Abrams Chapter 10 - NCLEX

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. A. Adhering to a low-fat diet B. Maintaining a healthy weight C. Walking for 30 minutes several times a week D. Eating a high-fiber diet E. Avoiding tobacco products

A. Adhering to a low-fat diet B. Maintaining a healthy weight C. Walking for 30 minutes several times a week D. Eating a high-fiber diet E. Avoiding tobacco products Metabolic syndrome is a cluster of risk factors that includes central adiposity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated fasting glucose. All the options will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome.

A client has had cholestyramine added to the treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed? A. Decreased absorption B. Increased metabolism C. Increased first-pass effect D. Faster excretion

A. Decreased absorption Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? Select all that apply. A. High HDL cholesterol B. High VLDL cholesterol C. Low LDL cholesterol D. Low triglycerides E. High total cholesterol

A. High HDL cholesterol C. Low LDL cholesterol D. Low triglycerides Overall, the most effective blood lipid profile for prevention or management of metabolic syndrome and its sequelae is high HDL cholesterol, low LDL cholesterol, and low total cholesterol. A low triglyceride level is also desirable.

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? A. Has no effect B. Decreases target serum LDL level C. Increases target serum HDL level D. Decreases target serum triglyceride level

B. Decreases target serum LDL level Existing cardiovascular disease lowers the target LDL serum level in these clients.

What classification of medications presents the client with an increased risk of developing dyslipidemias? Select all that apply. A. Antifungals B. Oral estrogens C. Glucocorticoids D. Beta-blockers E. Thiazide diuretics

B. Oral estrogens C. Glucocorticoids D. Beta-blockers E. Thiazide diuretics Dyslipidemia may be primary (e.g., genetic or familial) or secondary to dietary habits, other diseases (e.g., diabetes mellitus, alcoholism, hypothyroidism, obesity, obstructive liver disease), or medications (e.g., beta-blockers, cyclosporine, oral estrogens, glucocorticoids, and thiazide diuretics). Antifungal medications are not associated with dyslipidemia.

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? A. Increases the direct administration rate of renal excretion of LDL B. Reduces the amount of cholesterol synthesized by the liver C. Binds with LDL molecules and eliminating their potential for atherosclerosis D. Inhibits the absorption of dietary cholesterol in the small intestine

B. Reduces the amount of cholesterol synthesized by the liver The statins like atorvastatin inhibit an enzyme (HMG-CoA reductase) required for hepatic synthesis of cholesterol. None of the other options accurately describes the drug's therapeutic effect.

Which category of blood lipids is involved in the formation of atherosclerotic plaques? A. Triglycerides B. Nitroglycerin C. Cholesterol D. Phospholipids

C. Cholesterol Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Triglycerides and phospholipids are not involved in the formation of plaque. Nitroglycerin is not a blood lipid.

What health problems contraindicate the use of fibrates for the treatment of dyslipidemia? Select all that apply. A. Ischemic heart disease B. History of venous thromboembolism C. Liver disease D. Chronic renal failure E. Diabetes mellitus

C. Liver disease D. Chronic renal failure Contraindications to the use of fibrates include a hypersensitivity to fibrates, hepatic or (severe) renal impairment, preexisting gallbladder disease, primary biliary cirrhosis, or persistent liver function abnormalities of unknown origin. Currently fibrate treatment is not contraindicated for clients with a history of venous thromboembolisms, ischemic heart disease, or diabetes mellitus.

A 39-year-old nulliparous client 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? A. ''Atorvastatin can be taken safely throughout your pregnancy since it does not cross through the placenta.'' B. ''There's no evidence that atorvastatin is either safe or unsafe during pregnancy, so it's best to err on the side of caution.'' C. ''Atorvastatin is approved to be taken during pregnancy, but you would have to stop taking it if you chose to breastfeed.'' D. ''It's important that you stop taking atorvastatin before you stop using contraception.''

D. ''It's important that you stop taking atorvastatin before you stop using contraception.'' Statins like atorvastatin are potentially teratogenic (pregnancy category X). In a very few cases, potential benefits warrant use of these drugs in pregnant women, but this is exceptional. It is also contraindicated during breastfeeding. None of the other statements describe accurate educational information about atorvastatin and conception.

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived? A. Exercise B. Kidneys C. Medications D. Diet

D. Diet Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. Medications, exercise, and the kidneys do not play a role in synthesis.

While conducting a wellness workshop for a group of clients, a nurse discusses lifestyle changes to help increase the level of high-density lipoproteins. What activities would the nurse recommend? Select all that apply. A. Moderate-fiber diet B. Weight loss C. Low-fat diet D. Smoking cessation E. Regular aerobic exercise

B. Weight loss C. Low-fat diet D. Smoking cessation E. Regular aerobic exercise Weight loss, regular aerobic exercise, smoking cessation (for those who smoke), and low-fat, high-fiber diets all increase HDL cholesterol.

The nurse instructs a client about ''good'' cholesterol (HDL) and ''bad'' cholesterol (LDL, VLDL). The nurse informs the client that higher levels of what component are associated with HDL? A. Plasma B. Sodium C. Protein D. Lipids

C. Proteins The ''preferred'' or healthier configuration for a lipoprotein is to have a higher density. HDL contains a higher proportion of protein relative to fat than do LDL or VLDL.

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 rati A. Therapeutic lifestyle changes are the preferred method for lowering blood lipids. B. The needed lifestyle changes are usually easy for most people to achieve. C. Continued therapeutic lifestyle changes during drug therapy will guarantee success. D. Therapeutic lifestyle changes work only when used in conjunction with medications.

A. Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. Appropriate lifestyle changes should be maintained, but adherence will not guarantee success. Many clients may find lifestyle changes (e.g., smoking cessation) challenging.

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? A. ''The more serious side effects of atorvastatin involve a risk of bleeding.'' B. ''Some clients experience mild chest pain initially.'' C. ''Most people who experience side effects from atorvastatin report stiffness in their joints.'' D. ''The most common side effects of atorvastatin include mild gastrointestinal upset.''

D. ''The most common side effects of atorvastatin include mild gastrointestinal upset.'' Statins like atorvastatin are usually well tolerated. The most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient. Chest pain, joint stiffness, and bleeding are not common adverse effects.