My Lab Quiz 23 (Exam 2)
Which describes the mechanism of atorvastatin's (Lipitor) ability to lower blood cholesterol levels? a. Binds exogenous cholesterol and excreting it in the feces. b. Inhibits an enzyme that is essential for cholesterol synthesis. c. Increases excretion by activating enzymes within the hepatic system. d. Prevents dietary absorption within the GI tract.
b. Inhibits an enzyme that is essential for cholesterol synthesis. Rationale: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.
Which anatomical location is Ezetimibe (Zetia) effective in blocking the absorption of cholesterol? a. Gallbladder b. Jejunum c. Liver d. Stomach
b. Jejunum Rationale: Ezetimibe (Zetia) blocks the absorption of cholesterol from the jejunum of the small intestine. It does not block absorption of cholesterol from the stomach, stomach, or liver.
The nurse has completed the education for a client prescribed gemfibrozil (Lopid). Which statement made by the client indicates an understanding of the information? a. "I should take this medication on an empty stomach to help it absorb better." b. "My physician said it really doesn't matter how I take this medication." c. "I must take this medication with food or I can have heartburn." d. "Taking this medication with yogurt will help it to absorb better."
c. "I must take this medication with food or I can have heartburn." Rationale: Gemfibrozil should be administered w/ food to decrease gastrointestinal distress. Taking on empty stomach can cause gastrointestinal distress; food will decrease the distress. Should not be taken w/ yogurt bec fatty foods may decrease efficacy.
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? a. The drugs can be administered together. b. Bisacodyl (Dulcolax) can be given any time but must be taken with food. c. Four hours after administration of cholestyramine (Questran). d. One hour after administration of cholestyramine (Questran).
c. Four hours after administration of cholestyramine (Questran). Rationale: Other drugs must be administered +2 hrs before, or 4 hrs after, client takes cholestyramine bec it can bind to other drugs & interfere w/ their absorption.
A client asks the nurse how fat is carried in the blood. Which response should the nurse provide? a. "Fats are encapsulated inside little bags known as lecithin."' b. "Fats are free floating in your circulatory system." c. "Fats in your blood are carried inside small molecules called phospholipids." d. "Fats travel in the blood on little proteins called lipoproteins."
d. "Fats travel in the blood on little proteins called lipoproteins." Rationale: Lipids are carried thru blood as lipoproteins. Phospholipids= class of lipids, essential to building plasma membranes. Lecithin's= phospholipids found in egg yolks & soybeans. Nurse can answer question; Doesn't need to be referred to physician.
Which statement correctly identifies why restricting dietary intake of cholesterol generally will not result in a significant reduction of blood cholesterol? a. .The liver reacts to a low-cholesterol diet by making more cholesterol. b. Cholesterol is made within the body and cannot be absorbed via external sources. c. Most clients are not compliant with the dietary restriction. d. Cholesterol is found in nearly all foods, and it is not possible to eliminate it from the diet.
a. .The liver reacts to a low-cholesterol diet by making more cholesterol. Rationale: Recent research suggests that the amount of cholesterol consumed is only slightly related to the amount in the blood. The liver reacts to a low-cholesterol diet by making more cholesterol when saturated fats are present. In order to reduce cholesterol levels, the patient should reduce intake of saturated fats and refined carbohydrates.
Which assessment is a nursing priority for a client receiving cholestyramine (Questran)? a. Auscultation of bowel sounds in all four abdominal quadrants b. Assessment of 24-hour urine output c. Auscultation of heart sounds d. Palpation for peripheral edema in the lower extremities
a. Auscultation of bowel sounds in all four abdominal quadrants Rationale: Assessment of bowel sounds is a priority because cholestyramine (Questran) could cause obstruction of the intestines.
A patient has been prescribed gemfibrozil (Lopid). Which laboratory tests should the nurse schedule for the client on the next clinic appointment? Select all that apply. a. Blood glucose b. Liver enzymes c. Potassium d. Hemoglobin and hematocrit e. Urinalysis
a. Blood glucose b. Liver enzymes d. Hemoglobin and hematocrit Rationale: Gemfibrozil may increase serum glucose & liver enzyme levels. Gemfibrozil may decrease H&H. Potassium level should not be affected by gemfibrozil. Urinalysis is unnecessary.
Which type of lipoprotein is often referred to as "the good type?" a. HDL b. LDL c. Triglycerides d. VLDL
a. HDL Rationale: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease.
Which is the priority action of the nurse when caring for a client receiving a statin with elevated creatine kinase (CK) levels? a. Hold the prescription and notify the healthcare provider. b. Hold the prescription and obtain another creatine kinase (CK) level in 6 hours. c. Administer the prescription and continue to assess for muscle pain. d. Administer the prescription and obtain another creatine kinase (CK) level in 6 hours.
a. Hold the prescription and notify the healthcare provider. Rationale: Elevated creatine kinase (CK) levels could indicate myopathy; if this is suspected, the prescription is held and the healthcare provider notified.
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? Select all that apply. a. Sardines b. Shrimp c. Almonds d. Olive oil e. Carrots
a. Sardines c. Almonds d. Olive oil Rationale: Sardines, almonds, & olive oil= high in these nutrients. Shrimp & carrots are not.
The nurse reviewing records should determine that which client's lab values are associated with the highest risk of developing heart disease? a. Total 220, LDL 162, HDL 20 b. Total 186, LDL 125, HDL 54 c. Total 200, LDL 104, HDL 30 d. Total 210, LDL 135, HDL 58
a. Total 220, LDL 162, HDL 20 Rationale: Total 220 = borderline high risk; LDL 162= high risk; HDL 20= low risk.
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? Select all that apply. a. Tricor b. Zetia c. Lopid d. Colestid e. Zocor
a. Tricor c. Lopid Rationale: Tricor= fibric acid agent used to decrease blood cholesterol levels. Lopid= fibric acid agent used to decrease blood cholesterol levels. Zetia= unclassified agent used to decrease blood cholesterol levels. Colestid= bile acid sequestrant used to decrease blood cholesterol levels. Zocor = HMG-CoA reductase medication used to decrease blood cholesterol levels.
The educator is preparing education about the different types of lipids for a nurse. Which should the educator include in the presentation? Select all that apply. a. Triglycerides b. Phospholipids c. Steroids d. Lecithins e. Bile acids
a. Triglycerides b. Phospholipids c. Steroids Rationale: Triglycerides= most common classifications of lipids. Phospholipids= class of lipids essential to build plasma membranes. Steroids= diverse classification of lipids. Lecithins= not classification of lipid. Lecithin= best-known phospholipid. Bile acids = not classification of lipids. Cholesterol= building block of bile acids.
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? Select all that apply. a. "I will maintain an optimal weight." b. "I will implement a medically supervised exercise plan." c. "I will increase saturated fat in my diet." d. "I will increase insoluble fiber in my diet." e. "I will eliminate tobacco use."
a. "I will maintain an optimal weight." b. "I will implement a medically supervised exercise plan." e. "I will eliminate tobacco use." Rationale: Maintaining optimal weight= nonpharmaco therapeutic lifestyle change, can control cholesterol levels in blood. Medically supervised exercise plan = nonpharmaco therapeutic lifestyle change, can control cholesterol levels in blood. Patient should decrease dietary saturated fats & cholesterol in diet. Recommended to increase soluble fiber, not insoluble, in diet. Eliminating tobacco use= nonpharmaco therapeutic lifestyle change, can decrease cholesterol levels in blood.
Which assessment data obtained from a client receiving a statin is a priority for the nurse to report to the healthcare provider? a. "My heart rate really went up this morning." b. "My calves hurt, and I had a hard time walking to the bathroom." c. "Will you call my healthcare provider? I have a really bad headache." d. "I know I just started this medicine yesterday, but my stomach really is upset."
b. "My calves hurt, and I had a hard time walking to the bathroom." Rationale: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis.
Which information about the dietary intake of lipids should the nurse provide a client? select all that apply. a. "Phospholipids will help prevent Alzheimer's disease." b. "Phospholipids are essential to building plasma membranes." c. "Cholesterol is a building block for estrogen and testosterone." d. "Triglycerides are the major form of fat in the body." e. "Cholesterol in the diet is unnecessary as the liver synthesizes it."
b. "Phospholipids are essential to building plasma membranes." c. "Cholesterol is a building block for estrogen and testosterone." d. "Triglycerides are the major form of fat in the body." e. "Cholesterol in the diet is unnecessary as the liver synthesizes it." Rationale: Triglycerides= the major form of fat in body, phospholipids= essential to building plasmamembranes, cholesterol= building block for estrogen & testosterone, & cholesterol= not needed in diet bec liver synthesizes adequate amounts from other chemicals. No evidence to support phospholipids will prevent Alzheimer's disease.
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? a. Beef tenderloin with gravy and noodles, fruit salad with apples and grapefruit, slice of rye bread, and apple pie b. Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, andlow-fat chocolate pudding c. Low-fat hamburger with whole-wheat bun, tossed salad with walnuts and olive oil, and raisin-oatmeal cookie d. Grilled chicken salad with strawberries and pecans, baked macaroni and cheese, and low-fat brownie
b. Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, andlow-fat chocolate pudding Rationale: lipid-reducing diet should include soluble fiber & plant sterols & stanols in diet. Best menu choice includes rice, broccoli, walnuts, apples, & whole-wheat bread. Menu w/ beef has some health, but gravy is too high in fat, apple pie too. Menu w/ low-fat hamburger has some health, but low-fat hamburger= too high in fat, cookie too. Menu w/ grilled chicken salad has no health except for pecans; Mac & cheese= high in fat.
The nurse is providing education about lipids for a client with hyperlipidemia. Which information should the nurse include in the education? a. High density lipoprotein (HDL) is called good cholesterol because it increases the oxygen content in the arteries and reduces the amount of plaque buildup. b. High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver. c. High density lipoprotein (HDL) decreases the bad cholesterol (low density lipoprotein [LDL]), and promotes excretion of it through the kidneys. d. 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.
b. High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver. Rationale: (HDL) assists in the transport of cholesterol away from body tissues & back to liver in process called reverse cholesterol transport. (HDL) does not reduce (LDL), which is excreted in feces, not kidneys. (HDL) does not increase oxygen content in arteries. Very low density lipoprotein (VDRL) reduces to become (LDL).
Which statement provides the best rationale for monitoring HDL and LDL as opposed to total cholesterol? a. HDL and LDL monitoring is less expensive than measuring total cholesterol. b. Total cholesterol does not differentiate the amounts of "good" cholesterol and "bad" cholesterol. c. HDL and LDL measurements are more general and frequently used to assessed clients that are not at risk for heart disease. d. Total cholesterol measurements are often inaccurate and not as reliable as HDL and LDL.
b. Total cholesterol does not differentiate the amounts of "good" cholesterol and "bad" cholesterol. Rationale: Total cholesterol tests include the "good" and "bad" cholesterol and does not indicate the specific amounts of either. HDL and LDL are more specific tests, not more general.
Which assessment finding for a client receiving a statin is a priority for the nurse to report to the healthcare provider? a. Urine output of 200 mL/hour. b. Urine output of 20 mL/hour. c. Moderate elevation in liver function tests (LFTs). d. Bowel sounds markedly increased in all four quadrants of the abdomen.
b. Urine output of 20 mL/hour. Rationale: Rhabdomyolysis is a rare, but serious, side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure.
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? select all that apply. a. "The best drugs to raise the high density lipoprotein (HDL) levels are the fibric acid drugs." b. "The statin drugs are good but will cause a lot of flushing if you swallow them with warm fluids." c. "The bile resins keep cholesterol from being absorbed but have some side effects." d. "The statin drugs inhibit the making of cholesterol and are considered the best choice." e. "Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high."
c. "The bile resins keep cholesterol from being absorbed but have some side effects." d. "The statin drugs inhibit the making of cholesterol and are considered the best choice." e. "Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high." Rationale: Statin drugs inhibit HMG-CoA reductase- necessary for biosynthesis of cholesterol & are drugs of 1st choice in reducing serum lipid levels. Bile resins= effective, but # side effects limit usefulness. Fibric acid agents= effective but won't reduce (LDL) levels. Niacin will cause flushing, which is worse w/ warm fluids. Best drugs to raise (HDL) levels= statins, not fibric acid drugs.
The nurse is preparing to provide education for a client prescribed a statin. Which adverse effects should the nurse include in the teaching? Select all that apply. a. Headache b. Abdominal pain c. Myopathy d. Muscle or joint pain e. Rhabdomyolysis
c. Myopathy e. Rhabdomyolysis Rationale: Severe myopathy= rare & serious adverse effect associated w/ statins. Rhabdomyolysis= example of rare & serious adverse effect associated w/ statins. Headache, abdominal pain, & muscle/joint pain = minor adverse effects.
Which lipid type is associated with the highest risk for the development of atherosclerosis? a. Lecithins b. Triglycerides c. Steroids d. Phospholipids
c. Steroids Rationale: Cholesterol is a steroid and is known for its role in promoting atherosclerosis.
Which type of lipid serves as fuel for the body when energy is needed? a. Steroids b. Lecithins c. Triglycerides d. Phospholipids
c. Triglycerides Rationale: Triglycerides are the major storage form of fat in the body and the only type of lipid that serves as an important energy source.
The nurse has provided education for a client prescribed fenofibrate (Lofibra). Which statement made by the client indicates an understanding of the information? a. "I will report nausea and vomiting to my healthcare provider." b. "I will monitor myself for bruising." c. "I will take my prescription with food." d. "I will expect to see a change in color of my stool."
d. "I will expect to see a change in color of my stool." Rationale: Fenofibrate increases the risk of bleeding. A change in color of stool should be reported to the healthcare provider. It should be taken with meals to avoid adverse gastrointestinal symptoms. It is a fibric acid drug w/ a risk of bruising & bleeding. Nausea & vomiting are adverse effects of fenofibrate & should be reported to healthcare provider to avoid dehydration.
Which information should the nurse include in the education for a client prescribed niacin to lower lipid levels? a. "Be sure to take your niacin on an empty stomach as soon as you arise." b. "Take your niacin tablet with food and at least one full glass of water." c. "It may be time to ask your healthcare provider about switching to another drug." d. "Take one aspirin 30 minutes before you take your niacin."
d. "Take one aspirin 30 minutes before you take your niacin." Rationale: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect.
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? a. "Low density lipoprotein (LDL) cholesterol is converted to saturated fat, which is stored in your coronary arteries." b. "It is a good idea to decrease low density lipoprotein (LDL) cholesterol in your diet, although current research has not proven a correlation yet." c. "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." d. "The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them."
d. "The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them." Rationale: Storage of cholesterol in lining of coronary blood vessels contributes to plaque buildup & atherosclerosis; this contributes to coronary artery disease. (LDL) cholesterol is not converted to saturated fat & stored in coronary arteries. Coronary artery disease is caused by plaque buildup in coronary arteries, not peripheral arteries. For # years, research has demonstrated a correlation betw high levels of (LDL) & coronary artery disease
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? a. Validate that the client understands the importance of lifestyle changes. b. The client's achievement of normal lipid levels through compliance with medications. c. Education about diet and exercise. d. Maintenance of normal lipid levels without the use of pharmacotherapy.
d. Maintenance of normal lipid levels without the use of pharmacotherapy. Rationale: Client has borderline laboratory levels; clients w/ borderline laboratory values can control their dyslipidemia thru nonpharmacological interventions. Maintenance of normal lipid values w/out pharmacotherapy should be a therapeutic goal. Educating patient about diet/exercise= intervention not outcome. Validation of understanding of importance of lifestyle changes= intervention, not outcome.
Which statement is accurate regarding the use of nicotinic acid (Niacin) for lowering blood cholesterol levels? a. High doses of 25-30 mg per day are often necessary. b. Due to adverse effects, niacin should not be used with statins. c. Works primarily by lowering LDL and HDL levels. d. Niacin may also reduce triglyceride levels.
d. Niacin may also reduce triglyceride levels. Rationale: Taking an aspirin prior to the niacin can reduce the adverse effect of flushing. Niacin is used as a vitamin supplement in doses of 25 mg/day. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.