Chapter 27 Antilipemic

Before the nurse administers simvastatin, which baseline data are collected to help prevent adverse effects of therapy? Select all that apply.

Muscle pain Renal function Liver enzymes Gastric distress

The nurse is caring for a patient who has hypercholesterolemia and who has been prescribed atorvastatin. Which instruction will the nurse receive from the primary healthcare provider for the safe administration of the medication?

"Administer 10 mg of atorvastatin orally."

The nurse teaches the nursing student about statin drugs. Which statements by the student indicate effective learning? Select all that apply.

"Fluvastatin with warfarin increases the risk of bleeding. "Pravastatin is not as effective as simvastatin for the inhibition of CYP3A4."

Which statement made by the patient indicates an understanding of discharge instructions on antihyperlipidemic medications?

"I will continue my exercise program to help increase my high-density lipoprotein serum levels."

A patient receiving atorvastatin therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response?

"Stop taking the drug and visit the clinic immediately." The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins, leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic.

When teaching the nursing student about coronary heart disease, which statement will the nurse include in the session? 1 "Coronary heart disease occurs due to the formation of atherosclerotic plaques." 2 "Coronary heart disease cannot be prevented by changing lifestyle modifications." 3 "Coronary heart disease is due to decreases in the cholesterol levels to below 200 mg/dL." 4 "Coronary heart disease is nonlethal and cannot be prevented by antilipemic medications."

1 "Coronary heart disease occurs due to the formation of atherosclerotic plaques."

A patient is prescribed Lovaza and simvastatin for hyperlipidemia. The nurse is looking at the patient's medication history and expresses concern over which medication? 1 Aspirin 2 Lisinopril 3 Procardia 4 Levothyroxine

1 Aspirin

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? 1 Muscle pain and tenderness 2 Platelet count of 100 × 103/mm3 3 Blood pressure of 140/90 mm Hg 4 Wheezing and shortness of breath

1 Muscle pain and tenderness

A patient with hyperlipidemia has been prescribed simvastatin [Zocor]. While caring for the patient, the nurse unknowingly administers niacin [Nicobid] along with simvastatin [Zocor]. Which complication may the patient have due to the drugs' interaction? 1 Myopathy 2 Blurred vision 3 Bowel obstruction 4 Hepatic dysfunction

1 Myopathy

Laboratory reports indicate that a patient's serum cholesterol concentration is 250 mg/dL and triglyceride levels are 450 mg/dL. The healthcare provider prescribes gemfibrozil [Lopid] to lower cholesterol levels. What is the desired effect of the drug on the patient's lipoprotein levels? 1 There would be a decrease in low-density lipoprotein (LDL) levels. 2 There would be an increase in low-density lipoprotein (LDL) levels. 3 There would be a decrease in high-density lipoprotein (HDL) levels. 4 There would be an increase in very-low-density lipoprotein (VLDL) levels.

1 There would be a decrease in low-density lipoprotein (LDL) levels.

The nurse is caring for a patient who has hypercholesterolemia and newly prescribed atorvastatin [Lipitor]. Which instruction will the nurse receive from the primary healthcare provider for the safe administration of the medication? 1 "Administer 2 mg of atorvastatin [Lipitor] orally." 2 "Administer 20 mg of atorvastatin [Lipitor] orally." 3 "Administer 10 mg of atorvastatin [Lipitor] orally." 4 "Administer 40 mg of atorvastatin [Lipitor] orally."

3 "Administer 10 mg of atorvastatin [Lipitor] orally."

Which drug is the most effective for lowering low-density lipoprotein (LDL) cholesterol? 1 Gemfibrozil 2 Ezetimibe [Zetia] 3 Atorvastatin [Lipitor] 4 Cholestyramine [Questran]

3 Atorvastatin [Lipitor]

A patient with dyslipidemia has been prescribed atorvastatin [Lipitor]. After a few days, the patient reports to the nurse that her pregnancy test is positive and that she has severe constipation. What medication does the nurse expect the provider to order for the patient? 1 Ezetimibe [Zetia] 2 Simvastatin [Zocor] 3 Niacin (nicotinic acid) 4 Cholestyramine [Questran]

3 Niacin (nicotinic acid)

A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? 1 The patient has leukemia. 2 The patient has renal disease. 3 The patient has chronic pulmonary disease. 4 The patient has chronic pulmonary disease.

3 The patient has chronic pulmonary disease.

A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? 1 The patient has leukemia. 2 The patient has renal disease. 3 The patient has hepatic disease. 4 The patient has chronic pulmonary disease.

3 The patient has hepatic disease.

The nurse is teaching a medication regimen to a patient who has type II hyperlipoproteinemia and who has been prescribed cholestyramine [Questran]. Of what will the nurse inform the patient during the teaching? 1 Include milk in the diet while taking this medication. 2 Avoid taking vitamin A supplements while taking the medication. 3 Avoid doing deep breathing exercises after taking the medication. 4 Take other medications 1 hour before or 4 hours after the administration of cholestyramine.

4 Take other medications 1 hour before or 4 hours after the administration of cholestyramine.

The nurse plans which intervention to decrease flushing associated with niacin?

Administer aspirin 30 minutes before nicotinic acid

The nursing instructor is teaching nursing students about niacin therapy for the treatment of different types of hyperlipidemia. What will the nursing instructor include in this teaching? Select all that apply.

Always check the patient's medical history for gout. Always check the patient's medical history for diabetes It is always preferable to give the extended-release dosage form of the drug to the patient

On assessment of a patient with hyperlipidemia, the nurse learns that the patient has recently undergone a liver transplantation. Which antihyperlipidemic drug does the nurse expect to be excluded from the patient's prescription?

Atorvastatin The patient who has undergone organ transplantation uses immunosuppressants such as cyclosporine to minimize graft rejection. Antihyperlipidemic drugs such as atorvastatin interact with the immunosuppressants like cyclosporine and increase the risk of myopathy. Atorvastatin should not be prescribed to the patient.

A patient is receiving clofibrate. A careful adjustment of the dosage of warfarin is required for patients taking this medication because of the risk of which condition?

Bleeding

The nurse knows that simvastatin exerts its action by doing what?

By inhibiting the enzyme HMG-CoA reductase.

The nurse is caring for a patient who has undergone kidney transplantation. The patient's laboratory reports show hyperlipidemia. Which antihyperlipidemic drug would be most beneficial for the patient?

Colesevelam Colesevelam is better tolerated by high-risk patients who have intolerance to other antilipemic medications. It can be prescribed for patients who have undergone organ transplantation or have serious liver or kidney disease.

A patient with hyperlipidemia is prescribed atorvastatin; however, the patient does not want to take a pill and prefers powder form. What alternative medication available in powder form would be most beneficial for the patient?

Colestipol

Which antilipemic medication reduces serum cholesterol by inhibiting its absorption in the small intestine?

Ezetimibe

Which are positive risk factors for coronary heart disease (CHD)? Select all that apply.

Family history of premature CHD Blood pressure higher than 140/90 mm Hg

The nurse is caring for a patient who has elevated triglyceride levels and is unresponsive to HMG-CoA reductase inhibitors. What does the nurse expect the primary health care provider to prescribe to the patient?

Gemfibrozil

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report?

High levels of low-density lipoproteins (LDL)

What are the common side effects of fenofibrate, a fibric acid derivative? Select all that apply

Impotence, nausea, abdominal pain, and an increase in gallstone formation

The nurse is assessing a patient who has been prescribed cholestyramine [Questran]. The nurse finds that the patient has decreased peristalsis and bloating. Which intervention should the nurse perform to relieve the symptoms? Select all that apply. A Provide a diet rich in fiber. B Check the patient's weight. C Increase the intake of fluid. D Include milk in the patient's diet. E Monitor the patient's blood pressure.

Increase the intake of fluid

A patient with hypercholesterolemia has been prescribed simvastatin. Which action should the nurse perform while caring for the patient?

Inform the patient that this drug may cause nausea

A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the nurse?

Muscle pain Patients who experience severe muscle pain while taking pravastatin sodium need to report the findings right away because this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal.

A patient with hyperlipidemia has been prescribed simvastatin. While caring for the patient, the nurse unknowingly administers niacin along with simvastatin. Which complication may the patient have due to the drug interaction?

Myopathy

The nurse is assessing a patient who has hyperlipidemia and who is prescribed gemfibrozil. For which condition will the nurse assess in the patient before administering the drug? Select all that apply.

Renal dysfunction Gallbladder disease Hepatic dysfunction

The nurse assesses a patient who has hyperlipidemia and who is on antihyperlipidemic therapy and informs the primary health care provider that the patient has keratomalacia. Which drug does the nurse expect to be included in the patient's treatment regimen?

Retinol

The nurse is teaching a medication regimen to a patient who has type II hyperlipoproteinemia and who has been prescribed cholestyramine. Of what will the nurse inform the patient during the teaching

Take other medications 1 hour before the administration of cholestyramine.

The nurse is caring for a patient who has hyperlipidemia and who has been prescribed gemfibrozil. On reviewing the medical history of the patient, the nurse learns that the patient is taking warfarin. What does the nurse anticipate after reviewing the patient's medical history?

The patient has an increased risk of bleeding

A patient with hyperlipidemia is treated with atorvastatin. On the follow-up visit, the nurse discovers that the patient has had no improvement in cholesterol levels. What could be the reason for this?

The patient is taking the medication in the morning

Laboratory reports indicate that a patient's serum cholesterol concentration is 250 mg/dL and triglyceride levels are 450 mg/dL. The health care provider prescribes gemfibrozil to lower cholesterol levels. What is the desired effect of the drug on the patient's lipoprotein levels?

There would be an increase in low-density lipoprotein (LDL) levels

An older adult patient with hypertension and hyperlipidemia who has been prescribed a statin medication comes for a follow-up visit after 4 months of therapy. The patient's lab reports show elevated blood cholesterol levels, and the urine examination reveals rhabdomyolysis. What could be the reasons for this condition? Select all that apply.

Verapamil, amiodarone, and grapefruit juice inhibit the metabolic protein CYP3A4 and thus decrease the metabolism of the statins. This leads to sustained blood levels of unmetabolized statins and rhabdomyolysis.

The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. During the assessment, the patient tells the nurse, "These days, my urine has a burnt odor." Which medications prescribed for the patient may be responsible for such an adverse effect? Select all that apply.

colestipol and cholestyramin

The nurse is assessing a patient with diabetes who has hyperlipidemia. The patient asks the nurse to suggest either an herbal medication or a dietary modification to reduce cholesterol levels. Which suggestion given by the nurse would be most beneficial to the patient? 1 "Include flax seeds in your food." 2 "Eat foods rich in omega-3 fatty acids." 3 "Consume excessive amounts of garlic." 4 "Take 20 mg of St. John's wort regularly."

2 "Eat foods rich in omega-3 fatty acids."

The nurse is assessing a patient who has been prescribed atorvastatin [Lipitor]. What instruction should the nurse provide for the patient to ensure proper administration of the medication? 1 "Take the drug after breakfast." 2 "Take the drug in the evening." 3 "Take the drug with an antacid." 4 "Take the drug on an empty stomach."

2 "Take the drug in the evening."

Which nursing intervention will decrease the flushing reaction of niacin? 1 Administering niacin with an antacid 2 Administering aspirin 30 minutes before niacin 3 Applying cold compresses to the head and neck 4 Administering diphenhydramine hydrochloride [Benadryl] with niacin

2 Administering aspirin 30 minutes before niacin

Which discharge instructions should the nurse include for a patient prescribed cholestyramine? 1 "Mix the drug with water or juice." 2 "Take with all other morning medications." 3 "Take 325 mg of aspirin 30 minutes before each dose." 4 "Notify the healthcare provider if upper abdominal discomfort occurs."

1 "Mix the drug with water or juice."

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? 1 "Stop taking the drug and visit the clinic immediately." 2 "Continue taking the drug; leg pain is a common side effect." 3 "Stop taking the drug if the symptoms persist for another week." 4 "Continue taking the drug along with niacin [Niaspan] and a pain killer."

1 "Stop taking the drug and visit the clinic immediately."

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? 1 High levels of low-density lipoproteins (LDL) 2 High levels of high-density lipoproteins (HDL) 3 Low levels of very-low-density lipoproteins (VLDL) 4 Low levels of intermediate-density lipoproteins (IDL)

1 High levels of low-density lipoproteins (LDL)

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? 1 Apolipoprotein B-100 2 Low-density lipoprotein (LDL) 3 High-density lipoprotein (HDL) 4 Very-low-density lipoprotein (VLDL)

2 Low-density lipoprotein (LDL)

The nurse is caring for a patient who has hyperlipidemia and who has been prescribed gemfibrozil [Lopid]. On reviewing the medical history of the patient, the nurse learns that the patient is taking warfarin [Coumadin]. What does the nurse anticipate after reviewing the patient's medical history? 1 The patient has an increased risk of infection. 2 The patient has an increased risk of bleeding. 3 The patient has an increased risk of vitamin K toxicity. 4 The patient has an increased risk of bowel obstruction.

2 The patient has an increased risk of bleeding.

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? 1 "Give 10 mg of medication daily." 2 "Give the medication before meals." 3 "Discontinue administering the medication." 4 "Give the medication with 250 mL of water."

3 "Discontinue administering the medication."

Which statement made by the patient indicates to the nurse that understanding of the discharge instructions on antihyperlipidemic medications has occurred? 1 "I will stop taking the medication if it causes nausea and vomiting." 2 "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." 3 "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels." 4 "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol."

3 "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels."

Which statement indicates the patient understands discharge instructions regarding cholestyramine [Questran]? 1 "I will weigh myself weekly." 2 "I will have my blood pressure checked weekly." 3 "I will take Questran with water, fruit juice, or soup." 4 "I will take Questran 1 hour before my other medications."

3 "I will take Questran with water, fruit juice, or soup."

Which drug is approved for hyperlipidemia and to help control hyperglycemia in patients with type 2 diabetes? 1 Ezetimibe [Zetia] 2 Niacin (nicotinic acid) 3 Colesevelam [Welchol] 4 Cholestyramine [Questran]

3 Colesevelam [Welchol]

A patient diagnosed with hypercholesterolemia is prescribed lovastatin [Mevacor]. Based on this medication order, the nurse will contact the healthcare provider about which reported condition in the patient's history? 1 Leukemia 2 Renal disease 3 Hepatic disease 4 Chronic pulmonary disease

3 Hepatic disease

A patient comes to the clinic and is diagnosed with gouty arthritis. When the nurse looks over the patient's medication list, what medication could have caused this adverse effect? 1 Ezetimibe [Zetia] 2 Gemfibrozil [Lopid] 3 Niacin (nicotinic acid) 4 Colesevelam [Welchol]

3 Niacin (nicotinic acid)

The nurse would question an order for colesevelam if the patient has which condition in the medical history?

Impaction

A patient with metabolic syndrome requires antilipemic therapy after a myocardial infarction. Which antilipemic medication is the best choice to reach this patient's treatment goals?

Nicotinic acid Metabolic syndrome is a set of risk factors that includes hypertriglyceridemia and a low concentration of high-density lipoprotein. Nicotinic acid is the best choice to decrease serum triglyceride levels and to increase HDL levels in this patient because it decreases triglycerides by 30% to 70% and increases HDLs by 20% to 35%. The only antilipemic agent that affects the triglycerides and HDLs more favorably than nicotinic acid is a fibric acid derivative such as gemfibrozil.

A patient with hypercholesterolemia is prescribed lovastatin. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the health care provider. What did the nurse find in the patient's medical history?

The patient has hepatic disease Lovastatin can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis, and lovastatin concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disorder (COPD).

The nurse is assessing a patient who is receiving antilipemic drug therapy. After 3 weeks of treatment, the nurse finds decreased levels of cognition, learning dysfunction, and behavioral changes in the patient. What does the nurse infer from this observation? Select all that apply.

The patient is treated with cholestyramine drug therapy. The patient has a previous history of phenylketonuria (PKU