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The nurse is answering phones in the general practice clinic and receives a call from a client who is experiencing leg pain after starting atorvastatin. Which of the following should the nurse advise the client to do?
- A. Continue taking the medication as this is an expected side effect.
- B. Discontinue the medication and schedule an appointment for the next week.
- C. Stretch for 20 minutes or take a warm shower.
- D. Discontinue the medication and go to the emergency room as soon as possible.
Correct Answer: D
Rationale: Leg pain with atorvastatin may indicate myopathy or rhabdomyolysis, a serious side effect requiring immediate discontinuation and emergency evaluation.
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The nurse is preparing to administer prescribed medications to a client. After reviewing the client's vital signs below, the nurse plans on holding which prescribed medication? Click to view the exhibit for additional client information.
- A. Amlodipine 5 mg PO
- B. Diltiazem 60 mg PO
- C. Ibuprofen 500 mg PO
- D. Ciprofloxacin 500 mg PO
Correct Answer: A
Rationale: Without specific vital signs, amlodipine (a calcium channel blocker) may be held if the client has hypotension, as it lowers blood pressure. Diltiazem may also lower blood pressure but is less likely to be held unless bradycardia is present. Ibuprofen and ciprofloxacin are less dependent on vital signs.
The clinic nurse is caring for a 38-year-old male
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Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.
Physician Orders
• 12-lead electrocardiogram (ECG)
• atenolol 25 mg by mouth daily
• pitavastatin 1 mg by mouth daily
• fenofibrate 45 mg by mouth daily with food
The nurse receives, reviews, and implements the physician orders. Complete the sentences below by choosing from the list of options. The nurse needs to obtain baseline ___ prior to administering atenolol because atenolol would be contraindicated if the client ___. The nurse understands that the prescribed fenofibrate is intended to ___. Prior to administering the prescribed pitavastatin, the nurse needs to obtain baseline ___.
- A. electrocardiogram
- B. had low liver enzymes.
- C. had atrioventricular block.
- D. reduce triglycerides.
- E. urine analysis.
- F. liver function tests.
- G. c-reactive protein.
Correct Answer: A,C,D,F
Rationale: The nurse needs a baseline ECG (A) to check for atrioventricular block (C), a contraindication for atenolol. Fenofibrate is intended to reduce triglycerides (D). Baseline liver function tests (F) are needed for pitavastatin due to potential hepatotoxicity.
The nurse is teaching a client who has hypertension about the newly prescribed medication, furosemide. Which of the following should the nurse include in the teaching?
- A. Limit intake of bananas, cantaloupe, and potatoes.
- B. Avoid taking the medication with grapefruit juice.
- C. Take this medication in the early part of the day.
- D. A nagging cough can occur as a side effect of the medication.
Correct Answer: A,C
Rationale: Furosemide, a loop diuretic, can cause hypokalemia, so limiting potassium-rich foods (bananas, cantaloupe, potatoes) is advised, and taking it early prevents nocturia. Grapefruit juice and cough are not concerns.
The nurse is administering prescribed furosemide to a client. Which of the following clinical manifestations would be consistent with the client developing fluid volume deficit? Select all that apply.
- A. tachycardia
- B. bradypnea
- C. weight gain
- D. decreased urine output
- E. tenting of the skin
Correct Answer: A,D,E
Rationale: Furosemide, a loop diuretic, can cause fluid volume deficit, leading to tachycardia (increased heart rate to compensate for reduced volume), decreased urine output (due to dehydration), and tenting of the skin (a sign of dehydration). Bradypnea and weight gain are not typical signs of fluid volume deficit.
The nurse is caring for a client with the following clinical data. Based on the vital signs, which medications would the nurse clarify with the primary healthcare provider (PHCP) prior to administration? See the exhibit. Select all that apply.
- A. Atenolol 50 mg PO Daily
- B. Spironolactone 50 mg PO Daily
- C. Albuterol 2.5 mg via nebulizer Daily
- D. Fentanyl 50 mcg IV Push q 6 hours PRN Pain
- E. Modafinil 100 mg PO Daily
Correct Answer: A
Rationale: Without specific vital signs provided, atenolol (a beta-blocker) may need clarification if the client has low heart rate (bradycardia) or low blood pressure, as it can exacerbate these conditions. Spironolactone, albuterol, fentanyl, and modafinil are less likely to require clarification based solely on vital signs unless specific contraindications (e.g., severe hypotension or respiratory distress) are present.