The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately?

• A. Client takes medications with grape juice.
• B. Client takes herbal therapy including kava kava.
• C. Client is on oral contraceptives.
• D. Client was started on penicillin for a respiratory infection.

Answer: (C)

Atorvastatin can cause birth defects if a patient is pregnant, so the most urgent safety concern for a woman of childbearing potential is ensuring she is not pregnant while taking the medication and that reliable contraception is being used. Noting that the patient is on an oral contraceptive flags this risk, so the nurse should immediately verify pregnancy status and reinforce the importance of ongoing contraception. If there is any possibility of pregnancy, the statin should be reconsidered or discontinued.

Grapefruit juice, herbal supplements like kava kava, and other interactions are important safety considerations with statins, but the immediate priority in this history is preventing fetal exposure to a teratogenic drug by confirming pregnancy status and contraception use. Penicillin has no specific interaction with atorvastatin that would prompt an immediate change in this context.