Which of the following client findings should the nurse identify as a contraindication to the administration of simvastatin? Select all that apply.

A. Blood pressure: The blood pressure reading of 140/90 mm Hg does not interfere with simvastatin therapy and does not increase the risk of adverse reactions. Statins do not significantly affect blood pressure, and hypertension alone is not a contraindication. This finding does not prevent safe administration of the medication. B. Creatinine kinase: The creatine kinase level of 200 units/L is above the normal range and indicates possible muscle injury. Elevated CK increases concern for statin-associated myopathy, which can progress to rhabdomyolysis if the medication is continued. Withholding simvastatin until further evaluation protects the client from worsening muscle damage. C. BUN: The BUN level of 15 mg/dL is normal and does not indicate renal impairment or dehydration. Simvastatin is not contraindicated in clients with normal kidney function. Because this value shows stable renal status, it does not affect the safety of initiating statin therapy. D. Prescription for diltiazem: Diltiazem inhibits CYP3A4, the enzyme responsible for metabolizing simvastatin, and can significantly raise simvastatin levels. Higher serum concentrations increase the risk of severe myopathy and rhabdomyolysis. This drug interaction requires reconsideration of simvastatin dosing or alternative therapy. E. Client report of muscle aches: Muscle pain is an early sign of statin-related myopathy and warrants immediate attention before giving another dose. Continuing the medication may worsen muscle breakdown and contribute to elevated CK levels. Holding the statin until the cause of the symptoms is evaluated promotes client safety.