A nurse is teaching a newly licensed nurse about expired medications. Which of the following instructions should the nurse include in the teaching?

• Renal impairment: Simvastatin can lead to rhabdomyolysis, which releases myoglobin into the bloodstream and can cause acute kidney injury. Assessing for renal impairment allows early detection of potential kidney damage and prevents complications.
• Rhabdomyolysis: The elevated creatinine kinase (CK) level and new-onset leg pain and weakness indicate possible muscle breakdown. Early assessment for rhabdomyolysis is critical to initiate treatment, prevent further muscle damage, and reduce the risk of renal failure.

• Abdominal pain: While the client reports mild abdominal discomfort, this symptom is less urgent compared to potential renal impairment or rhabdomyolysis, which are life-threatening complications of statin therapy.
• Impaired nutrition: Indigestion and bloating may affect appetite but are not immediately dangerous. They are secondary to the more serious concern of muscle breakdown and kidney injury.
• Constipation: Constipation is a mild gastrointestinal issue and does not indicate acute or severe complications related to simvastatin therapy.
• Dyspepsia: Dyspepsia is a common side effect of simvastatin but is not life-threatening. It should be addressed after evaluating for more urgent complications like rhabdomyolysis.

A. A client who has a history of menorrhagia: Combined oral contraceptives can actually help manage menorrhagia by regulating menstrual cycles and reducing blood loss, making this condition a therapeutic indication rather than a contraindication.

B. A client who is scheduled for orthopedic surgery in 3 weeks: Combined oral contraceptives increase the risk of thromboembolism. Surgery and postoperative immobility further elevate this risk, so the provider should be notified, and the medication may need to be discontinued before surgery.

C. A client who is 4 months postpartum: By 4 months postpartum, the risk of thromboembolism has decreased significantly, and combined oral contraceptives can typically be used safely, especially if the client is not breastfeeding.

D. A client who has a history of renal disease: While renal disease requires careful monitoring, it is not an absolute contraindication to combined oral contraceptive use. The primary concern remains the increased risk of clot formation in high-risk situations such as surgery or immobility.