoagulation by enhancing antithrombin’s inhibition of clotting factors. This rapid action is critical for acute thrombotic conditions. A 1-hour delay applies to drugs with slower absorption, not IV heparin’s direct action.