Chapter 23

The nurse has provided client education regarding therapeutic lifestyle changes to help control cholesterol levels. Which statement made by the client indicates an understanding of the information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "I will maintain an optimal weight." 2) "I will implement a medically supervised exercise plan." 3) "I will increase saturated fat in my diet." 4) "I will increase insoluble fiber in my diet." 5) "I will eliminate tobacco use."

1) "I will maintain an optimal weight." 2) "I will implement a medically supervised exercise plan." 5) "I will eliminate tobacco use."

Which assessment data obtained from a client receiving a statin is a priority for the nurse to report to the healthcare provider? 1) "My calves hurt, and I had a hard time walking to the bathroom." 2) "I know I just started this medicine yesterday, but my stomach really is upset." 3) "Will you call my healthcare provider? I have a really bad headache." 4) "My heart rate really went up this morning."

1) "My calves hurt, and I had a hard time walking to the bathroom."

The client states to the nurse, "My healthcare provider says I have heart disease and I need to decrease the cholesterol in my diet. I don't understand how this happened." Which response should the nurse provide the client? 1) "The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them." 2) "Low density lipoprotein (LDL) cholesterol is converted to saturated fat, which is stored in your coronary arteries." 3) "It is a good idea to decrease low density lipoprotein (LDL) cholesterol in your diet, although current research has not proven a correlation yet." 4) "Too much low density lipoprotein (LDL) cholesterol narrows all the arteries in your body so your heart does not receive enough blood to be healthy."

1) "The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them."

A patient has been prescribed gemfibrozil (Lopid). Which laboratory tests should the nurse schedule for the client on the next clinic appointment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Blood glucose 2) Liver enzymes 3) Potassium 4) Hemoglobin and hematocrit 5) Urinalysis

1) Blood glucose 2) Liver enzymes 4) Hemoglobin and hematocrit

The nurse is providing education about lipids for a client with hyperlipidemia. Which information should the nurse include in the education? 1) High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver. 2) High density lipoprotein (HDL) is called good cholesterol because it increases the oxygen content in the arteries and reduces the amount of plaque buildup. 3) High density lipoprotein (HDL) decreases the bad cholesterol (low density lipoprotein [LDL]), and promotes excretion of it through the kidneys. 4) High density lipoprotein (HDL) decreases low density lipoprotein (LDL) and prevents it from converting to very low density lipoprotein (VDRL), which is the worst kind of cholesterol in the body.

1) High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver.

The nurse reviewing a client's serum cholesterol levels notes the following: Low density lipoprotein (LDL) = 105 mg/dl High density lipoprotein (HDL) = 37 mg/dl Low density lipoprotein (LDL)/high density lipoprotein (HDL) ratio = 4.1 Which should the nurse identify as the priority outcome in the client's plan of care? 1) Maintenance of normal lipid levels without the use of pharmacotherapy 2) Education about diet and exercise 3) Validate that the client understands the importance of lifestyle changes 4) The client's achievement of normal lipid levels through compliance with medications

1) Maintenance of normal lipid levels without the use of pharmacotherapy

The nurse is discussing with a client, the dietary intake of omega-3 and CoQ10-rich foods to control lipid levels. Which foods should the nurse include in the discussion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Sardines 2) Shrimp 3) Almonds 4) Olive oil 5) Carrots

1) Sardines 3) Almonds 4) Olive oil

The educator is reviewing the classifications of prescriptions used to decrease blood cholesterol levels with a nurse. Which prescriptions should the educator include in the discussion of fibric acid agents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Tricor 2) Zetia 3) Lopid 4) Colestid 5) Zocor

1) Tricor 3) Lopid

The educator is preparing education about the different types of lipids for a nurse. Which should the educator include in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Triglycerides 2) Phospholipids 3) Steroids 4) Lecithins 5) Bile acids

1) Triglycerides 2) Phospholipids 3) Steroids

A client asks the nurse how fat is carried in the blood. Which response should the nurse provide? 1) "Fats in your blood are carried inside small molecules called phospholipids." 2) "Fats travel in the blood on little proteins called lipoproteins." 3) "Fats are free floating in your circulatory system." 4) "Fats are encapsulated inside little bags known as lecithin."

2) "Fats travel in the blood on little proteins called lipoproteins."

The nurse has completed the education for a client prescribed gemfibrozil (Lopid). Which statement made by the client indicates an understanding of the information? 1) "I should take this medication on an empty stomach to help it absorb better." 2) "I must take this medication with food or I can have heartburn." 3) "My physician said it really doesn't matter how I take this medication." 4) "Taking this medication with yogurt will help it to absorb better."

2) "I must take this medication with food or I can have heartburn."

The nurse has provided education for a client prescribed fenofibrate (Lofibra). Which statement made by the client indicates further teaching is required? 1) "I will expect to see a change in color of my stool." 2) "I will take my prescription on an empty stomach." 3) "I will monitor myself for bruising." 4) "I will report nausea and vomiting to my healthcare provider."

2) "I will take my prescription on an empty stomach."

Which information about the dietary intake of lipids should the nurse provide a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Phospholipids will help prevent Alzheimer's disease." 2) "Phospholipids are essential to building plasma membranes." 3) "Cholesterol is a building block for estrogen and testosterone." 4) "Triglycerides are the major form of fat in the body." 5) "Cholesterol in the diet is unnecessary as the liver synthesizes it."

2) "Phospholipids are essential to building plasma membranes." 3) "Cholesterol is a building block for estrogen and testosterone." 4) "Triglycerides are the major form of fat in the body." 5) "Cholesterol in the diet is unnecessary as the liver synthesizes it."

Which information should the nurse include in the education for a client prescribed niacin to lower lipid levels? 1) "Be sure to take your niacin on an empty stomach as soon as you arise." 2) "Take one aspirin 30 minutes before you take your niacin." 3) "Take your niacin tablet with food and at least one full glass of water." 4) "It may be time to ask your healthcare provider about switching to another drug."

2) "Take one aspirin 30 minutes before you take your niacin."

Which assessment is a nursing priority for a client receiving cholestyramine (Questran)? 1) Auscultation of heart sounds 2) Auscultation of bowel sounds in all four abdominal quadrants 3) Assessment of 24-hour urine output 4) Palpation for peripheral edema in the lower extremities

2) Auscultation of bowel sounds in all four abdominal quadrants

The patient is receiving cholestyramine (Questran) and complains of constipation. The physician orders bisacodyl (Dulcolax) tablets. When is the best time for the nurse to administer the bisacodyl (Dulcolax) tablets? 1) The drugs can be administered together. 2) Four hours after administration of cholestyramine (Questran). 3) Bisacodyl (Dulcolax) can be given any time but must be taken with food. 4) One hour after administration of cholestyramine (Questran).

2) Four hours after administration of cholestyramine (Questran).

Which type of lipoprotein is often referred to as "the good type?" 1) Triglycerides 2) HDL 3) LDL 4) VLDL

2) HDL

Which statement provides the best rationale for monitoring HDL and LDL as opposed to total cholesterol? 1) HDL and LDL monitoring is less expensive than measuring total cholesterol. 2) Total cholesterol does not differentiate the amounts of "good" cholesterol and "bad" cholesterol. 3) HDL and LDL measurements are more general and frequently used to assess clients that are not at risk for heart disease. 4) Total cholesterol measurements are often inaccurate and not as reliable as HDL and LDL.

2) Total cholesterol does not differentiate the amounts of "good" cholesterol and "bad" cholesterol.

Which type of lipid serves as fuel for the body when energy is needed? 1) Phospholipids 2) Triglycerides 3) Steroids 4) Lecithins

2) Triglycerides

A client tells the nurse they will need a prescription for high cholesterol but does not know which would be best. Which information should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "The best drugs to raise the high density lipoprotein (HDL) levels are the fibric acid drugs." 2) "The statin drugs are good but will cause a lot of flushing if you swallow them with warm fluids." 3) "The bile resins keep cholesterol from being absorbed but have some side effects." 4) "The statin drugs inhibit the making of cholesterol and are considered the best choice." 5) "Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high."

3) "The bile resins keep cholesterol from being absorbed but have some side effects." 4) "The statin drugs inhibit the making of cholesterol and are considered the best choice." 5) "Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high."

The nurse has completed nutritional teaching for a client with a high low density lipoprotein (LDL) level. Which menu choice made by the client indicates an understanding of the teaching? 1) Beef tenderloin with gravy and noodles, fruit salad with apples and grapefruit, slice of rye bread, and apple pie 2) Grilled chicken salad with strawberries and pecans, baked macaroni and cheese, and low-fat brownie 3) Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, and low-fat chocolate pudding 4) Low-fat hamburger with whole-wheat bun, tossed salad with walnuts and olive oil, and raisin-oatmeal cookie

3) Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, and low-fat chocolate pudding

The nurse is preparing to provide education for a client prescribed a statin. Which serious adverse effects should the nurse include in the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Headache 2) Abdominal pain 3) Myopathy 4) Muscle or joint pain 5) Rhabdomyolysis

3) Myopathy 5) Rhabdomyolysis

Which statement is accurate regarding the use of nicotinic acid (Niacin) for lowering blood cholesterol levels? 1) Works primarily by lowering LDL and HDL levels. 2) Due to adverse effects, niacin should not be used with statins. 3) Niacin may also reduce triglyceride levels. 4) High doses of 25-30 mg per day are often necessary.

3) Niacin may also reduce triglyceride levels.

Which lipid type is associated with the highest risk for the development of atherosclerosis? 1) Phospholipids 2) Lecithins 3) Steroids 4) Triglycerides

3) Steroids

The nurse reviewing records should determine that which client's lab values are associated with the highest risk of developing heart disease? 1) Total 200, LDL 104, HDL 30 2) Total 210, LDL 135, HDL 58 3) Total 220, LDL 162, HDL 20 4) Total 186, LDL 125, HDL 54

3) Total 220, LDL 162, HDL 20

Which assessment finding for a client receiving a statin is a priority for the nurse to report to the healthcare provider? 1) Bowel sounds markedly increased in all four quadrants of the abdomen 2) Urine output of 200 mL/hour 3) Urine output of 20 mL/hour 4) Moderate elevation in liver function tests (LFTs)

3) Urine output of 20 mL/hour

Which is the priority action of the nurse when caring for a client receiving a statin with elevated creatine kinase (CK) levels? 1) Hold the prescription and obtain another creatine kinase (CK) level in 6 hours. 2) Administer the prescription and continue to assess for muscle pain. 3) Administer the prescription and obtain another creatine kinase (CK) level in 6 hours. 4) Hold the prescription and notify the healthcare provider.

4) Hold the prescription and notify the healthcare provider.

Which describes the mechanism of atorvastatin's (Lipitor) ability to lower blood cholesterol levels? 1) Binds exogenous cholesterol and excreting it in the feces 2) Increases excretion by activating enzymes within the hepatic system 3) Prevents dietary absorption within the GI tract 4) Inhibits an enzyme that is essential for cholesterol synthesis

4) Inhibits an enzyme that is essential for cholesterol synthesis

Which anatomical location is Ezetimibe (Zetia) effective in blocking the absorption of cholesterol? 1) Stomach 2) Gallbladder 3) Liver 4) Jejunum

4) Jejunum

Which statement correctly identifies why restricting dietary intake of cholesterol generally will not result in a significant reduction of blood cholesterol? 1) Most clients are not compliant with the dietary restriction. 2) Cholesterol is found in nearly all foods, and it is not possible to eliminate it from the diet. 3) Cholesterol is made within the body and cannot be absorbed via external sources. 4) The liver reacts to a low-cholesterol diet by making more cholesterol.

4) The liver reacts to a low-cholesterol diet by making more cholesterol.