Pharm Quiz #3
While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?
"I should use aspirin to control my arthritis pain."
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."
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 client is receiving low-molecular-weight heparin (LMWH) to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin."
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."
aPTT expected range
1.5-2 times normal range of 30-40 seconds (desired range for anticoagulation)
A client asks the nurse what dose of acetylsalicylic acid (aspirin) is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?
300 mg
A client diagnosed with nonvalvular atrial fibrillation is prescribed dabigatran etexilate. What information about the client will cause the nurse to contact the health care provider before administering the medication? Select all that apply.
80 years old difficulty swallowing capsules creatinine clearance is 23 mL/min prescription for 325 mg of aspirin daily
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
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver -Active liver disease is a contraindication to the use of statins.
A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?
Aspirin - Used together to prevent thrombus formation
What can increase the effects of Warfin?
Aspirin and Vit K
A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of the medications and the report of pain, what should the nurse suspect is the cause of the pain?
Bleeding
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
Bleeding
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 the urine or stool
Which category of blood lipids is involved in the formation of atherosclerotic plaques?
Cholesterol
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 would be classified as a bile acid sequestrant?
Cholestyramine
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 nurse is preparing to administer a prescribed bile acid resin to a client with hyperlipidemia. The nurse understands that this class of drugs can decrease serum levels of several medications, primarily via which mechanism?
Decreased gastrointestinal absorption
Which of the following best reflects the action of ezetimibe?
Decreases the absorption of dietary cholesterol from the small intestine
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
A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility?
Flushing of the skin
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder
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 client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
Giving intramuscular injections
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
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
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
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
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
Heparin
An instructor describes the action of some anticoagulants as blocking the formation of thrombin from prothrombin. Which drugs would the instructor use as examples for this action? (Select all that apply.)
Heparin Argatroban Bivalirudin
Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?
Hypercoagulation
A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:
Intake of vitamin K
A client is receiving warfarin. Which would the nurse monitor to determine the effectiveness of therapy? (Select all that apply.)
International normalized ratio Prothrombin time
Which lipid level would the nurse interpret as being high?
LDL cholesterol of 190 mg/dL
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 -Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy.
The nurse is caring for a patient who is on thrombolytic therapy. The patient has a co-morbidity of renal insufficiency. What does the nurse know about the amount of heparin required to treat this patient?
Lower doses are required
A client being initiated on cholestyramine for the treatment of hyperlipidemia should be counseled that what can occur? (Select all that apply.)
Malabsorption of vitamin K Aggravation of hemorrhoids Flatulence
AST and ALT
Measure liver function
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDS - NSAIDS have a antiplatelet affect
A client is taking lovastatin. Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation
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
A client is receiving warfarin. The nurse would expect to administer this drug by which route?
Oral
When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?
Orally
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?
PT and INR
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stools
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A male client's laboratory results indicate that both cholesterol and triglycerides are elevated. Which medications may be ordered? (Select all that apply.)
Statin (Atorvastatin) Ezetimibe Gemfibrozil - A bile acid sequestrant agent (cholestyramine and colesevelam) is not recommended to lower both cholesterol and triglycerides.
A client is to receive enoxaparin. The nurse would administer this drug by which route?
Subcutaneous injection
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?
Tarry Stools
A stable daily dose of warfarin is reached when which parameter is achieved?
The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding.
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
The medication will increase my risk of bleeding
TSH test
Thyroid Function
What information would be included in a lipoprotein profile? Select all that apply:
Total cholesterol Triglycerides LDL
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
What information would be included in a lipoprotein profile? Select all that apply
Triglycerides LDL Total cholesterol
A patient with metabolic syndrome usually has increased plasminogen activator levels.
True
A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
Vitamin K
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the modifiable factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
Weight Diet
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:
aPTT
aPTT
activated partial thromboplastin time
A nurse is responsible for patient education for a 48-year-old woman who has been prescribed colestipol. The nurse will instruct the patient to take the medication
before a meal. -Colestipol is a bile acid sequestrant that promotes the oxidation of cholesterol to bile acids. Colestipol binds with the bile acids in the intestine to make them nonresorbable. The bile acids are then eliminated in the stool.
Warfarin Mech
decreases the production of vitamin K dependent clotting factors
The nurse, providing postprocedural care for a client scheduled for a cardiac catheterization, will plan to implement which intervention to manage the risk for a common adverse effect of the procedure?
direct pressure to arterial access site
Nulliparous
female who has borne no offspring
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence.
A client is prescribed alteplase as treatment for acute coronary arterial thromboembolism. For which conditions in the client's medical history will the nurse question giving this medication? Select all that apply.
history of severe hypertension arteriovenous malformation cranial surgery 1 month ago closed head injury 3 months ago
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:
hold the dose and contact the provider. -During heparin therapy, aPTT values are typically maintained between 1.5 to 2.5 times the control value. Since an aPTT value of 92 seconds is greater than 2.5 times this client's control value, the anticoagulation effect is too great
Fondaparinux Mech
inhibits factor Xa and blocks the clotting cascade to prevent clot formation.
BUN and creatinine
kidney function test
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.
Plasminogen Activator
protein that breaks down blood clots
PT/INR
prothrombin time/international normalized ratio
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