34 Antihyperlipidemic Drugs

A client is starting cholestyramine therapy for the treatment of hyperlipidemia. When teaching the client about possible adverse reactions, which of the following would the nurse include? Select all that apply. A) Diarrhea B) Malabsorption of vitamin K C) Aggravation of hemorrhoids D) Flatulence E) Myopathy

Ans: B, C, D Feedback: Adverse reactions reported with the use of bile acid resins, such as cholestyramine, include constipation (that can become severe), aggravation of hemorrhoids, abdominal cramps, flatulence, nausea, increased bleeding related to vitamin K malabsorption, and vitamin A and D deficiencies.

A nurse is reviewing the medical record of a client who is prescribed statin therapy. The nurse understands that this class of drugs is contraindicated in clients with which of the following conditions? Select all that apply. A) Kidney disease B) Pregnancy C) Serious hepatic disease D) Carcinoma of the breast E) Lactation

Ans: B, C, E Feedback: Statin drugs are contraindicated in individuals with known hypersensitivity to the drugs or serious liver disease and during pregnancy (category X) and lactation.

A nurse is caring for a client who has been prescribed colestipol granules. Which of the following would the nurse do when administering the drug to the client? A) Mix the granules in 2 to 6 fluid ounces of water. B) Take care not to crush the granules. C) Give the granules once or twice daily with meals. D) Mix the drug in 90 mL of liquid.

Ans: D Feedback: The nurse should mix the drug in 90 mL of liquid, soups, cereals, carbonated drinks, or pulpy fruits when administering the colestipol granules to the client. Cholestyramine powder is mixed in 2 to 6 fluid ounces of water. Colestipol tablets are not crushed. Colesevelam tablets are taken once or twice daily with meals.

A client with hypercholesterolemia is prescribed lovastatin. When instructing the client how to take the drug, which of the following would the nurse include? A) Taking the drug with his evening meal B) Combining the drug with the artificial sweetener aspartame C) Mixing the drug with highly fluid soups or pulpy fruits D) Taking the drug with grapefruit juice

Ans: A Feedback: For the self-administration of lovastatin, the nurse should suggest the client take the drug with his evening meal. Cholestyramine powder is mixed with highly fluid soups or pulpy fruits. Cholestyramine is available combined with the artificial sweetener aspartame. The client should not drink grapefruit juice when taking lovastatin.

A client with hyperlipidemia has been prescribed niacin by a physician. Which of the following adverse reactions should the nurse monitor for in the client? A) Tingling B) Constipation C) Diarrhea D) Cholelithiasis

Ans: A Feedback: The nurse should monitor for tingling in the client as an adverse reaction to the drug niacin. Constipation, diarrhea, and cholelithiasis are adverse reactions to the drug fenofibrate.

Which of the following should be included by the nurse during client teaching to improve client outcomes for a client receiving antihyperlipidemic drugs? Select all that apply. A) Measures to minimize gastrointestinal upset B) Consultation with a dietitian for assistance with diet teaching C) Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels D) Focus on the importance of taking drug exactly as prescribed E) Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider

Ans: A, B, D, E Feedback: Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels.

Which of the following would the nurse include in the client teaching about HMG-CoA reductase inhibitors (statins)? Select all that apply. A) Photosensitivity can occur. B) The drug should be continued even if the client feels better. C) Muscle pain and weakness are normal. D) Juices other than grapefruit juice are okay to use. E) Statins should be administered in the evening.

Ans: A, B, D, E Feedback: When teaching about statins, the nurse should include information about the possibility of photosensitivity, the need to continue the drug even if feeling better, juices other than grapefruit juice as appropriate, and administration in the evening. Muscle pain and weakness should be reported to the client's physician as soon as they occur.

1. A client is receiving atorvastatin. The nurse would be alert to client complaints of which of the following? Select all that apply. A) Headache B) Sedation C) Insomnia D) Diarrhea E) Constipation

Ans: A, C, E Feedback: Atorvastatin is an HMG-CoA reductase inhibitor (statin). Adverse reactions of statins include headache, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, and nausea.

A client who is prescribed niacin comes to the clinic complaining of significant skin flushing and itching. The client states, It's really uncomfortable, so much so that I almost stopped taking the drug. The nurse informs the primary health care provider. Which of the following would the nurse anticipate that the primary health care provider may recommend? A) Prednisone B) Aspirin C) Ibuprofen D) Hydrocortisone

Ans: B Feedback: Aspirin may be recommended before taking niacin preparations to reduce adverse reactions when niacin causes skin reactions that are severe or cause extreme discomfort.

A client with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. The nurse understands that this drug would be contraindicated if the client has which condition? A) Endocrine disorder B) Primary biliary cirrhosis C) Arterial bleeding D) Respiratory depression

Ans: B Feedback: The fibric acid derivative clofibrate is contraindicated in clients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in clients with an endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in clients with respiratory depression.

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class identifies which of the following as true? A) Low-fat diet raises LDL cholesterol levels. B) Being overweight causes HDL levels to go up. C) Physical activity raises HDL cholesterol levels. D) Excess body weight causes LDL cholesterol to go down.

Ans: C Feedback: Saturated fat and cholesterol in the food raises total and LDL cholesterol levels. Being overweight can make LDL cholesterol levels go up and HDL levels go down. Increased physical activity helps to lower LDL cholesterol and raise HDL cholesterol levels.

A client is receiving pravastatin to reduce the risk of coronary heart disease due to hyperlipidemia. The client is also receiving amiodarone for an arrhythmia. The nurse understands that the client is at risk for which of the following based on these two drugs? A) Increased anticoagulant effect B) Increased hypoglycemic effect C) Increased risk of myopathy D) Decreased effects of pravastatin

Ans: C Feedback: When the HMG-CoA reductase inhibitor pravastatin is administered with amiodarone, the nurse should monitor the client for increased risk of myopathy as an effect of the interaction between the two drugs. Increased anticoagulant effect is observed in clients receiving warfarin along with pravastatin. Increased hypoglycemic effects are observed in clients receiving sulfonylureas with fibric acid derivatives. The interaction of pravastatin with amiodarone does not decrease the effect of pravastatin.

A client is receiving warfarin therapy as part of the treatment plan for atrial fibrillation. The client is also to begin therapy with cholestyramine. When assessing the client, the nurse would be alert for which of the following? Select all that apply. A) Bruising B) Blood in the stool C) Subtherapeutic INR D) Supratherapeutic INR E) Calf pain and warmth

Ans: C, E Feedback: Coadministration of warfarin and cholestyramine can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

A client is currently taking propranolol (Inderal) for hypertension, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client, which of the following would likely result? Select all that apply. A) The client would experience hypoglycemia from increased absorption of glipizide. B) The client would experience decreased analgesia from decreased absorption of acetaminophen. C) The client would experience an increase in blood pressure due to decreased absorption of propranolol. D) The client would experience hypotension from increased absorption of propranolol. E) The client would experience hyperglycemia from decreased absorption of glipizide.

Ans: C, E Feedback: The use of bile acid resins, like cholestyramine, decreases the absorption of some medications including glipizide and propranolol. This decreased absorption could result in hyperglycemia and an increase in blood pressure for this particular client.

A nurse is caring for a client taking a cholestyramine drug. What instructions should the nurse give to this client to prevent constipation? A) Eat foods high in dietary fiber. B) Follow a complete liquid diet. C) Be sure to stay on complete bed rest. D) Take the water-soluble form of vitamin A.

Ans: A Feedback: The nurse should instruct the client taking a cholestyramine drug to eat foods high in dietary fiber to prevent constipation. The nurse need not instruct the client to have a complete liquid diet or complete bed rest; instead, the nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.

A nurse is explaining how statin drugs help lower cholesterol, LDL, and triglycerides. Which of the following would the nurse include in the explanation? Select all that apply. A) Decreased absorption of cholesterol from the GI tract B) Promotion of cholesterol breakdown C) Formation of a substance that is excreted in the feces D) Decreased breakdown of fat to cholesterol E) Inhibition of cholesterol production

Ans: A, B Feedback: Statins inhibit the manufacture of cholesterol or promote the breakdown of cholesterol. The bile acid resins bind to bile acids to form an insoluble substance that cannot be absorbed by the intestine, so it is excreted in the feces.

The nurse discusses the benefit of adding a statin drug to a client's medication regimen based on the understanding that this group of drugs can reduce the risk of death from which of the following? Select all that apply. A) Stroke B) Transient ischemic attack C) Kidney disease D) Hepatic disease E) Cancer

Ans: A, B Feedback: The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks.

A nurse is obtaining a lipoprotein profile for a client diagnosed with hyperlipidemia. Which of the following measurements would be obtained? Select all that apply. A) Total cholesterol B) Triglycerides C) LDL D) ALT E) AST

Ans: A, B, C Feedback: A lipoprotein profile is a laboratory test that reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be reported from liver function tests.

A client is prescribed nicotinic acid. When teaching the client about this drug, which of the following would the nurse include as a normal skin reaction that may occur? Select all that apply. A) Flushing B) Sensations of warmth C) Tingling D) Rash E) Pustule formation

Ans: A, B, C Feedback: Generalized skin flushing, a sensation of warmth, and severe itching and tingling can occur with the administration of nicotinic acid, especially at higher doses.

The nurse is preparing a client for discharge. The client is prescribed antihyperlipidemic drug therapy. The nurse would include which of the following in the discharge teaching? Select all that apply. A) Reason for taking the prescribed drug B) Drug name C) Correct dose D) Frequency of administration E) Dosage form

Ans: A, B, C, D, E Feedback: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration, as part of a client's discharge counseling.

Prior to administering an antihyperlipidemic drug to a client, which of the following would the nurse assess? Select all that apply. A) Dietary history B) Vital signs C) Blood glucose D) Weight E) Input and output

Ans: A, B, D Feedback: Before administering an antihyperlipidemic drug, the nurse would assess a lipid profile, liver function tests, dietary history, vital signs, and weight and inspect for xanthomas.

The nurse is reviewing a client's medical record for predisposing factors for myopathy requiring that the client be started on low doses of statins and titrated as tolerated or until cholesterol goals are met. Which of the following would the nurse identify as one of these factors? Select all that apply. A) Asian descent B) Severe renal insufficiency C) Use of antihistamines D) Use of cyclosporine E) Cigarette smoking

Ans: A, B, D Feedback: Predisposing factors for myopathy with statin therapy include Asian descent, severe renal insufficiency, and use of cyclosporine.

A nurse is preparing to administer gemfibrozil to a client. The nurse understands that this drug lowers cholesterol via which of the following mechanisms? Select all that apply. A) Increases excretion of cholesterol B) Reduces very-low-density lipoproteins (VLDLs) C) Increases breakdown of VLDLs D) Reduces production of triglycerides E) Inhibits cholesterol formation

Ans: A, D Feedback: Gemfibrozil increases the excretions of cholesterol and reduces the production of triglycerides. The drug does not reduce VLDLs, increase VLDL breakdown, or inhibit cholesterol formation.

A nurse is caring for a client receiving gemfibrozil. Which of the following would the nurse include in the teaching plan for this client? A) Take the drug along with meals. B) Observe caution while driving. C) Take a single dose once daily in the evening. D) Be alert for mild to severe facial flushing.

Ans: B Feedback: When preparing a teaching plan for the client receiving the fibric acid derivative gemfibrozil, the nurse should instruct the client to observe caution while driving. Rosuvastatin calcium is taken as a single dose once daily in the evening. The nurse instructs a client prescribed nicotinic acid to take it along with meals; it may also cause mild to severe facial flushing.

After administering an antihyperlipidemic drug, the nurse continues to assess which of the following? Select all that apply. A) Blood glucose B) Vital signs C) Assessment of bowel function D) Input and output E) Stool sample

Ans: B, C Feedback: Clients on antihyperlipidemic medications should have vital signs checked and bowel function assessed because an adverse reaction to these drugs is constipation. Constipation may become serious if not treated early in the medication regimen.

When reviewing a client's history, the nurse notes that the client uses garlic to promote cardiovascular health. The nurse understands that which of the following is a benefit of its use? Select all that apply. A) Improved LDL-to-HDL ratio B) Lower serum triglyceride levels C) Lower blood pressure D) Prevention of atherosclerosis E) Reduced risk for blood clots

Ans: B, C, D Feedback: The benefits of garlic include lowering serum cholesterol and triglyceride levels, improving the ratio of HDL to LDL cholesterol, lowering blood pressure, and helping to prevent the development of atherosclerosis.

A client is experiencing constipation due to an antihyperlipidemic drug. The client asks the nurse how to manage this problem. Which suggestion would be most appropriate? Select all that apply. A) Stop taking the antihyperlipidemic medication. B) Increase your fluid intake. C) Eat foods rich in dietary fiber. D) Be sure to exercise every day. E) Use a stool softener.

Ans: B, C, D, E Feedback: Constipation resulting from an antihyperlipidemic drug can be treated by increasing fluid intake, consuming food rich in dietary fiber, exercising daily, and using a stool softener or laxative if needed.

A client is receiving pravastatin. The nurse understands that which of the following should be avoided with this client to prevent the risk of myopathy? Select all that apply. A) Quinapril (Accupril) B) Niacin (Niaspan) C) Clarithromycin (Biaxin) D) Albuterol (Proventil E) Verapamil (Calan)

Ans: B, C, E Feedback: Niacin, clarithromycin, and verapamil when coadministered to a client taking a statin, like pravastatin, can result in increased myopathy.

A nurse is reviewing a client's laboratory test results after being on statin therapy for several months. Which of the following would the nurse interpret as indicating effectiveness of the drug? Select all that apply. A) Total cholesterol 220 mg/dL B) LDL cholesterol 80 mg/dL C) HDL cholesterol 30 mg/dL D) LDL cholesterol 165 mg/dL E) HDL cholesterol 60 mg/dL

Ans: B, E Feedback: Effectiveness of therapy would be indicated by values that are low or optimal. This would include a total cholesterol below 200 mg/dL, LDL less than 100 mg/dL, and HDL greater than 40 mg/dL.

A nurse in a health care facility is caring for a client receiving colesevelam. The nurse would anticipate administering this drug cautiously to a client with which condition? A) Diabetes B) Peptic ulcer disease C) Liver disease D) Unstable angina

Ans: C Feedback: Colesevelam is administered with caution in clients with liver disease. Fibric acid derivatives are administered with caution in clients with peptic ulcer disease and diabetes. Niacin is used with caution in clients with unstable angina.

After teaching a group of nursing students about bile acids, the instructor determines that the teaching was successful when the students identify which of the following as true about bile? Select all that apply. A) Bile is manufactured by the gallbladder. B) Bile is stored in the liver. C) Bile emulsifies fat and lipids. D) Bile is secreted by the liver. E) Bile is classified as a hormone.

Ans: C, D Feedback: Bile is manufactured and secreted by the liver and stored in the gallbladder; it emulsifies fat and lipids, and these products pass through the intestine.

A client is prescribed a bile acid resin and has been taking this therapy long term. The primary health care provider has prescribed vitamins A and D in water-soluble form. Which nursing diagnosis would be most likely? A) Risk for Impaired Skin Integrity B) Constipation C) Risk for Injury D) Risk for Imbalanced Nutrition: Less Than Body Requirements

Ans: D Feedback: Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for Injury may be appropriate for clients taking fibrates or statins.

A client with hyperlipidemia is prescribed ezetimibe. Which of the following assessments should the nurse perform during treatment? A) Taking a dietary history of the client B) Inspecting skin and eyelids for evidence of xanthomas C) Obtaining reports of fasting blood sugar levels D) Frequently monitoring blood cholesterol

Ans: D Feedback: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a client receiving ezetimibe. Taking a dietary history of the client and inspecting the skin and eyelids for evidence of xanthomas are the preadministration assessments that a nurse should perform for a client receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a client with diabetes.