A nurse is preparing to administer phenytoin IV to a client who had a tonic-clonic seizure. Which of the following actions should the nurse plan to take?

The pharmacological management of acute maniainvolves mood stabilizers and antipsychotics to achieve rapid symptomatic control. Safety standards prohibit the use of trailing zerosin medication orders to prevent ten-fold dosing errors. A decimal point followed by a zero can be easily misread in a clinical environment, leading to iatrogenic harmand severe medication toxicity.

Rationale:

A.Risperidone 3.0 mg contains a trailing zero, which is a dangerous notation that must be clarified and corrected to 3 mg. If the decimal point is not clearly visible, a clinician might mistakenly administer 30 mg, which could lead to severe extrapyramidal symptoms or neuroleptic malignant syndrome. Following the "Do Not Use" list from The Joint Commission is essential for patient safety.

B.Clonazepam 0.5 mg is a correctly formatted prescription for a benzodiazepine often used as an adjunct in mania to promote sedation and reduce agitation. The leading zero before the decimal point is required to prevent the dose from being read as 5 mg. Since this order follows safe labeling practices and falls within therapeutic ranges, it does not require clarification.

C.Lithium 300 mg is a standard starting dose for a primary mood stabilizer used in the treatment of bipolar disorder. The order is written clearly without dangerous abbreviations or incorrect decimal placements. Because the dose is typical for achieving a therapeutic serum concentration between 0.8 and 1.2 mEq/L, the nurse can proceed with administration and monitoring.

D.Divalproex sodium 0.5 g is an anticonvulsant mood stabilizer written using a leading zero, which is the correct safety format for decimal values. While often prescribed in milligrams (500 mg), the use of grams is clear and follows standard metric notation. There is no ambiguity in this order that would increase the risk of a significant medication error for the patient.

Atorvastatin is an HMG-CoA reductase inhibitorthat lowers cholesterol by blocking the rate-limiting step of hepatic cholesterol synthesis. Its primary therapeutic goal is the reduction of atherogenic lipoproteinsto prevent cardiovascular disease and stroke. Effective therapy is measured by a significant improvement in the lipid profile, specifically targeting the reduction of low-density lipoproteins(LDL).

Rationale:

A.Decreased HDL levels would indicate a worsening of the patient's cardiovascular risk profile rather than effective treatment. High-density lipoprotein (HDL) is considered "good" cholesterol because it helps remove other forms of cholesterol from the bloodstream. A successful response to statin therapy would involve maintaining or slightly increasing HDL levels to provide better cardioprotective benefits.

B.Increased serum transaminase levels are an adverse effect of atorvastatin indicating potential hepatotoxicity, not therapeutic effectiveness. Statins are metabolized by the liver and can occasionally cause inflammation or damage to hepatocytes. If these enzymes (AST and ALT) rise significantly, the nurse must report this finding as it may necessitate the discontinuation of the medication.

C.Decreased LDL levels are the hallmark indicator of effective atorvastatin therapy. Low-density lipoprotein is the primary target for statins because it contributes to plaque buildup in the arteries, leading to atherosclerosis. A significant reduction in LDL proves that the HMG-CoA reductase inhibitor is successfully lowering the production of harmful cholesterol and reducing overall cardiovascular risk.

D.Increased creatine kinase (CK) levels are a laboratory marker for muscle damage and a sign of a serious adverse effect called rhabdomyolysis. This condition involves the breakdown of skeletal muscle fibers, which can lead to acute renal failure. Elevated CK levels are a reason for concern and immediate clinical intervention, not a sign that the cholesterol-lowering treatment is working.