Karch PrepU Chapter 47: Lipid-Lowering Agents

A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give?

"Take the thiazide diuretic about 1 hour before the colestipol."

A client who had a total cholesterol-to-HDL cholesterol ratio of 5.3 has been losing weight and participating in an exercise program. His total cholesterol-to-HDL ratio is now 3.9. What LDL reading is also important to further decrease his risk of coronary artery disease?

95 mg/dL

A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for:

Blood in urine or stool

A nurse is preparing a teaching plan for a client who is prescribed cholestyramine. Which information would the nurse include as a possible adverse reaction associated with this drug? Select all that apply.

Constipation Abdominal cramping Bruising

Which drug is most effective in reducing serum triglyceride levels?

Fibrates

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?

Heart disease

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?

Pregnancy Category X

What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.)

Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form

Which adverse effects would the nurse include in the teaching plan for a patient receiving fenofibric acid as common? (Select all that apply.)

Runny nose Respiratory infections

Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

Statins

A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important for the nurse to teach this client?

The administration of ezetimibe (Zetia) is four hours after cholestyramine.

What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia?

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic?

Triglyceride level above 150 mg/dL

A patient with metabolic syndrome usually has increased plasminogen activator levels.

True

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet

What factor determines the "preferred" density of the cholesterol?

higher amount of protein

A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin:

inhibits the production of cholesterol.

A nurse is caring for a patient who is receiving lovastatin. Which assessment by the nurse would indicate that there is possible damage to the patient's skeletal muscle as a result of the drug therapy?

Brownish colored urine

A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?

Cholestyramine

Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?

HMG-CoA reductase inhibitors

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?

headache and flatulence.

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? Select all that apply.

low triglycerides high HDL cholesterol low LDL cholesterol low total cholesterol

A client with hypertriglyceridemia is prescribed an omega 3-acid ester medication. Which teaching about this medication would the nurse emphasize with this client?

"Do not use any aspirin products when taking this medication."

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:

"I will take the digoxin about an hour before the cholestyramine."

The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug?

"The most common side effects of atorvastatin include some mild gastrointestinal upset."

The client wants information about triglycerides and cholesterol. Which response by the nurse would be correct?

"Triglycerides and cholesterol are fatlike substances found in your blood."

The client has been prescribed lovastatin to treat mixed lipidemia. In addition to monitoring cholesterol levels, what other laboratory test value needs to be monitored on a routine basis during therapy?

AST and ALT

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis

Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?

Cholesterol

A client asks the nurse what the atorvastatin (Lipitor) prescribed for the client will do. What is an expected outcome for this client?

Decrease in serum cholesterol and LDL levels

Treatments for clients with dyslipidemia are determined according to blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on treatment recommendations?

Decreases target serum LDL level

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?

Digoxin

Niacin is prescribed to a client to increase HDL levels. What are the most common adverse effects of this therapy? Select all that apply.

Flushing of the face Nausea Vomiting

After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?

Gemfibrozil

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?

Gemfibrozil

The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:

Greater drug effectiveness is achieved at this time.

The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values?

HDL 58 LDL 96 Cholesterol 178

After reviewing information about lipoproteins, a group of students demonstrate understanding of the information when they identify which of the following as being loosely packed?

HDLs

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?

High

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?

His dietary intake of saturated fat

Which lipid level would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL

The health care provider prescribes fibrate for a client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the provider to order?

LFTs

A client diagnosed with hyperlipidemia is prescribed a statin. The nurse is reviewing the client's history and would notify the client's health care provider if which condition was noted in the client's history?

Liver disease

An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy?

Liver panel

Which agent would the nurse identify as inhibiting the release of free fatty acids from adipose tissue?

Niacin

A client has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the client has been prescribed cholestyramine. What change in this client's lipid profile will the nurse identify as the most likely goal of therapy?

Reduction in LDL cholesterol levels

A client with moderately elevated lipid levels requests immediate pharmacotherapy for dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered based on what rationale?

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high?

Triglycerides 180 mg/dL

Which category of blood lipids is involved in the formation of atherosclerotic plaques?

cholesterol

Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?

decreases target serum LDL level

A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for a(n):

increase in plasma concentration of lovastatin.

A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner?

inhibits cholesterol syntheses.

The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which?

rhabdomyolysis.

A female client is taking a large dose of nicotinic acid to treat hyperlipidemia. She calls the clinic and reports that her face, neck, and chest are red. Which would be an appropriate response by the nurse?

"This is an expected adverse effect of the drug. It should subside in time."

The nurse is caring for a client who takes fluvastatin . Which laboratory value should be assessed regularly in this client?

LFT

The nurse knows that part of the education plan for a client with the diagnosis of hyperlipidemia needs to include which lifestyle changes? (Select all that apply.)

Reduction of the intake of saturated fats Weight loss Increased physical activity

A client diagnosed with metabolic syndrome is encouraged to implement nonpharmacologic measures to improve existing risk factors. What actions demonstrate an understanding of appropriate measures? Select all that apply.

Adhering to a low-fat diet Walking for 30 minutes several times a week Eating a high-fiber diet Avoiding tobacco products Maintaining a healthy weight

A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?

Constipation

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the health care provider to do?

Decrease the dosage of his medication

A client is taking lovastatin. The nurse will teach the client about which potential adverse effects?

nausea and constipation

A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?

Constipation

An 8-year-old male client requires treatment for dyslipidemia. What would the nurse expect the health care provider to order?

Pravastatin

A nurse is caring for several clients. Which client would have the greatest chance of developing CAD as determined by total cholesterol?

a 62-year-old White client with total cholesterol of 260 mg/dl

An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The client is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin. The nurse should anticipate what prescription from the health care provider?

"Atorvastatin 10 mg PO daily"

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:

Enhanced drug effectiveness

A 57-year-old female client is postmenopausal. Lifestyle changes have not made a significant impact on her lipids. What would the nurse expect the physician to suggest?

Estrogen replacement therapy

After teaching a group of students about drugs used to treat hyperlipidemia, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.

HMG-CoA reductase inhibitors Fibric acid derivatives Bile acid resins

A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:

It decreases the absorption of cholesterol in the small intestine.

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.)

Low triglycerides High HDL cholesterol Low LDL cholesterol

A female client presents to the health care provider's office with recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia?

Niacin

The nurse is developing a plan of care for a male client who has been admitted to the hospital after a myocardial infarction. The client begins lovastatin to lower his LDL levels and increase his HDL levels. Based on the adverse reaction of this medication, what would be the most appropriate nursing diagnosis?

Risk for injury to skeletal muscles related to adverse effects of drug therapy

A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:

muscle pain.

The nurse is providing education to a client who has been prescribed atorvastatin. In what way will the nurse describe how the drug achieves its desired therapeutic effect?

reduces the amount of cholesterol synthesized by the liver

A 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?

"It's important that you stop taking atorvastatin before you stop using contraception."

A patient is receiving atorvastatin. The nurse would anticipate that the maximum effectiveness of the drug would occur within which time frame?

1 to 2 hours

A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this client?

"It's a good idea to keep your intake of saturated fat to a bare minimum."

When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?

Oral

A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication:

at bedtime.

Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drug achieves its therapeutic effect by:

oxidizing cholesterol to bile acids.

A client with a high body mass index who has an elevated triglyceride level and reduced high-density lipoprotein (HDL) cholesterol is seen by the primary health care provider. The nurse should focus education on lifestyle modifications to prevent which disorder?

atherosclerosis

A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?

decreased absorption

What should the nurse suggest to assist a client to improve his cholesterol levels?

Smoking cessation

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:

Bleeding

Which of the following best reflects the action of ezetimibe?

Decreases the absorption of dietary cholesterol from the small intestine

Which client does the nurse recognize that has an increased risk for the development of atherosclerotic cardiovascular disease (ASCVD)?

a sexually active adult client who does not use condoms for birth control

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitor blood cholesterol.