Which data indicates to the nurse that the client's current dose of simvastatin has been effective?

Total cholesterol 198 mg/dL

Blood pressure 132/80

Serum triglycerides 172 mg/dL

Low density lipoprotein (LDL) 90 mg/dL

Answer and Explanation

The Correct Answer is D

Choice A reason: Total cholesterol is not the best indicator of the effectiveness of simvastatin, a drug that lowers cholesterol levels and reduces the risk of cardiovascular disease. ¹ Total cholesterol includes both LDL and HDL (high density lipoprotein), which have opposite effects on the heart and blood vessels. ² The normal range of total cholesterol for adults is less than 200 mg/dL, but this does not reflect the balance between LDL and HDL.

Choice B reason: Blood pressure is not directly related to the effectiveness of simvastatin, although high blood pressure and high cholesterol are both risk factors for cardiovascular disease. ³ Simvastatin does not lower blood pressure, but it may prevent or slow down the development of atherosclerosis, which is the narrowing and hardening of the arteries due to plaque buildup. ¹ The normal range of blood pressure for adults is less than 120/80 mmHg.

Choice C reason: Serum triglycerides are another type of fat in the blood that can contribute to cardiovascular disease. ² Simvastatin can lower triglyceride levels, but this is not its main effect. ¹ The normal range of serum triglycerides for adults is less than 150 mg/dL.

Choice D reason: LDL is the main target of simvastatin therapy, as it is the "bad" cholesterol that can cause plaque buildup and damage the arteries. ¹ Simvastatin works by inhibiting an enzyme that produces LDL in the liver. The optimal level of LDL for adults is less than 100 mg/dL, and even lower for those with high risk of cardiovascular disease. ² A LDL level of 90 mg/dL indicates that the client's current dose of simvastatin has been effective.

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Correct Answer is ["A","C"]

Explanation

Choice A: Elevated troponins. This is a correct answer. Troponins are proteins that regulate the myocardial contractile process². They are released into the bloodstream when the myocardial cells are damaged by ischemia or infarction². Troponins are highly specific and sensitive indicators of myocardial injury². The normal range for troponin I is less than 0.03 ng/mL and for troponin T is less than 0.01 ng/mL².

Choice B: Decreased homocysteine levels. This is not a correct answer. Homocysteine is an amino acid that is involved in the metabolism of methionine². Elevated homocysteine levels are associated with an increased risk of cardiovascular disease, but they are not a direct marker of myocardial injury². The normal range for homocysteine is 5 to 15 micromol/L².

Choice C: Elevated CK-MB. This is a correct answer. CK-MB is one of the isoenzymes of creatine kinase, an enzyme that catalyzes the conversion of creatine to phosphocreatine, which is used for energy storage in the muscles². CK-MB is found mainly in the myocardium and is released into the blood when the myocardial cells are injured². CK-MB is a specific and sensitive marker of myocardial injury, but it is less specific than troponins². The normal range for CK-MB is 0 to 3 ng/mL².

Choice D: Decreased alkaline phosphatase (ALP).This is not a correct answer. ALP is an enzyme that is found in various tissues, such as the liver, bone, intestine, and placenta². ALP is not a marker of myocardial injury, and its levels are not affected by ischemia or infarction². The normal range for ALP is 30 to 120 U/L².

Choice E: Increased platelet count.This is not a correct answer. Platelets are blood cells that are involved in hemostasis and clot formation². Increased platelet count, or thrombocytosis, can be a sign of inflammation, infection, malignancy, or other conditions². Platelet count is not a marker of myocardial injury, and it does not reflect the extent of ischemia or infarction². The normal range for platelet count is 150,000 to 450,000 per microliter of blood².

A. Document the pulse rate and administer the medications as prescribed B. Assess for chest pain and administer atenolol if pain free C. Hold the atenolol and administer the diltiazem D. Withhold the medications and reassess the heart rate in 30 minutes

Correct Answer is C

Explanation

Choice A reason: This is not the best nursing action. Documenting the pulse rate and administering the medications as prescribed may be harmful to the client. Atenolol and diltiazem are both medications that lower the blood pressure and the heart rate. Atenolol is a beta blocker that blocks the effects of adrenaline on the heart and blood vessels. Diltiazem is a calcium channel blocker that relaxes the muscles of the heart and blood vessels. Giving both medications to a client who already has a low and irregular heart rate may cause further bradycardia, which is a heart rate below 60 beats/minute, or arrhythmia, which is an abnormal heart rhythm. The nurse should check the parameters and the contraindications for the medications before administering them.

Choice B reason: This is not the best nursing action. Assessing for chest pain and administering atenolol if pain free may not be appropriate for the client. Chest pain can be a sign of angina or myocardial infarction, which are conditions where the blood flow to the heart is reduced or blocked. Atenolol can help relieve chest pain by reducing the oxygen demand of the heart, but it can also lower the heart rate and the blood pressure. The client already has a low and irregular heart rate, which may indicate a problem with the electrical conduction of the heart. The nurse should not give atenolol without checking the pulse rate and the blood pressure, and consulting the health care provider.

Choice C reason: This is the best nursing action. Holding the atenolol and administering the diltiazem is the most appropriate for the client. Atenolol can lower the heart rate and the blood pressure, which may worsen the client's condition. The nurse should hold the atenolol and notify the health care provider of the client's pulse rate and rhythm. Diltiazem can also lower the heart rate and the blood pressure, but it can also help regulate the heart rhythm by slowing down the electrical impulses in the heart. The nurse should administer the diltiazem as prescribed, and monitor the client's vital signs and cardiac status.

Choice D reason: This is not the best nursing action. Withholding the medications and reassessing the heart rate in 30 minutes may delay the treatment and the care of the client. The client has a low and irregular heart rate, which may indicate a serious cardiac problem that needs immediate attention. The nurse should not wait for 30 minutes to reassess the heart rate, but rather act promptly and notify the health care provider. The nurse should also administer the diltiazem as prescribed, unless there is a specific reason to withhold it.

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Which data indicates to the nurse that the client's current dose of simvastatin has been effective?

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Naxlex Comprehensive Predictor Exams

The nurse is reviewing the chart of a client with an indication of myocardial infarction or unstable angina. Which laboratory test result(s) should the nurse recognize as an indication of myocardial injury? (Select all that apply)

Correct Answer is ["A","C"]

Explanation

A client is scheduled to receive atenolol 25 mg PO and diltiazem 60 mg PO at 0800. The nurse assesses the client's heart rate as 45 beats/minute and irregular. What is the best nursing action at this time?

Correct Answer is C

Explanation

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