A 54-year-old woman with severe hypercholesterolemia is to be treated with a combination of niacin and atorvastatin. With this drug combination, it is important that the patient be monitored closely for signs of

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Myopathy. When a patient is prescribed a combination of niacin and atorvastatin to manage hypercholesterolemia, they are at an increased risk of developing myopathy, which is a known adverse effect of statin medications like atorvastatin. Myopathy presents as muscle pain, weakness, or tenderness, and can progress to severe complications like rhabdomyolysis. Option A) Agranulocytosis is not typically associated with niacin or atorvastatin therapy. Agranulocytosis is a condition characterized by a dangerously low white blood cell count. Option B) Gallstones are not a common side effect of niacin or atorvastatin therapy. Gallstones are more commonly associated with rapid weight loss or high cholesterol levels. Option C) Lactic acidosis is a rare but serious side effect of some medications like metformin, but it is not typically associated with niacin or atorvastatin. Educationally, understanding the potential side effects of cardiovascular medications is crucial for nurses and healthcare providers to ensure patient safety and optimal outcomes. Monitoring for signs and symptoms of myopathy in patients on niacin and atorvastatin can help in early detection and management of this adverse effect, preventing serious complications.

Correct Answer: B

Rationale: The correct answer is B) Its total initial oral and parenteral digitalization dose is the same. Digitoxin, a cardiac glycoside, is primarily administered orally due to its high bioavailability. The oral and parenteral routes have equivalent efficacy in achieving therapeutic levels, making parenteral administration unnecessary. This is important to ensure patient comfort and compliance, as well as reducing the risk of adverse effects associated with parenteral administration. Option A is incorrect because the rationale for not giving digitoxin parenterally is not related to pain. Option C is incorrect because digitoxin is not quickly metabolized when given intravenously or intramuscularly. Option D is incorrect because while IV route may be preferred in certain situations, it is not the sole reason for not giving digitoxin parenterally. In an educational context, understanding the rationale behind drug administration routes is crucial for healthcare professionals to make informed decisions regarding patient care. By knowing the reasons why certain drugs are given through specific routes, healthcare providers can optimize treatment outcomes, minimize risks, and ensure patient safety and comfort. This knowledge is essential for passing exams like the NCLEX and for providing high-quality patient care in clinical practice.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Lidocaine. Lidocaine is a class IB anti-arrhythmic drug commonly used to treat ventricular arrhythmias. It works by blocking sodium channels in the heart, thus stabilizing cell membranes and reducing abnormal electrical activity. Option B) Procainamide is a class IA anti-arrhythmic drug, not class IB like lidocaine. Procainamide works by slowing conduction in the heart and prolonging the action potential duration. Option C) Mexiletine is also a class IB anti-arrhythmic drug, similar to lidocaine. However, in this case, lidocaine is a more common and widely recognized class IB anti-arrhythmic drug. Option D) Metoprolol is a beta-blocker, which is not classified as a class IB anti-arrhythmic drug. Beta-blockers work by blocking the effects of adrenaline on the heart, reducing heart rate and blood pressure. Understanding the classification of anti-arrhythmic drugs is crucial for nursing students preparing for the NCLEX exam. Knowing the specific characteristics and mechanisms of action of each class helps in selecting the appropriate drug for a given arrhythmia scenario. It is essential to differentiate between the various classes to ensure safe and effective medication administration in clinical practice.

Correct Answer: B

Rationale: The correct answer is B) It must be taken at least 2 hours before and 4 hours after a bile acid sequestrant. This is because Zetia (exetimibe) can bind to bile acid sequestrants in the intestine, which can reduce the absorption of Zetia. Therefore, to ensure optimal absorption and effectiveness of Zetia, it should be taken separately from bile acid sequestrants. Option A) It must be taken with food - This is incorrect as Zetia can be taken with or without food. Option C) It cannot be taken with milk - This is incorrect as Zetia can be taken with milk or other dairy products. Option D) It cannot be taken with a statin drug - This is incorrect as Zetia can be taken with a statin drug. In fact, Zetia is often prescribed in combination with a statin to help lower cholesterol levels more effectively. Educationally, it is important for nurses to understand the specific medication instructions for Zetia to ensure its optimal therapeutic effects. By educating clients on the appropriate timing of taking Zetia in relation to other medications like bile acid sequestrants, nurses can help prevent drug interactions and ensure the best outcomes for the patient's cardiovascular health.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) D-dimer. Alteplase is a thrombolytic medication used to dissolve blood clots in conditions like acute myocardial infarction (heart attack). When alteplase is administered to a patient with ST-segment elevation myocardial infarction (STEMI), it works by activating plasminogen to convert it into plasmin, which then degrades fibrin clots in the coronary arteries. This process leads to the release of degradation products, including D-dimer, into the bloodstream. Option A) AST (Aspartate Aminotransferase) and option B) CK-MB (Creatine Kinase-MB) are markers used to assess cardiac damage, specifically in conditions like myocardial infarction. However, in this case, the primary mechanism of action of alteplase is thrombolysis, not direct myocardial injury, so these markers would not be directly influenced by alteplase administration. Option D) Myoglobin is a marker for muscle injury and can be elevated in conditions like myocardial infarction as well. However, in the context of alteplase administration, the more specific marker to monitor for thrombolytic activity would be D-dimer. Educationally, understanding the mechanisms of action and specific markers associated with different medications is crucial for healthcare professionals, especially in emergency situations like myocardial infarction. Being able to differentiate between markers of cardiac damage and markers of thrombolytic activity can guide clinical decision-making and patient management effectively.