CH 47 PREPU: Lipid-lowering agents
After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement? "I can take the drug with grapefruit juice." "I should take the dose around bedtime." "I need to be careful when I'm out in the sun." "I should report any problems with muscle pain or weakness."
"I can take the drug with grapefruit juice."
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? "Atorvastatin can be taken safely throughout your pregnancy since it does not cross through the placenta." "It's important that you stop taking atorvastatin before you stop using contraception." "There's no evidence that atorvastatin is either safe or unsafe during pregnancy, so it's best to err on the side of caution." "Atorvastatin is approved to be taken during pregnancy, but you would have to stop taking it if you chose to breastfeed."
"It's important that you stop taking atorvastatin before you stop using contraception."
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? A 72-year-old man who has emphysema and a long history of cigarette smoking An obese male client who is a heavy alcohol user and who has cirrhosis of the liver A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept)
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
The clinic nurse has been assigned to a 43-year-old client who is obese and loves to eat. The client has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which dietary instruction would be a priority for the nurse to discuss with the client? Avoid drinking grapefruit juice Decrease intake of plant stanols Increase intake of milk and other dairy products Increase intake of fatty acids
Avoid drinking grapefruit juice
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for: Abdominal pain Bleeding Cataract development Liver failure
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: Blurred vision Yellowing of the skin Abdominal pain Blood in urine or stool
Blood in urine or stool
What drug or drug class decreases the delivery of intestinal cholesterol to the liver? Bile acid sequestrant Statin Fibrate Cholesterol absorption inhibitor
Cholesterol absorption inhibitor
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? Digoxin Vitamin D Calcium carbonate Cholestyramine
Cholestyramine
Which would be classified as a bile acid sequestrant? Ezetimibe Gemfibrozil Lovastatin Cholestyramine
Cholestyramine
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 sitosterol and serum cholesterol Decrease in serum cholesterol and LDL levels Decrease in serum cholesterol only Decrease in campesterol and LDL levels
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? Has no effect Increases target serum HDL level Decreases target serum triglyceride level Decreases target serum LDL level
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 Medications Exercise Kidneys
Diet
A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication? Acetaminophen Digoxin Ibuprofen Aspirin
Digoxin
A male client's triglycerides are still elevated despite lifestyle changes. What does the nurse expect the health care provider to order for this client? Fenofibrate Niacin Cholestyramine Atorvastatin
Fenofibrate
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 Dyspnea Tachycardia Weakness
Flushing of the skin
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 Niacin Colesevelam Ezetimibe
Gemfibrozil
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? Fibrates HMG-CoA reductase inhibitors Niacin Bile acid sequestrants
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? Niacin Bile acid sequestrants Fibrates HMG-CoA reductase inhibitors
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 Hypertension Glaucoma Diabetes
Heart disease
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 waist size His dietary intake of saturated fat His sedentary lifestyle His alcohol intake
His dietary intake of saturated fat
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.) Increased physical activity Reduction of the intake of saturated fats Weight loss Reduction in the intake of carbohydrates
Increased physical activity Reduction of the intake of saturated fats Weight loss
Which lipid level would the nurse interpret as being high? Triglyceride level of 160 mg/dL Total cholesterol of 200 mg/dL LDL cholesterol of 190 mg/dL HDL cholesterol of 48 mg/dL
LDL cholesterol of 190 mg/dL
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? Complete blood count (CBC) Reticulocyte count Liver panel INR and aPTT
Liver panel
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? Pregnancy Category B Pregnancy Category X Pregnancy Category C Pregnancy Category A
Pregnancy Category X
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 related to elevated blood lipid levels Risk for injury to skeletal muscles related to adverse effects of drug therapy Alteration in nutrition, more than body requirement, related to excessive dietary intake of fats Altered cardiac output related to damage to the heart
Risk for injury to skeletal muscles related to adverse effects of drug therapy
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 Gall stones Joint pain Constipation
Runny nose Respiratory infections
What should the nurse suggest to assist a client to improve his cholesterol levels? Diet high in polysaturated fats Smoking cessation Limit exercise to the weekends Weight lifting
Smoking cessation
Which single class drug is known to be most effective in reducing the major types of dyslipidemia? Fibrates Niacin Bile acid sequestrants Statins
Statins
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? Fasting blood glucose below 110 mg/dL Blood pressure below 130/85 mm Hg Waist measurement over 35 inches in men Triglyceride level above 150 mg/dL
Triglyceride level above 150 mg/dL
A patient with metabolic syndrome usually has increased plasminogen activator levels. False True
True
Which might occur in a client receiving colestipol? Fecal incontinence Vitamin A deficiency Increased vitamin K absorption Thrombosis
Vitamin A deficiency
A nurse is caring for several clients. Which client would have the greatest chance of developing CAD as determined by total cholesterol? a 48-year-old Black client with total cholesterol of 198 mg/dl a 62-year-old White client with total cholesterol of 260 mg/dl a 26-year-old Native American client with total cholesterol of 150 mg/dl a 32-year-old Asian American with total cholesterol of 120 mg/dl
a 62-year-old White client with total cholesterol of 260 mg/dl
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? increased metabolism faster excretion increased first-pass effect decreased absorption
decreased absorption
What factor determines the "preferred" density of the cholesterol? higher amount of lipids higher amount of protein higher amount of carbohydrates higher amount of plasma
higher amount of protein
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? is a bile-acid resin. is a hormone. consists of a fibric acid derivative. inhibits cholesterol syntheses.
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? cholelithiasis. pruritis. rhabdomyolysis. cholecystitis.
rhabdomyolysis.
Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD? Fibrates Niacin Bile acid sequestrants HMG-CoA reductase inhibitors
diet
A client with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a health care provider. The provider has instructed the nurse to continue the drug therapy for 3 days. The drug is available in 10-mg capsules. How many capsules of the drug should the nurse administer to the client during the entire therapy? 3 capsules 1 capsule 4 capsules 2 capsules
3 capsules
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? Inspect skin and eyelids for evidence of xanthomas. Frequently monitor blood cholesterol. Take a dietary history of the patient. Obtain reports of fasting blood sugar levels.
Frequently monitor blood cholesterol.
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. Continued therapeutic lifestyle changes during drug therapy will guarantee success. Nonpharmacologic interventions are cheaper than using medications. Therapeutic lifestyle changes are easier to comply with than medication therapies.
Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include? "Some people get very flushed skin when they take this medication." "It's important to avoid eating shellfish and to tell your care provider before having any diagnostic imaging tests." "Sometimes this causes a full body rash when you first take it, but that doesn't necessarily mean you're allergic to it." "You're likely to have some nausea when you begin taking the drug, but this will dissipate with time."
"Some people get very flushed skin when they take this medication."
In addition to being synthesized in the liver and intestine, from where are blood lipids derived? diet exercise medications kidneys
diet
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 Very high Optimal Desirable
High
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 more serious side effects of atorvastatin involve a risk of bleeding." "Some clients experience mild chest pain initially." "Most people who experience side effects from atorvastatin report stiffness in their joints." "The most common side effects of atorvastatin include some mild gastrointestinal upset."
"The most common side effects of atorvastatin include some mild gastrointestinal upset."
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. dry mouth. pruritus (itching) increased thirst.
muscle pain.
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 115 Cholesterol 210 HDL 82 LDL 96 Cholesterol 240 HDL 78 LDL 115 Cholesterol 189 HDL 58 LDL 96 Cholesterol 178
HDL 82 LDL 96 Cholesterol 240
