A nurse is reviewing the laboratory values of a client who is taking atorvastatin. Which of the following laboratory values indicates the treatment has been effective?
Decreased HDL levels
Increased serum transaminase levels
Decreased LDL levels
Increased creatine kinase levels
The Correct Answer is C
Atorvastatin is an HMG-CoA reductase inhibitor that lowers cholesterol by blocking the rate-limiting step of hepatic cholesterol synthesis. Its primary therapeutic goal is the reduction of atherogenic lipoproteins to 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Furosemide is a potent loop diureticthat facilitates the excretion of water, sodium, and potassium by inhibiting the Na-K-2Cl symporter. Its use is frequently associated with profound electrolyte imbalances, particularly hypokalemia, which can lead to life-threatening cardiac arrhythmias and altered myocardial repolarization.
Rationale:
A.A widened QRS complex is usually associated with hyperkalemia or bundle branch blocks rather than the hypokalemia caused by furosemide. Since furosemide promotes potassium excretion, it would typically be used to help lower potassium levels in some clinical scenarios. While a widened QRS is a significant finding, it does not represent the specific electrolyte risk associated with the immediate administration of a loop diuretic.
B.A blood pressure of 168/74 mmHg indicates hypertension, which is often an indication for, rather than a contraindication to, the administration of furosemide. The diuretic will help reduce the circulating fluid volume, thereby lowering the systemic blood pressure. The nurse should administer the medication as prescribed to treat the elevated pressure, provided the patient is not displaying signs of acute dehydration or shock.
C.Inverted T waves on an electrocardiogram are a classic sign of hypokalemia, indicating that the patient's potassium levels are dangerously low. Because furosemide aggressively flushes potassium out of the body, giving it to a patient who is already hypokalemic could lead to fatal ventricular arrhythmias. The nurse must withhold the dose and contact the provider to address the electrolyte deficit before proceeding with diuresis.
D.A urinary output of 30 mL over 3 hr is low (10 mL/hr) and may suggest oliguria or renal insufficiency, but it is often the reason furosemide is being given. The drug is intended to stimulate the kidneys to increase urine production in patients with fluid overload. While the nurse should monitor renal function, low output alone is not as immediate a contraindication as the cardiac signs of severe electrolyte depletion.
Correct Answer is D
Explanation
Clozapine is an atypical antipsychoticused for treatment-resistant schizophrenia. It carries a black box warning for agranulocytosis, a severe reduction in granulocytes that predisposes patients to fatal sepsis. Monitoring the absolute neutrophil count and leukocytelevels is a mandatory safety requirement for this therapy.
Rationale:
A.A BMI of 28 indicates that the client is overweight, which is a common metabolic side effect of clozapine therapy. While weight gain should be managed through diet and lifestyle interventions, it does not represent an acute, life-threatening emergency. The nurse should document this finding but prioritize more urgent hematological complications during the assessment.
B.A fasting blood glucose of 180 mg/dL indicates hyperglycemia, reflecting the metabolic dysregulation often induced by second-generation antipsychotics. Clozapine can cause insulin resistance and new-onset diabetes mellitus. While this requires medical management and potential pharmacotherapy, it is not as immediately life-threatening as the risk of profound immunosuppression and systemic infection.
C.An LDL level of 220 mg/dL signifies hyperlipidemia, which increases the long-term risk of cardiovascular disease in patients taking clozapine. Dyslipidemia is a recognized adverse effect of the medication's impact on metabolic pathways. Although this value requires follow-up and statin therapy, it does not necessitate immediate notification compared to an urgent hematological crisis.
D.A WBC count of 2,500/mm3 is a critical finding indicating severe leukopenia and a high risk for agranulocytosis. This condition compromises the immune system, making the client highly vulnerable to life-threatening infections. The nurse must report this to the provider immediately, withhold the medication, and initiate protective isolation protocols to prevent the development of sepsis.
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