Chapter 10: Drug Therapy for Dyslipidemia, Chapter 27 Dysrhythmias, Chapter - 27 Drug therapy for dysthymia, Pharm Chapter 27 Drug Therapy for Dysrhythmias

The nurse is taking a health history on a 58-year-old client who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug? "How many alcoholic drinks do you have in a typical day or week?" "How would you describe your caffeine intake?" "Do you use any over-the-counter medications for headaches or colds?" "Do you do any physical exercise on a regular basis?"

"How many alcoholic drinks do you have in a typical day or week?" Explanation: Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease, so it is important for the nurse to ask about the client's use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be addressed by the nurse, but it is unrelated to safe medication use.

The client receives a prescription for niacin, and the nurse is providing education about the medication. What should the nurse teach the client about possible adverse effects of the medication? It's important to avoid eating shellfish and to tell your care provider before having any diagnostic imaging tests." "Some people get very flushed skin when they take this medication." "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." Explanation: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? A) Take this medication in the evening. B) Change position slowly when rising from a chair. C) Maintain a steady intake of green leafy vegetables. D) Consume no more than 1 L/day of fluid.

A) Take this medication in the evening.

Which of the following would be classified as a bile acid sequestrant? a) Gemfibrozil b) Lovastatin c) Ezetimibe d) Cholestyramine

Answer: Cholestyramine Explanation: Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.

Cholesterol is the base unit for the formation of steroid hormones. a) False b) True

Answer: True

A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? SELECT ALL THAT APPLY. A) Muscle aches B) Hyperglycemia C) Hearing loss D) Flushing of the skin E) Jaundice

B) Hyperglycemia D) Flushing of the skin E) Jaundice

A nurse is caring for a client who has a new prescription for alirocumab to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of this drug? SELECT ALL THAT APPLY. A) Muscle aches B) Vasculitis C) Hearing loss D) Urticaria E) Jaundice

B) Vasculitis E) Jaundice

A nurse is collecting data from a client who is taking gemfibrozil Which of the following assessment findings should the nurse identify as an adverse reaction to the medication? A) Mental status changes B) Tremor C) Jaundice D) Pneumonia

C) Jaundice

A patient is administered diltiazem (Cardizem) IV, which is followed by propranolol (Inderal) IV. The nurse should assess for what potential effect of this medication combination? A) Hypertensive crisis B) Anaphylaxis C) Valve regurgitation D) Impaired contractility

D

A patient is admitted to the emergency department in ventricular fibrillation. The patient is administered amiodarone hydrochloride (Cordarone). What is a major effect of this medication? A) It produces skeletal muscle relaxation. B) It decreases automaticity in the ventricles. C) It stimulates the sympathetic nervous system. D) It slows the process of repolarization

D

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of following instructions should nurse include in the teaching? A) "Take digoxin with your morning dose of colesnvelam B) "Your sodium and potassium levels will be monitored periodically while taking colesevelam. C) "Watch for bleeding or bruising while taking colesnvelam. D) "Take colesevelam with food at least one glass of water.

D) "Take colesevelam with food at least one glass of water.

Amidorone and dofetilide given together can cause?

Life threatening arrhythmia's

The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values? a) HDL 58 LDL 96 Cholesterol 178 b) HDL 82 LDL 96 Cholesterol 240 c) HDL 78 LDL 115 Cholesterol 189 d) HDL 58 LDL 115 Cholesterol 210

a) HDL 58 LDL 96 Cholesterol 178 Rationale: Normal HDL should be less than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.

The administration of cholestyramine (Questran) with warfarin (Coumadin) would most likely cause a client to present with which of the following? Select all that apply: a) Subtherapeutic INR b) Blood in the stool c) Bruising d) Calf pain and warmth e) Supratherapeutic INR

a) Subtherapeutic INR d) Calf pain and warmth Rationale: Co-administration of warfarin and cholestyramine can result in decreased anticoagulant effect leading to subtherapeutic INR and increase chance of clotting (signs and symptoms of DVT or PE).

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: a)"I will take the digoxin about an hour before the cholestyramine." b)"I need to take both drugs at the same time of the day." c)"I'll take the cholestyramine at 8 AM and the digoxin at 9 AM." d)"I'll take the digoxin about 15 minutes before the cholestyramine."

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

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? a)pruritis. b)rhabdomyolysis. c)cholelithiasis. d)cholecystitis.

b)rhabdomyolysis.

A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this client? t a) The two medications should be taken together. b) The ezetimibe inhibits cholesterol in the liver. c) The administration of ezetimibe (Zetia) is four hours after or 2 hours before cholestyramine d) The cholestyramine (Questran) is administered one hour before ezetimibe.

c) The administration of ezetimibe (Zetia) is four hours after or 2 hours before cholestyramine Feedback:Ezetimibe (Zetia) should be taken 2 hours before or 4 hours after a bile acid sequestrant.The two medications should not be taken together. Ezetimibe acts in the small intestineto inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol inthe liver. They do not inhibit the absorption of cholesterol. Cholestyramine should notbe administered 1 hour after ezetimibe.

A client is going home on cholestyramine (Questran). Client teaching should state that this medication should be administered: a)with other medications. b)1 hour before other medications. c)1 hour after other medications. d)on an empty stomach.

c)1 hour after other medications. Explanation: Drugs that interact with cholestyramine should be administered 1 hour before or 4 to 6 hours after cholestyramine. Otherwise, cholestyramine may prevent the absorption of other drugs.

A nurse should question the order for Quinidine for which of the following patients. A. A patient with life-threatening ventricular dysrhythmias b. A patient with super ventricular tachycardia c. A patient currently on Digoxin therapy D. A patient with chronic ventricular tachycardia without heartblock

c. A patient currently on Digoxin therapy Rationale; Quinidine interacts with Digoxin to increase toxicity which could be life-threatening

An Asthmatic patient present in the facility with Super ventricular tachycardia without heartblock. Which of the medication regimen should the nurse expect to NOT use for this patient a. Lidocaine b. Quinidine c. Propanolol d. Procainamide

c. Propanolol Rationale; Beta blockers Should not be used for any patient with Respiratory disorder.

As a nurse, you should be aware of which of the following as a high alert medication? a. Lidocaine b. Atenolol c. Quinidine d. Amiodarone

d. Amiodarone Amiodarone is a class 3 medication and is considered a High-alert medication

Arrhythmia may be triggered by which of the following? Select all that apply:

heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances.

A patient presents at the clinic with shortness of breath, fatigue, and difficulty performing ADLs. The nurse notes bluish color around the patient's mouth and in the patient's nail beds. The nurse expects that the patient has:

heart failure.

the nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition?

oliguria, hypotension, mental confusion or syncope, or shortness of breath

Initiation of the heart's electrical impulses depends predominantly on what electrolyte movement? Select all that apply.

predominately on the movement of sodium and calcium ions into a myocardial cell and movement of potassium ions out of the cell

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? "You need to decide if you want to take this medication. The flushing will be present as long as you take the medication." "Don't worry about it. I'm sure it's not really noticeable." "You need to stop taking the medication immediately. I will notify the health care provider." "This is an expected adverse effect of the drug. It should subside in time."

"This is an expected adverse effect of the drug. It should subside in time." Explanation: Large doses of nicotinic acid produce peripheral vasodilation, mostly in the cutaneous vessels of the face, neck, and chest. Vasodilation results in flushing of the skin and is usually transient. The vasodilation is due to the histamine release caused by the medication. A nurse would never tell a client not to worry and to stop taking the medication, unless the prescriber told her to. The flushing should subside and will not be present for the duration of the course of the drug.

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." "Triglycerides are found in your blood. Cholesterol is found in the gallbladder." "Triglycerides are found in your blood. Cholesterol is how the fat is transported." "Triglycerides transport cholesterol throughout the body."

"Triglycerides and cholesterol are fatlike substances found in your blood." Explanation: Triglycerides and cholesterol are lipids that are found in blood. Cholesterol is produced mostly by the liver.

A nurse is required to monitor the blood concentration levels of the drug in a client receiving IV lidocaine for cardiac arrhythmia. Which blood concentration level should the nurse to report to the health care provider immediately?

6mcg he nurse should report to the health care provider immediately when the blood concentration level of lidocaine reaches 6 mcg/mL. Above a level of 6 mcg/mL, the risk of central nervous system and cardiac depression is significantly increased. Immediate reporting is needed as the dose of the drug may need to be changed.

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? 120 mg/dL 140 mg/dL 95 mg/dL 105 mg/dL

95 mg/dL Explanation: In conjunction with an acceptable total cholesterol-to-HDL ratio, it is also important for the LDL reading to be between 80 and 100 mg/dL to further decrease the risk of coronary artery disease.

A 59-year-old man with a history of coronary artery disease is undergoing cardiac catheterization. The procedure has been proceeding as planned, but the patient suddenly begins exhibiting ventricular tachycardia. What drug should the nurse most likely prepare for administration? A) Lidocaine B) Magnesium sulfate C) Digoxin D) Epinephrine

A

A critical care nurse is well aware that amiodarone (Cordarone) is normally reserved for use in patients with life-threatening dysrhythmias. In some cases, however, low-dose amiodarone may be used to prevent recurrence of A) atrial fibrillation. B) angina pectoris. C) ventricular hypertrophy. D) mitral valve regurgitation

A

A nurse is teaching a cardiac patient about the ability of the heart to generate an electrical impulse. Which of the following teaching points should the nurse convey to the patient? A) "There are many different parts of your heart that can initiate an electrical impulse." B) "Electrical signals travel along the blood vessels that provide oxygen to your heart." C) "Your heart depends on your brainstem to initiate electrical signals." D) "The lining of your left ventricle is the site where electrical signals usually originate."

A

A patient is administered medications for the treatment of a rapid dysrhythmia. What is the mechanism of action for these medications? A) Reducing automaticity B) Increasing conduction C) Repolarizing myocardial cells D) Reducing refractory period

A

A patient is admitted in atrial flutter. Which of the following nonpharmacological interventions will best assist in long-term maintenance of a normal sinus rhythm? A) Implantation of a cardioverter-defibrillator B) Initiation of an isometric exercise program C) A high-potassium diet D) Surgical intervention with a new mitral valve

A

The nurse is providing medication teaching to a patient who will begin taking niacin with a bile acid sequestrant. How does the nurse instruct the patient to take these two medications? A) "Both medications should be taken 4 to 6 hours apart." B) "Both medications should be taken in the morning." C) "One medication should be taken in the morning but the other is taken at bedtime." D) "Both medications can be taken at once just before going to bed."

A) "Both medications should be taken 4 to 6 hours apart." Feedback:When niacin is prescribed with a bile acid sequestrant, the patient should be told to take the two medications 4 to 6 hours apart in the evening, with the niacin normally taken first.

The nurse practitioner adds cholestyramine to statin therapy in a patient with markedly elevated serum levels of LDL cholesterol. Which of the following if stated by the patient indicates that patient teaching has been successful? SELECT ALL THAT APPLY. A) "I need to mix the powder with water or other fluids before I take it." B) "I should wait 1 hour after I eat to take the medication." C) "I need to maintain good oral hygiene as the medication can damage my teeth." D) "If I notice an increased bleeding tendency, I need to notify the nurse practitioner." E) "I might have some GI effects, including constipation or abdominal pain."

A) "I need to mix the powder with water or other fluids before I take it." C) "I need to maintain good oral hygiene as the medication can damage my teeth." E) "I might have some GI effects, including constipation or abdominal pain."

The nurse is taking a health history on a 38-year-old man who is taking atorvastatin (Lipitor) for high cholesterol. What will the nurse question specifically related to the safe use of this drug? A) Alcohol B) Nicotine C) Caffeine D) Herbal therapy

A) Alcohol Feedback:Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the patients use of alcohol. Nicotine, caffeine, and herbal therapies are usually not identified as producing any drugdrug interactions with atorvastatin.

A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug would the nurse suspect is most likely to contribute to this adverse effect? A) Bile acid sequestrants B) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors C) Cholesterol absorption inhibitor D) Fibrates

A) Bile acid sequestrants Feedback:Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates.

A client is taking atorvastatin to reduce serum cholesterol. Which aspect of client teaching is most important? A) Call the health care provider if muscle pain develops. B) It is unacceptable to eat dietary fats. C) Decrease the dose if lethargy occurs. D) Eat two eggs per day to increase protein stores.

A) Call the health care provider if muscle pain develops. Feedback:Patients should be advised to notify their health care provider if unexplained musclepain or tenderness occurs. The patient should avoid saturated fats when taking statinsbut should not entirely eliminate fats from his diet. The patient should not decrease thedose of statins without the physician's knowledge. The patient should not increase theintake of eggs due to the increase in cholesterol.

The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum cholesterol levels. What lipid lowering medication would be appropriate for the nurse to administer to this patient? A) Colesevelam (Welchol) B) Pravastatin (Pravachol) C) Simvastatin (Zocor) D) Atorvastatin (Lipitor)

A) Colesevelam (Welchol) Feedback:Bile acid sequestrants are the drug of choice for pregnant women if a lipid-lowering agent is needed. Women of child-bearing age should not take beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors because they are in Pregnancy Category X. Pravastatin, simvastatin, and atorvastatin are all HMG-CoA reductase inhibitors.

The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his diet to lose weight and control serum lipid levels without success. He is currently taking a combination of medications but his total cholesterol remains above 200. What future therapy might help this patient? A) Endocannabinoid blocker B) Bile acid sequestrant with niacin C) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and gemfibrozil D) Peroxisome proliferator receptor alpha activator

A) Endocannabinoid blocker Feedback:Blocking the endocannabinoid system results in feelings of satiety and decreased appetite, leading to weight loss; decreased release of growth hormone, increased oxygen and glucose use in the muscle, decreased fat synthesis in the liver, decreased levels of triglycerides and low density lipoproteins, and increased levels of high density lipoproteins, improving the lipid profile; increased sensitivity of insulin receptor sites, leading to decreased blood glucose levels; decreased fat production and storage; increased levels of adiponectin; and decreased activity of tumor necrosis factor, a proinflammatory agent, and decreased activity of C-reactive protein, which is associated with proinflammatory and prothrombotic states. Combining bile acid sequestrant with niacin or HMG-CoA with gemfibrozil is contraindicated. Peroxisome proliferator receptor alpha activators help to control lipid levels but do not contribute to dietary changes and appetite suppression.

A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what? A) Fatty streaks B) White blood cells (WBCs) C) Foam cells D) Platelets and fibrin

A) Fatty streaks Feedback:Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of characteristic foam cells, containing fats and WBCs that further injure the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting

The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and explains that exercise has what effect? A) Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL) B) Increases LDL and decreases triglycerides C) Decreases HDL and increases LDL D) Decreases both HDL and LDL

A) Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL) Feedback:Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels.

The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD). What condition does the nurse encourage the patient to control in order to reduce CAD risk? (Select all that apply.) A) Obesity B) Hypertension C) Bradycardia D) Depression E) High stress levels

A) Obesity B) Hypertension E) High stress levels Feedback:Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Depression and bradycardia have not been linked to CAD.

The nurse conducts a review of research related to Beta-hydroxy-beta-methylglutaryl coenzyme A inhibitors and finds the only one associated with data to show a reduction in coronary artery disease and incidence of myocardial infarction is what drug? A) Pravastatin (Pravachol) B) Lovastatin (Mevacor) C) Atorvastatin (Lipitor) D) Fluvastatin (Lescol)

A) Pravastatin (Pravachol) Feedback:Pravastatin is the only statin with outcome data to show effectiveness in decreasing coronary artery disease and incidence of myocardial infarction (MI); it prevents a first MI even in patients who do not have a documented elevated cholesterol level. The other medications do not have any evidence of effectiveness for this patient.

The patient receives a prescription for a lipid lowering medication from the health care provider and, before discharge, asks the nurse what else he or she can do to improve his or her lipid levels besides just taking medication. What recommendation will the nurse make? (Select all that apply.) A) Quitting smoking B) Exercising C) Following a low sodium diet D) Reducing stress E) Avoiding alcohol

A) Quitting smoking B) Exercising D) Reducing stress Feedback:Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels. Although a low sodium diet is a healthy choice, it is not associated with elevating lipid levels.

When providing patient teaching to a patient beginning therapy with a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? (Select all that apply.) A) Renal function tests B) Liver function tests C) Lipid panel D) Hemoccult of stool E) Albumin level

A) Renal function tests B) Liver function tests C) Lipid panel Feedback:It is important to monitor renal and liver function to identify early signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG-CoA reductase inhibitors.

Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies? A) Soy B) Ginkgo biloba C) Green tea D) Garlic

A) Soy Feedback: Soy is used as a food source and has been researched extensively to lower cholesterol. Ginkgo biloba, green tea, and garlic do not have extensive scientific research to support the lowering of cholesterol.

The nurse provides patient teaching related to medication and lifestyle changes the patient can make to reduce serum lipid levels. One month later, the nurse evaluates the patient teaching as having been effective based on what data? (Select all that apply.) A) Total cholesterol 184 B) High density lipoprotein (HDL) cholesterol 84 C) Low density lipoprotein (LDL) cholesterol 164 D) Triglycerides 184 E) Weight loss of 8 pounds

A) Total cholesterol 184 B) High density lipoprotein (HDL) cholesterol 84 E) Weight loss of 8 pounds Feedback:Serum lab levels within the desirable level would indicate the teaching was effective; they include a total cholesterol level of less than 200, an HDL cholesterol level of higher than 40, an LDL cholesterol level of less than 129, and a triglyceride level of less than 50. Weight loss is also a positive outcome.

A 48-year-old man visits his health care provider for his annual checkup. He is otherwise in good health, but assessment findings reveal the new onset of a slight increase in blood pressure and a total serum cholesterol of 240 mg/dL. What can the nurse anticipate as the preferred treatment for this patient? A) a low-lipid diet and an exercise program B) a low-lipid diet and a cholesterol synthesis inhibitor C) an exercise program and a fibrate D) a low-lipid diet and an exercise program

A) a low-lipid diet and an exercise program

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication? A) digoxin B) ibuprofen C) aspirin D) acetaminophen

A) digoxin Feedback:Bile acid sequestrants may decrease absorption of digoxin (Lanoxin). Cholestyraminewill not decrease the ibuprofen, aspirin, or acetaminophen.

The primary focus for prevention and management of metabolic syndrome and its sequelae is A) elevated high-density lipoprotein (HDL) cholesterol, depressed low-density lipoprotein (LDL) cholesterol, and low total cholesterol B) low HDL cholesterol, low LDL cholesterol, and low total cholesterol C) low triglycerides D) high HDL cholesterol, low LDL cholesterol, and low triglycerides

A) elevated high-density lipoprotein (HDL) cholesterol, depressed low-density lipoprotein (LDL) cholesterol, and low total cholesterol

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 patient develops supraventricular tachycardia. Vagal maneuvers were tried but were unsuccessful. Drug therapy is initiated. Which agent would the nurse expect to be used?

Adenosine

The client wants to know the difference between triglycerides and cholesterol. Which of the following responses by the nurse would be correct? a) "Triglycerides are found in your blood. Cholesterol is found in the gallbladder." b) "Triglycerides transport cholesterol throughout the body." c) "Triglycerides and cholesterol are fatlike substances found in your blood." d) "Triglycerides are found in your blood. Cholesterol is how the fat is transported."

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

A patient with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a physician. The physician 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 the patient during the entire therapy? a) 2 capsules b) 1 capsule c) 3 capsules d) 4 capsules

Answer: 3 capsules Rationale: The nurse should administer 3 capsules of ezetimibe to the patient during the therapy.

An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level? a) <275 mg/dL b) <239 mg/dL c) <200 mg/dL d) <100 mg/dL

Answer: <200 mg/dL

An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level? a) <275 mg/dL b) <200 mg/dL c) <239 mg/dL d) <100 mg/dL

Answer: <200 mg/dL Rationale: A total serum cholesterol level of <200 mg/dL is recommended. The other options are incorrect.

Which of the following should be included by the nurse during client teaching to improve outcome? Select all that apply: a) Reviews measures to minimize gastrointestinal upset. b) Contacts dietitian for assistance with diet teaching. c) Emphasizes that drug therapy alone will significantly lower blood cholesterol levels. d) Stresses importance of taking drug exactly as prescribed. e) Instructs in possible adverse reactions and signs and symptoms to report to primary health care provider.

Answer: A, B, D, C

What cardiac risk factors are related to metabolic syndrome? (Select all that apply.) a) Central adiposity b) Reduced high density lipoprotein cholesterol c) Elevated fasting blood glucose d) Postural hypotension e) Elevated triglycerides

Answer: A, B, E Rationale: Metabolic syndrome is a group of cardiovascular risk factors that are linked with obesity and include elevated waist circumference (central adiposity), elevated triglycerides, reduced high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose.

What should the nurse tell a client about the normal skin reactions that can occur with the use of nicotinic acid? Select all that apply: a) Sensations of warmth are normal. b) Rash is normal. c) Flushing is normal. d) Pustule formation is normal. e) Tingling is normal.

Answer: A, C, E Rationale: Generalized skin flushing, a sensation of warmth, and severe itching and tingling can occur with the administration of nicotinic acid, especially are higher doses.

The nurse is taking a health history on a 38-year-old male bar owner who is taking atorvastatin (Lipitor) for high cholesterol. The nurse will be sure to ask a specific group of questions regarding the patient's use of what? a) Nicotine b) Caffeine c) Herbal therapy d) Alcohol

Answer: Alcohol Rationale: HMG-CoA reductase inhibitors are contraindicated with liver disease or a history of alcoholic liver disease. Nicotine, caffeine, or herbal therapies are usually not identified as producing any drug-to-drug interactions with atorvastatin.

What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? Select all that apply: a) Reason for taking the prescribed drug b) Drug name c) Dosage form d) Correct dose e) Frequency of administration

Answer: All Explanation: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration as part of a client's discharge counseling.

Which of the following activities increases high-density lipoproteins? a) Regular aerobic exercise b) All of these c) Weight loss d) Smoking cessation

Answer: All of these

The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor as inhibiting what? a) An enzyme used to make bile acids b) An enzyme that combines with proteins to become chylomicrons c) An enzyme used immediately for energy d) An enzyme that controls the final step in production of cellular cholesterol

Answer: An enzyme that controls the final step in production of cellular cholesterol Feedback:HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids.

A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients? a) A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept) b) An obese male client who is a heavy alcohol user and who has cirrhosis of the liver c) A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year d) A 72-year-old man who has emphysema and a 55-pack-year history of cigarette smoking

Answer: An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Rationale: Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.

The clinic nurse has been assigned to a 43-year-old man who is obese and loves to eat. He has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which of the following dietary instructions would be a priority for the nurse to discuss with the patient? a) Increase intake of milk and other dairy products b) Drink more grapefruit juice and increase intake of soluble fiber c) Decrease intake of plant stanols d) Avoid drinking grapefruit juice and decrease intake of fatty acids

Answer: Avoid drinking grapefruit juice and decrease intake of fatty acids

Your dad returned from his annual physical with the news that he has metabolic syndrome and is quite shaken with the news. Knowing the elements of metabolic syndrome, you begin to encourage him with non-pharmacologic measures he could implement to improve his risk factors. What do those non-pharmacologic measures include? Select all that apply. a) Begin to decrease intake of soluble fiber b) Begin a low-fat diet c) Begin regular walking program d) All of these

Answer: B and C Rationale: Decreasing dietary fat intake and instituting regular aerobic exercise will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome.

Statin drugs help lower cholesterol, LDL, and triglycerides by which of the following mechanisms? Select all that apply: a) Decreasing absorption of cholesterol from the GI tract. b) Promoting the breakdown of cholesterol. c) Increasing the storage of cholesterol as fat. d) Decreasing the breakdown of fat to cholesterol. e) Inhibiting the manufacturing of cholesterol.

Answer: B and E

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units? a) Micelles b) Chylomicrons c) Cholesterol d) Bile acids

Answer: Bile Acids Rationale: Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles. (less)

Your patient asks you what will the atorvastatin (Lipitor) they are prescribed do for them. What is an expected outcome for this patient? a) Decrease in serum cholesterol and LDL levels b) Decrease in sitosterol and serum cholesterol c) Decrease in serum cholesterol only d) Decrease in camperterol and LDL levels

Answer: Decrease in serum cholesterol and LDL levels

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the physician to do? a) Maintain the current dosage of his medication b) Discontinue his medication c) Decrease the dosage of his medication d) Increase the dosage of his medication

Answer: Decrease the dosage of his medication Rationale: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? a) Decreases target serum triglyceride level b) Decreases target serum LDL level c) Increases target serum HDL level d) Has no effect

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

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived? a) Exercise b) Diet c) Medications d) Kidneys

Answer: 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.

Which of the following are examples of modifiable risk factors for hyperlipidemia? (Select all that apply) a) Diet b) Women older than 55 years c) Weight d) Men older than 45 years e) Post menopausal female

Answer: Diet and Weight Rationale: Modifiable risks factors for hyperlipidemia are weight, diet, and physical inactivity. Non-modifiable risk factors for hyperlipidemia are age, gender, and family history.

A nurse is caring for a patient taking a cholestyramine drug. What instructions should the nurse give to this patient to prevent constipation? a) Take water-soluble form of vitamin A. b) Have a complete liquid diet. c) Eat foods high in dietary fiber. d) Have complete bed rest.

Answer: Eat foods high in dietary fiber

As part of a routine physical examination, a 60-year-old patient's primary care provider has ordered blood work that includes cholesterol levels. What result would most strongly suggest the need for treatment with an antihyperlipidemic drug? a) Elevated LDL levels b) A high ratio of HDL to LDL c) Elevated HDL levels d) Low VLDL levels

Answer: Elevated LDL levels Elevated LDL levels Explanation: Elevated LDL levels are considered a risk factor for coronary artery disease. Elevated HDL levels, low VLDL levels, and a high ratio of HDL to LDL are associated with a decreased risk of heart

What intervention may help the client increase HDL levels? a) Leg elevation b) TED hose c) Exercise d) Smoking cessation

Answer: Exercise

What intervention may help the client increase HDL levels? a) Exercise b) Leg elevation c) Smoking cessation d) TED hose

Answer: Exercise Rationale: It is known that HDL levels increase during exercise, which could explain why people who exercise regularly lower their risk of CAD.

A 10-year-old is brought into the clinic for an annual check-up and is diagnosed with hypercholesterolemia. What type of hypercholesterolemia is most often seen in children? a) Familial connection b) Gender specific c) Diet resistant d) Exercise resistant

Answer: Familial connection Feedback:Familial hypercholesterolemia may be seen in children. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.

A male client's triglycerides are still elevated despite lifestyle changes. What does the nurse expect the physician to order for this client? a) Cholestyramine b) Atorvastatin c) Fenofibrate d) Niacin

Answer: Fenofibrate

Which drug is most effective in reducing serum triglyceride levels? a) HMG-CoA reductase inhibitors b) Bile acid sequestrants c) Niacin d) Fibrates

Answer: Fibrates Feedback:Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing serum triglycerides. The other options are incorrect.

You are teaching your client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should you mention to the client? a) Flushing of the skin b) Drowziness c) Facial tics d) Fever

Answer: Flushing of the skin The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.

A patient with hyperlipidemia is prescribed ezetimibe. Which of the following ongoing assessments should the nurse perform during treatment? a) Take a dietary history of the patient. b) Frequently monitor blood cholesterol. c) Inspect skin and eyelids for evidence of xanthomas. d) Obtain reports of fasting blood sugar levels.

Answer: Frequently monitor blood cholesterol. Rationale: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.

After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify which of the following as the storage location of bile acids? a) Liver b) Stomach c) Small intestine d) Gallbladder

Answer: Gallblader Explanation: The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one) a) Feverfew b) Ginseng c) Hawthorne berry d) Black cohosh e) Garlic

Answer: Garlic

Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one) a) Garlic b) Black cohosh c) Hawthorne berry d) Ginseng e) Feverfew

Answer: Garlic

A patient has been prescribed atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury, which indicates potential rhabdomyolysis. The nurse knows that the use of atorvastatin with which of the following products places the patient at risk for rhabdomyolysis? a) Grapefruit juice consumption b) Over-the-counter (OTC) drug use c) Use of ginseng d) Use of saw palmetto

Answer: Grapefruit juice consumption Feedback:Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Patients on this drug should be cautioned to avoid drinking grapefruit juice. OTC drugs, ginseng, and saw palmetto are not associated with increased toxicity.

The nurse instructs a client to take the prescribed pravastatin at bedtime based on the understanding about which of the following? a) Compliance is enhanced with nighttime administration. b) Lack of dietary intake during sleep increases absorption. c) Adverse effects are less likely during the night. d) Greater drug effectiveness is achieved at this time.

Answer: Greater drug effectiveness is achieved at this time. Explanation: The drug is administered at bedtime because the highest rates of cholesterol synthesis occur between 12 and 5 AM, and the drug should be taken when it will be most effective.

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which of the following drug classes would the instructor identify as the most widely used dyslipidemia drugs? a) Niacin b) Bile acid sequestrants c) HMG-CoA reductase inhibitors d) Fibrates

Answer: HMG-CoA reductase inhibitors Rationale: HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.

The most common adverse effects of lovastatin include which of the following? a) Increased appetite and blood pressure b) Headache and flatulence c) Hiccups, sinus congestion, and dizziness d) Fatigue and mental disorientation

Answer: Headache and flatulence Rationale: The most common adverse effects of statins include GI symptoms (including nausea, constipation, flatulence, and abdominal pain), headache, and muscle aches. These effects are usually mild and transient.

Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition? (Choose one) a) Diabetes b) Heart Disease c) Hypertension d) Glaucoma

Answer: Heart Disease

A 54-year-old patient, has a cholesterol level of 240 mg/dL. What serum concentration of cholesterol would this patient have? a) High b) Desirable c) Very high d) Optimal

Answer: High Feedback:High is rated at or exceeding 240 mg/dL. Levels below 200 mg/dL are considered desirable, although lower levels may be preferred if the patient has a history of coronary artery disease. Low density lipoprotein (LDL) cholesterol below 100 mg/dL is considered optimal, whereas LDL levels above 190 or triglycerides above 500 mg/dL is considered very 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? a) His alcohol intake b) His dietary intake of saturated fat c) His sedentary lifestyle d) His waist size

Answer: His dietary intake of saturated fat

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism? a) His dietary intake of saturated fat b) His alcohol intake c) His sedentary lifestyle d) His waist size

Answer: His dietary intake of saturated fat Explanation: Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.

The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels, as they are elevated. One method to lower cholesterol levels is to exercise, which does what? a) Decreases both HDL and LDL b) Increases LDL and decreases triglycerides c) Increases HDL and decreases triglycerides d) Decreases HDL and increases LDL

Answer: Increases HDL and decreases triglycerides

A patient begins a gemfibrozil medication regimen to lower triglyceride levels. What effect does gemfibrozil have on lovastatin? a) Substantially increases the risk of myopathies b) Increases the blood level of lovastatin c) Increases the elimination of lovastatin d) Increases the effectiveness of lovastatin

Answer: Increases the blood level of lovastatin Rationale: Gemfibrozil may substantially increase the circulating blood levels of some statins, such as lovastatin. The combined use of a fibrate and a moderate-dose statin carries a somewhat increased risk of myopathy, but the incidence is low, especially if used in populations without multisystem diseases or currently taking multiple medications.

Which of the following lipid levels would the nurse interpret as being high? a) HDL cholesterol of 48 mg/dL b) LDL cholesterol of 180 mg/dL c) Triglyceride level of 160 mg/dL d) Total cholesterol of 200 mg/dL

Answer: LDL cholesterol of 180 mg/dL Rationale: LDL level of 180 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high. (less)

The physician prescribes fibrate for his client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the physician to order? a) Fibrate level b) CBC c) Electrolyte panel d) LFTs

Answer: LFTs Rationale: Niacin may cause hepatotoxicity, especially with doses greater than 2 g daily, with timed-release preparations, and if given in combination with a statin or a fibrate.

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 of the following conditions were noted in the client's history? a) Hypertension b) Asthma c) Liver disease d) Renal disease

Answer: Liver disease Liver disease Explanation: Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy.

A student asks the nursing instructor what the most common adverse effects of ezetimibe (Zetia) are. What would be the instructor's best response? a) Constipation and flank pain b) Neuropathy and flatulence c) Mild abdominal pain and diarrhea d) Bloating and flank pain

Answer: Mild abdominal pain and diarrhea Feedback:The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea. Bloating and flatulence are associated with bile acid sequestrants and the fibrates. Constipation is usually associated with bile acid sequestrants. Neuropathy and flank pain are usually not associated with lipid-lowering agents.

The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any "bad side effects" that she should be aware of. Which of the following statements should underlie the nurse's response? a) The patient will have to schedule regular blood work to closely monitor her kidney function for the duration of treatment. b) The patient may experience a dry cough, especially at night, for the first few weeks after starting to take the simvastatin. c) Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. d) Many patients experience gastrointestinal upset with statins, which can be partially alleviated by taking the drug with food.

Answer: Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. Rationale: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications.

The most common adverse effects of lovastatin (Mevacor) include which of the following? a) Nausea, flatulence, and constipation b) Increased appetite and blood pressure c) Fatigue and mental disorientation d) Hiccups, sinus congestion, and dizziness

Answer: Nausea, flatulence, and constipation Rationale: Gastrointestinal problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Options B, C, and D are not the most common adverse effects of lovastatin. GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin but patients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccups, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy.

A female client presents to the physician's office with complaints of a recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia? a) Atorvastatin b) Niacin c) Fenofibrate d) Cholestyramine

Answer: Niacin Niacin Explanation: Skin flushing may occur with niacin.

What should the nurse suggest to assist a client to improve his cholesterol levels? a) Limit exercise to the weekends b) Weight lifting c) Smoking cessation d) Diet high in polysaturated fats

Answer: Smoking cessation Explanation: Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.

Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. You explain the rationale for this regimen as: a) Therapeutic lifestyle changes are the preferred method for lowering blood lipids. b) Continued therapeutic lifestyle changes during drug therapy will guarantee success. c) Therapeutic lifestyle changes work only when used in conjunction with medications. d) None of the above.

Answer: 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.

A patient presents at the clinic after one week of taking pravastatin (Pravacol) with complaints of "just not feeling well." The nurse asks what liquid the patient has been taking their medication with and the patient tells the nurse that they drink a lot of grapefruit juice. The nurse should know that grapefruit juice increases the risk of which adverse effect? a) Nausea b) Diarrhea c) Toxicity d) Gastric ulceration

Answer: Toxicity Rationale: Grapefruit juice increases the risks of toxicity as it increases serum drug levels. It does not increase the risk of ulceration, nausea, or diarrhea.

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? a) Blood pressure below 130/85 mm Hg b) Triglyceride level above 150 mg/dL c) Fasting blood glucose below 110 mg/dL d) Waist measurement over 40 inches in women

Answer: Triglyceride level above 150 mg/dL Rationale: Characteristics of metabolic syndrome include fasting blood glucose levels greater than 110 mg/dL, waist measurement over 40 inches in men and over 35 inches in women, triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women, blood pressure greater than 130/85 mm Hg, increased macrophages, levels of interleukin-6 and TNF, and increased plasminogen activator levels.

A 64-year-old client has increased levels of LDL, VLDL, cholesterol, and triglycerides and xanthomas in his knees and elbows. What type of dyslipidemia does he have? a) Type I b) Type IIa c) Type IIb d) Type III

Answer: Type IIb Rationale: Type IIb dyslipidemia is characterized by increased levels of LDL, VLDL, cholesterol, and triglycerides and lipid deposits (xanthomas) in the feet, knees, and elbows.

A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication a) in the evening. b) in the early morning. c) at bedtime. d) in the afternoon.

Answer: at bedtime. Rationale: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning.

You are caring for a patient who has been prescribed lovastatin to control her blood lipid levels. While teaching her about the medication, you should caution her against consuming large amounts of a) grapefruit juice. b) high-fiber food. c) water. d) orange juice.

Answer: grapefruit juice

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 drugs achieves its therapeutic effect by a) inhibiting the synthesis of cholesterol. b) mitigating the harmful effects of atherosclerosis by promoting vasodilation. c) binding LDL to HDL. d) oxidizing cholesterol to bile acids.

Answer: oxidizing cholesterol to bile acids. Explanation: Unlike statins, which work by decreasing the synthesis of cholesterol, the bile acid sequestrants such as cholestyramine promote the oxidation of cholesterol to bile acids. Bile acid sequestrants do not promote vasodilation or bind HDL to LDL.

What term is used to describe the heart's ability to independently generate an electrical impulse?

Automaticy

A patient is administered amiodarone (Cordarone) intravenously. Which of the following assessments should the nurse consequently prioritize? A) Assess urine output every 5 minutes. B) Assess blood pressure at least every 5 minutes. C) Assess for increased bronchovesicular lung sounds. D) Assess for muscle rigidity.

B

A patient is receiving an antidysrhythmic medication intravenously. How often should the patient's blood pressure be assessed? A) Once per shift B) Every 1 to 5 minutes C) Every 15 minutes D) Every 2 hours

B

An adult male patient with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this patient? A) The need to measure his radial pulse for 1 minute prior to each dose of propranolol B) The importance of not stopping the medication abruptly C) The need to avoid taking over-the-counter antacids D) The need to limit his intake of high-potassium foods

B

Intravenous verapamil has been ordered STAT in the treatment of a patient with a supraventricular tachycardia. In order to ensure patient safety, the nurse should be aware that concurrent use of which of the following medications is absolutely contraindicated? A) Sodium bicarbonate B) Propranolol C) Diltiazem D) Lidocaine

B

The electrocardiogram of a patient in distress reveals the presence of paroxysmal supraventricular tachycardia. The cardiologist has consequently ordered adenosine, an unclassified antidysrhythmic that is specific to the treatment of this disorder. The nurse should prepare to facilitate what intervention? A) Cardiac catheterization B) Inserting a central venous catheter C) Holter monitoring D) Nonstress testing

B

The nurse is preparing a patient for discharge who will receive a prescription for an beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that they have a clear understanding of the teaching provided by the nurse? A) "I will not need to follow that low-fat diet anymore because this drug will take care of my lipids." B) "I should plan to take this drug before bedtime, because my body makes lipids mostly at night." C) "After I start taking this drug, I will not have to worry about the exercise routine the doctor prescribed." D) "I should take this drug first thing in the morning and make sure I drink a full glass of water."

B) "I should plan to take this drug before bedtime, because my body makes lipids mostly at night." Feedback:HMG-CoA inhibitors should be taken at bedtime because the body produces lipids mostly at night. Diet and exercise are still important when taking these drugs because the drug is most effective in combination with other lipid-lowering actions.

When planning patient care the nurse recognizes what patient is at greatest risk of developing coronary artery disease? A) A 32-year-old Asian American with total cholesterol of 120 mg/dL B) A 62-year-old white American with total cholesterol of 260 mg/dL C) A 48-year-old African American with total cholesterol of 198 mg/dL D) A 26-year-old Native American with total cholesterol of 150 mg/dL

B) A 62-year-old white American with total cholesterol of 260 mg/dL Feedback:White Americans have the highest incidence of coronary artery disease (CAD). This patient has total cholesterol of 260 mg/dL, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three patients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range.

The patient receives a prescription for niacin and the nurse is teaching his or her about the medication. The nurse instructs the patient to call the provider if what common adverse effect of niacin occurs? A) Hypotension B) Abdominal pain C) Vomiting D) Diarrhea

B) Abdominal pain Feedback:Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. It also increases serum levels of uric acid and may predispose patients to the development of gout. Hypotension, vomiting, and diarrhea are not normally associated with the drug.

A client has been reading about the use of flax seed to lower cholesterol. What should the client be taught about the use of oat bran and cholestyramine? A) Cholestyramine absorption will be increased with oat bran. B) Cholestyramine absorption will be decreased with oat bran. C) Bleeding will be increased with oat bran and cholestyramine. D) Hypoglycemia will result from oat bran and cholestyramine.

B) Cholestyramine absorption will be decreased with oat bran. Absorption of cholestyramine is decreased with flax seed. Bleeding is not increasedwith flax seed and cholestyramine. Hypoglycemia will not result from flax seed andcholestyramine.

A client is prescribed fenofibrate. When providing client teaching, which accurately describes the action of fenofibrate? A) It binds to bile acids in the intestinal lumen. B) It increases oxidation of fatty acids in the liver. C) It inhibits an enzyme required for hepatic synthesis. D) It inhibits mobilization of free fatty acids from peripheral tissues.

B) It increases oxidation of fatty acids in the liver. Feedback:Fibrates increase oxidation of fatty acids in the liver. Bile acid sequestrants bind to bileacids in the intestinal lumen. HMG-CoA reductase inhibitors inhibit an enzyme requiredfor hepatic synthesis. Niacin inhibits mobilization of free fatty acids from peripheraltissues.

A patient is being discharged on cholestyramine (Questran). Patient teaching should include what about this medication? A) Should be administered with other medications B) Should be administered 1 hour before or 4 to 6 hours after other medications C) Should be administered 1 hour after other medications D) Should be administered on an empty stomach

B) Should be administered 1 hour before or 4 to 6 hours after other medications Feedback:Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.

A client has an elevated total serum cholesterol of 260 mg/dL. Which aspect of client teaching of lifestyle changes is most important for the client? A) Eat organic foods. B) Stop smoking. C) Increase rest periods. D) Drink whole milk.

B) Stop smoking. Feedback:Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smokingcessation, change in diet, and drug therapy, are recommended to lower serumcholesterol. The patient with an elevated serum cholesterol should increase exercise andnot increase rest periods. The patient should consume low-fat dairy products and avoidwhole milk. Organic foods are not specifically recommended.

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? A) complete blood count (CBC) B) liver panel C) INR and aPTT D) reticulocyte count

B) liver panel Feedback:Because of the risk for hepatotoxicity, patients taking fenofibrate (TriCor) require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.

An obese client who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by the primary care provider. What do these data suggest in this client? A) the development of arthritic syndrome B) the development of metabolic syndrome C) the development of Reye's syndrome D) the development of Tay-Sachs disease

B) the development of metabolic syndrome Feedback: Metabolic syndrome is noted when the patient has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride levels and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome. Reye's syndrome is marked by acute encephalopathy and is seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurological deterioration in the first year of life.

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.

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.

Which statement would be true about the mechanism of action of class II antiarrhythmic agents?

Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.

The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and nitroglycerin. The nurse should recognize the need to closely monitor the which client assessment datum?

Blood pressure

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? Tanned colored skin Amber colored urine Brownish colored urine Reddish colored skin

Brownish colored urine Explanation: Prolonged use of lovastatin may damage skeletal muscle; the increased bilirubin from the dead cells changes the color of the urine from amber to brown. Tanned and reddish color skin indicates photosensitivities caused by the drug and are general adverse effects.

A patient has been diagnosed with digitalis-induced dysrhythmia. The patient is administered magnesium sulfate IV to resolve a low potassium level. What effect does hypomagnesemia have? A) Decreased QRS complex B) Increased stroke volume C) Myocardial irritability D) Elevated ST segment

C

A patient has been prescribed disopyramide (Norpace) to treat chronic ventricular tachycardia. The nurse's subsequent cardiac assessments and monitoring should be planned in the knowledge that this drug has the potential to cause what health problem? A) New-onset chest pain B) Mitral valve regurgitation C) Acute renal failure D) New dysrhythmias

C

A patient is being treated with quinidine to reduce automaticity. The nurse should advocate for a lower-than-normal dose if the patient has a history of A) type 1 or type 2 diabetes. B) primary hypertension. C) liver disease. D) chronic obstructive pulmonary disease.

C

A patient is diagnosed with acute supraventricular tachycardia, and a critical care nurse is contributing to his plan of care. Which of the following class IV calcium channel blockers is exclusively administered to treat acute supraventricular tachycardia? A) Bethanechol chloride (Urecholine) B) Chlorambucil (Leukeran) C) Diltiazem (Cardizem) D) Midazolam hydrochloride

C

A physician has ordered lidocaine IV for a patient with a ventricular dysrhythmia. The nurse has administered a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV? A) 0.25 to 0.75 mg/min B) 10 to 20 mg/min C) 1 to 4 mg/min D) 6 to 8 mg/min

C

Oral quinidine has been ordered for a patient who has a diagnosis of chronic ventricular tachycardia without heart block. In order to assess for the safety and efficacy of this treatment, the nurse should prioritize assessment of the patient's A) radial and brachial pulse. B) level of consciousness. C) serum drug levels. D) blood pressure.

C

A client is scheduled to have serum triglyceride level assessed. How long should the client be without food or fluids prior to the serum triglyceride test? A) 6 hours B) 8 to 10 hours C) 12 hours D) 24 hours

C) 12 hours Feedback:For accurate interpretation of a patient's lipid profile, blood samples for laboratorytesting of triglycerides should be drawn after the patient has fasted for 12 hours.

A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? A) History of severe constipation B) History of hypertension C) Active hepatitis C D) Type 2 diabetes mellitus

C) Active hepatitis C

The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse describing? A) Cholestyramine (Questran) B) Colesevelam (Welchol) C) Colestipol (Colestid) D) Ezetimibe (Zetia)

C) Colestipol (Colestid) Feedback:Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. The other two options are bile acid sequestrants, but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug.

The nurse is preparing to teach the patient about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important teaching point will the nurse include in the teaching plan? A) Increasing carbohydrate intake B) Reducing protein intake C) Increasing fiber intake D) Reducing fluid intake

C) Increasing fiber intake Feedback:The nurse would want to teach this patient to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the patient should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include? A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity

C) Obesity, inactivity, diet, and smoking Feedback:The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.

A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for genetically linked hyperlipidemia. In preparation for patient teaching concerning this drug, what initial action will the nurse take? A) Ask the parents to be present for the teaching session. B) Determine the appropriate time to discuss the drug with the patient. C) Question the doctor concerning the ordered dosage. D) Review the child's normal daily dietary intake of fatty foods.

C) Question the doctor concerning the ordered dosage. Feedback:The nurse should question the order initially. The dosage is twice the dose for a 9-year-old is expected to receive. The other options are appropriate and would be done. However, out of safety concerns, the nurse would clarify the dosage first.

The nurse is caring for a 35-year-old woman taking a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching this patient about her medications what priority teaching point will the nurse include in the teaching plan? A) Need for frequent ophthalmic examinations B) Information about a cholesterol-lowering diet C) Use of barrier contraceptives D) Calling her doctor with any respiratory symptoms

C) Use of barrier contraceptives Feedback:It is important to teach a woman of childbearing age taking HMG-CoA reductase inhibitors to use barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. She should have routine ophthalmic examinations but does not need more frequent examinations. Cholesterol lowering diet should have been initiated before beginning medications to lower lipid levels. There are no associated respiratory risks with these medications so she would call the doctor with respiratory symptoms as she normally would.

A client who has been taking a statin has seen an improvement in cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medication regimen? A) digoxin B) vitamin D C) cholestyramine D) calcium carbonate

C) cholestyramine Feedback:Cholestyramine is administered to patients to reduce LDL cholesterol in patients whoare already taking a statin drug. Digoxin is not given to lower LDL cholesterol. VitaminD is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDLcholesterol.

An older adult client is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The client's spouse has been participating actively in the client's care and performs much of the feeding and hygiene needs. This evening, the spouse has brought in a number of healthy snacks to keep at the client's bedside. Knowing that the client's medication regimen includes simvastatin, the nurse would remove which item? A) purple grapes B) cranberry cocktail C) grapefruit juice D) trail mix (salted nuts and seeds)

C) grapefruit juice Feedback:It is important to avoid taking simvastatin with grapefruit juice. None of the other listedfoods is contraindicated.

Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies? A) soy B) flaxseed oil C) red yeast rice D) garlic

C) red yeast rice

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.

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.

Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with what conditions?

Cardiac catheterization Cardiac surgery Digitalis-induced ventricular dysrhythmias

A client with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. Which should the nurse do before administering the drug?

Check the client's creatinine level.

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 Explanation: The cholesterol absorption inhibitors (e.g., ezetimibe), the newest class of dyslipidemic drugs, act in the small intestine to inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver, resulting in reduced hepatic cholesterol stores and increased clearance of cholesterol from the blood. This distinct mechanism is complementary to that of HMG-CoA reductase inhibitors.

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers?

Class III

What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential?

Class III Amiodorone

A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug? a)Abdominal pain b)Headache c)Constipation d)Indigestion

Constipation Explanation: Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.

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 Cholelithiasis Rash Vertigo

Constipation Explanation: The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil.

A 48-year-old male patient with no known history of cardiovascular disease has presented to the emergency department in atrial flutter. The on-call cardiologist has ordered propafenone PO 150 mg every 8 hours for 24 hours. What is the cardiac care nurse's priority assessment during this period? A) Every 1 hour monitoring of potassium levels B) Blood pressure monitoring every 10 minutes C) Echocardiography D) Continuous ECG monitoring

D

A patient is admitted to the emergency room with a ventricular dysrhythmia associated with an acute myocardial infarction. The physician has ordered a bolus of lidocaine IV. What assessment should the nurse make prior to administering this medication? A) Assess for lidocaine administration in the patient's history. B) Determine the patient's ability to swallow. C) Assess the patient's nutritional history for allergies. D) Determine if the patient has had a reaction to local anesthesia.

D

John Jones, a 47-year-old teacher, now takes cholestyramine, and the nurse teaches him about the medication and its use. The nurse should be concerned if, after the teaching session, Mr. Jones states A) "I should take the medicine with a full glass of water when I take my other medications" B) "I am taking this medication to decrease my LDL cholesterol level" C) "I should swallow the tablets whole" D) "I may need to supplement my intake of the fat-soluble vitamins A, D, E, and K"

D) "I may need to supplement my intake of the fat-soluble vitamins A, D, E, and K"

Karen James, a 32-year-old accountant with type 1 diabetes mellitus, is taking gemfibrozil to reduce her serum triglyceride level. She asks why she could not take niacin, as her husband does. The nurse responds A) "Either drug reduces triglycerides. Why don't you ask your nurse practitioner if the drug therapy could be changed?" B) "Gemfibrozil is the only drug recommended for use to lower cholesterol" C) "Niacin therapy is not recommended for use in women" D) "Niacin increases blood glucose levels and is not preferred for people with diabetes"

D) "Niacin increases blood glucose levels and is not preferred for people with diabetes"

The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurse's best response? A) "Micelles are absorbed into the intestinal wall and combined with proteins to become chylomicrons." B) "The drug makes the liver use cholesterol to produce more bile acids." C) "The drug works in the brush border of the small intestine to prevent the absorption of dietary cholesterol." D) "The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels."

D) "The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels." Feedback:Fenofibric acid is the first drug in this class. It activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma and reduction in the production to an enzyme that naturally inhibits lipid breakdown. The result is seen as a decrease in triglyceride levels, changes in low density lipoprotein production, which makes them more easily broken down in the body, and an increase in high density lipoprotein levels.

The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with diet cola twice per day. What is an appropriate nursing diagnosis for this patient? A) Acute pain related to central nervous system and GI effects B) Constipation related to GI effects C) Noncompliance related to how the drug is taken D) Deficient knowledge regarding drug therapy

D) Deficient knowledge regarding drug therapy Feedback:Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the patient is experiencing any adverse effects from the drug so that pain and constipation would not be optimal nursing diagnoses. Until the nurse assesses the patients understanding of how to take the drug, it would be incorrect to assume noncompliance when it may actually be lack of understanding.

The patient is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the nursing history the patient reveals he was taking Pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient complains of muscle pain. What does the nurse suspect caused this patient's renal failure? A) Gastric ulceration B) Rhabdomyolysis C) Congestive heart failure D) Drug Toxicity

D) Drug Toxicity Feedback:Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity would cause liver damage, whereas the breakdown of muscle that occurs with rhabdomyolysis results in kidney damage and acute renal failure. The patient identified no symptoms related to gastric ulceration or congestive heart failure.

The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL) concentrations. What is the correct answer? A) Fenofibrate (Tricor) B) Niacin (Niaspan) C) Atorvastatin (Lipitor) D) Gemfibrozil (Lopid)

D) Gemfibrozil (Lopid) Feedback:Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.

The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse explains that the desired goal for cholesterol levels is what? A) High high density lipoprotein (HDL) values and high triglyceride values B) Low soluble fiber C) Elevated blood lipids, fasting glucose less than 100 D) Low low density lipoprotein (LDL) values and high HDL values

D) Low low density lipoprotein (LDL) values and high HDL values Feedback:The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. HDL serves as a protective mechanism to reduce cholesterol so higher levels are desirable. High LDL levels increase plaque formation. Fiber does not contribute to risk for coronary artery disease (CAD) although a diet high in fiber is preferable. Elevated blood lipids are never desirable but control of blood sugar levels reduces CAD risk.

A person with type 1 diabetes mellitus and hypertension has the following lipid profile: total serum cholesterol 288 mg/dL, low-density lipoprotein (LDL) cholesterol 200 mg/dL, high-density lipoprotein (HDL) cholesterol 48 mg/dL, and triglycerides 200 mg/dL. How would you evaluate the results of the lipid profile? SELECT ALL THAT APPLY. A) LDL cholesterol is elevated. B) HDL cholesterol is within normal limits. C) Triglyceride level is elevated. D) Total cholesterol is within normal limits.

D) Total cholesterol is within normal limits.

A 36-year-old woman has been taking atorvastatin 20 mg PO daily for 6 months to treat mild dyslipidemia. At a clinic appointment, she tells the nurse she is 6 weeks pregnant. The nurse counsels the patient that it is likely that her midwife will counsel her A) to increase the dose of prenatal vitamins B) to reduce the dosage of her lovastatin to 20 mg PO daily C) to increase the dosage to 40 mg PO twice daily D) about discontinuing the drug during pregnancy

D) about discontinuing the drug during pregnancy

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? A) reduction in triglycerides B) reduction in total serum cholesterol levels C) increase in HDL levels D) reduction in LDL cholesterol levels

D) reduction in LDL cholesterol levels Feedback:Cholestyramine (Prevalite, Questran), the prototype bile acid sequestrant, has the abilityto reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either noeffect or an increased effect on triglyceride levels.

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.

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.

A nursing instructor is teaching a class on the action of statin drugs. The instructor determines the class is successful after the students correctly choose which actions? Select all that apply. Inhibit cholesterol production Formation of a substance excreted in the feces Decrease cholesterol absorption in GI tract Promote cholesterol breakdown Decrease breakdown of fat to cholesterol

Decrease cholesterol absorption in GI tract Promote cholesterol breakdown Inhibit cholesterol production Explanation: Statins inhibit the manufacture or production of cholesterol or promote the breakdown of cholesterol. The bile acid resins bind to bile acids to form an insoluble substance that cannot be absorbed by the intestine, so it is excreted in the feces.

A male client presents to the health care provider's office with symptoms of hyperglycemia. He is taking his oral antidiabetic medication and has not modified his diet or exercise program in any way. When the nurse interviews the client, he states that he now takes flax seed to reduce his cholesterol level. What may occur as a result of taking flax seed? Decreased excretion of the drug through the kidneys Increased absorption of his drugs Increased liver metabolism the kidneys Decreased absorption of his drugs

Decreased absorption of his drugs Explanation: Flax or flax seed is used internally as a laxative and a dyslipidemic agent. Absorption of all medications may be decreased when taken with flax, resulting in a less than therapeutic effect.

Verapamil (Calan) can produce which of the following effects on the cardiovascular system? Select all that apply:

Dilate coronary arteries. Dilate peripheral arteries. Slow conduction through the SA and AV nodes

A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?

Elevated glucose

The nursing instructor has completed a teaching session on bile acids with a group of nursing students. The instructor determines the session is successful when the students correctly choose which fact(s) as true about bile? Select all that apply. Classified as a hormone Stored in the liver Manufactured by the gallbladder Secreted by the liver Emulsifies fat and lipids

Emulsifies fat and lipids Secreted by the liver Explanation: Bile is manufactured and secreted by the liver and stored in the gallbladder; it emulsifies fat and lipids, and these products pass through the intestine. It is not considered a hormone.

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote: Increase absorption of the drug A decreased risk for adverse effects Improved compliance with therapy Enhanced drug effectiveness

Enhanced drug effectiveness Explanation: Simvastatin should be administered at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5 AM and the drug should be taken when it will be most effective.

Which agent would a nurse identify as a cholesterol absorption inhibitor? Simvastatin Ezetimibe Fenofibrate Colestipol

Ezetimibe Explanation: Ezetimibe is a cholesterol absorption inhibitor. Simvastatin is a HMG-CoA reductase inhibitor. Colestipol is a bile acid sequestrant. Fenofibrate is classified as a fibrate.

The health care provider has prescribed ezetimibe for a client diagnosed with hyperlipidemia. The nurse is prepared to prioritize which assessment to evaluate the drug's effectiveness? Taking a dietary history of the client Inspecting skin and eyelids for evidence of xanthomas Obtaining reports of fasting blood sugar levels Frequently monitoring blood cholesterol

Frequently monitoring blood cholesterol Explanation: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a client receiving ezetimibe. Taking a dietary history of the client and inspecting the skin and eyelids for evidence of xanthomas are the preadministration assessments that a nurse should perform for a client receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a client with diabetes.

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

Gemfibrozil Explanation: Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.

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. Bile acid resins HMG-CoA reductase inhibitors Calcium channel blockers Angiotensin II receptor blockers Fibric acid derivatives

HMG-CoA reductase inhibitors Fibric acid derivatives Bile acid resins Explanation: HMG-CoA reductase inhibitors, fibric acid derivatives, and bile acid resins are classes of medications used to treat hyperlipidemia. Calcium channel blockers and angiotensin II receptor blockers are used to treat hypertension.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

A client is to receive esmolol. The nurse would expect to administer this agent by which route?

IV

How long does amiodorone take to work?

Immediately

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect?

Increased digoxin level

A client with coronary artery disease has been prescribed fluvastatin. When reviewing this client's more recent laboratory values, what finding should the nurse attribute to adverse effects of this medication? Decreased hemoglobin and hematocrit Decreased serum potassium levels Increased liver enzyme levels Increased neutrophil levels

Increased liver enzyme levels Explanation: Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. These medications are not normally associated with increased white cell levels, hypokalemia, or anemia.

A patient is administered the HMG-CoA reductase inhibitor pravastatin to reduce the risk of coronary heart disease caused due to hyperlipidemia. The patient is also receiving amiodarone for cardiovascular problems. What effect of interaction between amiodarone and pravastatin should the nurse observe in the patient? Decreased effects of pravastatin Increased anticoagulant effect Increased risk of myopathy Increased hypoglycemic effect

Increased risk of myopathy Explanation: When the HMG-CoA reductase inhibitor pravastatin is administered with amiodarone, the nurse should monitor the patient for increased risk of myopathy as an effect of the interaction between the two drugs. Increased anticoagulant effect is observed in patients receiving warfarin along with pravastatin. Increased hypoglycemic effects are observed in patients receiving sulfonylureas with fibric acid derivatives. The interaction of pravastatin with amiodarone does not decrease the effect of pravastatin.

The nurse is providing care for a client who has been prescribed cholestyramine for the treatment of hyperlipidemia. During the client's latest clinic visit, the client states, "It seems like I bruise from the lightest little bumps or scrapes. What is the nurse's best action? Teach the client safety measures so that the risk for injury is reduced. Tell the client to stop taking the medication until the next appointment with the care provider. Reassure the client that this is an expected adverse effect of the medication. Inform the care provider so laboratory testing can be performed.

Inform the care provider so laboratory testing can be performed. Explanation: The nurse should follow up the client's risk for bleeding by informing the care provider and facilitating coagulation tests. Education about safety would be a relevant, but not sufficient, response. Reassurance does not address the client's actual problem. The nurse should not independently instruct the client to stop taking a medication.

A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?

Intravenous Esmolol is available only for IV administration.

Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia?

Intravenously The nurse should administer lidocaine intravenously for the treatment of ventricular arrhythmias.

Amiodarone is a potassium channel blocker that prolongs conduction in all cardiac tissues. What is another effect of amiodarone?

It decreases contractility of the left ventricle. It decreases heart rate.

A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that: Which of the following best reflects the action of ezetimibe? Its mechanism of action is not understood. It decreases the absorption of cholesterol in the small intestine. It reduces the production of triglycerides by the liver. It stimulates the breakdown of triglycerides.

It decreases the absorption of cholesterol in the small intestine. Explanation: Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.

A nurse is preparing to administer colesevelam to a client with hyperlipidemia. The nurse determines cautious administration is warranted after noting which condition in the client's history? Liver disease Unstable angina Hypotension Acute infection

Liver disease Explanation: Bile acid resins should be used cautiously in clients with diabetes, liver, peptic ulcer or kidney disease, and during pregnancy and lactation. Colesevelam is administered with caution in clients with liver disease. Niacin is used with caution in clients with unstable angina. Statins should be used cautiously in clients with hypotension and an acute infection.

The nurse is preparing to teach a client about the antihyperlipidemic drug which the health care provider has prescribed. Which instruction(s) should the nurse point out during the teaching session? Select all that apply. Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels Focus on the importance of taking drug exactly as prescribed Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider Consultation with a dietitian for assistance with diet teaching Measures to minimize gastrointestinal upset

Measures to minimize gastrointestinal upset Consultation with a dietitian for assistance with diet teaching Focus on the importance of taking drug exactly as prescribed Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels, but lifestyle changes may also be necessary such as diet and exercise.

The nurse is preparing to administer colestipol to the client. Which method should the nurse prioritize to administer this medication? Take care not to crush the granules. Mix the granules in 2-6 fluid ounces of water. Give the granules once or twice daily with meals. Mix the drug in 90 mL of liquid.

Mix the drug in 90 mL of liquid. Explanation: The nurse should mix the drug in 90 mL of liquid, soups, cereals, carbonated drinks, or pulpy fruits when administering the colestipol granules to the client. Cholestyramine powder is mixed in 2-6 fluid ounces of water. Colestipol tablets are not crushed. Colesevelam tablets are taken once or twice daily with meals.

Which of the following should not be administered to a client taking pravastatin (Pravachol) due to increased risk of myopathy? Select all that apply: Quinapril (Accupril) Niacin (Niaspan) Clarithromycin (Biaxin) Albuterol (Proventil Verapamil (Calan)

Niacin (Niaspan) Clarithromycin (Biaxin) Verapamil (Calan) Explanation: B, C, and E when co-administered to a client taking a statin, like pravastatin, can result in increased myopathy.

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?

Normal sinus rythm

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

Oral Explanation: Lipid-lowering agents are administered orally.

A nurse in a health care facility is caring for patients receiving the bile acid sequestrant colesevelam. In which category of patients is colesevelam administered with caution? Patients with unstable angina Patients with peptic ulcer disease Patients with diabetes Patients with liver disease

Patients with liver disease Explanation: Colesevelam is administered with caution in patients with liver disease. Fibric acid derivatives are administered with caution in patients with peptic ulcer disease and diabetes. Niacin is used with caution in patients with unstable angina.

A patient with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. In which of the following categories of patients is the use of clofibrate contraindicated? Patients with primary biliary cirrhosis Patients with arterial bleeding Patients with endocrine disorder Patients with respiratory depression

Patients with primary biliary cirrhosis Explanation: The fibric acid derivative clofibrate is contraindicated in patients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in patients with endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in patients with a history of endocrine disorders. Niacin is contraindicated in patients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in patients with respiratory depression.

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

Peripheral Vascular Resistance

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class correctly chooses which point as true? Excess body weight causes LDL cholesterol to go down. Low-fat diet raises LDL cholesterol levels. Being overweight causes HDL levels to go up. Physical activity raises HDL cholesterol levels.

Physical activity raises HDL cholesterol levels. Explanation: Saturated fat and cholesterol in the food raises total and LDL cholesterol levels. Being overweight can make LDL cholesterol levels go up and HDL levels go down. Increased physical activity helps to lower LDL cholesterol and raise HDL cholesterol levels.

A nurse is preparing to administer lovastatin to a client. The nurse should question this order if which disorder(s) is noted in the client's history? Select all that apply. A nurse should be aware that use of statin drugs is contraindicated in clients with which conditions? (Select all that apply.) Serious hepatic disease Kidney disease Carcinoma of the breast Pregnancy Lactation

Pregnancy Serious hepatic disease Lactation Explanation: Statin drugs are contraindicated in individuals with known hypersensitivity to the drugs or serious liver disease and during pregnancy (category X) and lactation. Clients with kidney disease should use bile acid resins cautiously. There is no recognized interaction with statins and breast cancer.

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? Pregnancy Category X Pregnancy Category B Pregnancy Category C Pregnancy Category A

Pregnancy Category X Explanation: HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C, studies have shown adverse effects to the fetus; however, benefit may outweigh the potential harm—the risk has not been ruled out.

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered?

Premature ventricular contraction

The nurse is caring for a client receiving lidocaine IV. Which factor is most relevant to administration of this medication?

Presence of premature ventricular contractions (PVCs) on cardiac monitor

The health care provider has prescribed fenofibrate for a client discovered to have very high serum triglyceride levels. The nurse should question this order if the client has a history of which additional disorder? Arterial bleeding Endocrine disorder Primary biliary cirrhosis Respiratory depression

Primary biliary cirrhosis Explanation: The fibric acid derivative fenofibrate is contraindicated in clients with primary biliary cirrhosis. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. Respiratory depression is a potential adverse reaction to fenofibrate.

A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate

A patient on anti-arrhythmic drug therapy reports nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which drug should the nurse consider as the cause for these adverse effects?

Quinidine

How do you explain to her the recent changes in dysrhythmic therapy?

Recent changes include greater use of nonpharmacologic management of dysrhythmias.

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.) Weight loss Reduction in the intake of carbohydrates Reduction of the intake of saturated fats Increased physical activity

Reduction of the intake of saturated fats Weight loss Increased physical activity Explanation: The NCEP ATP IV recommends a multipronged approach in reducing LDL levels. They term this approach therapeutic lifestyle changes. These lifestyle changes include reduced intake of saturated fats, trans fats, and cholesterol; minimum intake of fatty acids; weight reduction; increased physical activity; increased intake of soluble fiber; and possibly increased intake of plant stanols and sterols.

A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client?

Respiratory assessment Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects.

A client with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be best determined? Assessing the client's resting heart rate and postural blood pressures Performing a focused cardiac assessment Assessing the client's exercise tolerance and activities of daily living Reviewing the client's laboratory blood work results

Reviewing the client's laboratory blood work results Explanation: The benefits of lipid-lowering agents are frequently not perceived by the client and do not often change the client's day-to-day cardiac function or activity level. They are most often assessed by reviewing the client's cholesterol levels.

What is the most serious side effect of lovastatin? Liver damage Rhabdomyolysis Headache Muscle aches

Rhabdomyolysis Explanation: One adverse effect with potentially serious consequences is muscle damage, the exact cause of which is not known. The most serious skeletal muscle effect that may result from lovastatin is rhabdomyolysis, although it is very rare (occurring in 0.1% of patients on statins as monotherapy). Rhabdomyolysis is an acute, sometimes fatal disease, in which direct injury to the plasma membrane of the skeletal muscle occurs (manifested by increased levels of CK, also known as creatine phosphokinase [CPK]). The damage to the muscle causes leakage of the skeletal muscle components (myoglobin) into the blood or the urine; brown urine usually results.

After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse?

SA node

The electrical impulses flow in the following manner:

Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and Purkinje fibers.

Which would be a contraindication for the use of a class II antiarrhythmic?

Sinus bradycardia Class II antiarrhythmics are contraindicated in sinus bradycardia but should be used cautiously in clients with diabetes, thyroid dysfunction, and hepatic dysfunction.

Before the administration of any anti-arrhythmic, what should the nurse's pre-assessment of the client's general condition include?

Skin color Orientation Level of consciousness

It is determined that a client's cardiac rhythm is being originated in the sinoatrial (SA) node. What mechanism is responsible for the triggering of this node?

Specialized cells within the node itself

The nurse should discuss the benefit of adding a statin drug to a client's medication regimen. Statin drugs can reduce the risk of death from which of the following? Select all that apply: Hepatic disease Cancer Transient ischemic attack Stroke Kidney disease

Stroke Transient ischemic attack Explanation: The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks.

You are teaching a client how to follow his antidysrhythmic drug regimen. Which of the following should you advise the client to report as a possible adverse effect of his therapy?

Syncope, dizziness or fainting spells. These symptoms may indicate drug-induced hypotension.

A client diagnosed with a dysrhythmia has not responded appreciably to treatment with oral propranolol. When the medication is discontinued, what instruction should the nurse provide the client to maximize safety?

Taper down the propranolol dose over a period of 2 weeks.

What primary event has occurred when a client experiences an ectopic focus?

The location of the heart's functioning pacemaker is no longer the sinoatrial (SA) node

Ms. Case is admitted to the cardiac care unit because she developed premature ventricular contractions. What could be causes of this ectopic beats?

These ectopic pacemakers may result from hypokalemia, myocardial ischemia, emotional stress, or hypoxia.

The nurse is preparing to administer niacin to a client with hyperlipidemia. Which adverse reaction should the nurse prioritize on ongoing assessment? Diarrhea Constipation Tingling Cholelithiasis

Tingling Explanation: The nurse should monitor for tingling in the client as an adverse reaction to the drug niacin. Constipation, diarrhea, and cholelithiasis are adverse reactions to the drug fenofibrate.

A client is questioning the new prescription for a statin. The nurse should point out the statin will reduce the risk of which disorder(s) for the client? Select all that apply. Transient ischemic attack Stroke Kidney disease Hepatic disease Cancer

Transient ischemic attack Stroke Explanation: The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks. Individuals with kidney disease should use bile acid resin antihyperlipidemic drugs cautiously. Statins are contraindicated in individuals with severe hepatic disease. Whether a client with cancer could use a statin would depend on the location of the cancer and would be decided on a case-by-case manner.

The teaching plan for a client taking amiodarone should include which instruction?

Use a reliable form of birth control while taking this medication. Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy

Which might occur in a client receiving colestipol? Increased vitamin K absorption Thrombosis Fecal incontinence Vitamin A deficiency

Vitamin A deficiency Explanation: With cholestyramine, malabsorption of fat soluble vitamins may occur, leading to deficiencies of vitamins A, D, E, and K. Subsequently, the client is at risk for increased bleeding due to decreased absorption of vitamin K and decreased production of clotting factors. Fecal impaction, not incontinence, may occur.

A man has not been able to decrease his low-density lipoprotein (LDL) cholesterol levels with lifestyle management, and his nurse practitioner has prescribed atorvastatin, a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. The nurse explains to him that atorvastatin is best administered A) without regard for time of day B) at noon, taken with grapefruit juice C) with a snack in the early afternoon D) every other day with a dose of red yeast rice

With food Explanation: Lovastatin should be taken with food; fluvastatin, pravastatin, or simvastatin should be taken in the evening, with or without food; atorvastatin may be taken with or without food and without regard to time of day.

The nurse is caring for a patient receiving intravenous lidocaine for treatment of dysrhythmia. Which of the following dysrhythmias is this patient most likely to have?

a class 1B antidysrhythmic drug, is used in the treatment of symptomatic PVC and ventricular tachycardia. It is used to prevent ventricular fibrillation. Drug treatment of asymptomatic PVC and nonsustained ventricular tachycardia is not recommended.

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? a)"It's a good idea to keep your intake of saturated fat to a bare minimum." b)"I'll give you the names of some salt substitutes that you can start using to season your food." c)"A low-fat diet is a good idea, and the animal sources of fat are always preferable to plant sources." d)"Try to get most of your food energy from protein sources rather than carbohydrates."

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

When describing the action of atorvastatin, which would the nurse include? a)Blocking the enzyme that is involved in cholesterol synthesis b)Binding with bile acids to form an insoluble complex that is excreted c)Stimulating the breakdown of lipoproteins from the tissues d)Decreasing dietary cholesterol absorption from the small intestine

a)Blocking the enzyme that is involved in cholesterol synthesis Explanation: HMG-CoA reductase inhibitors, such as atorvastatin, block the enzyme involved in cholesterol synthesis. Bile acid sequestrants block bile acids to form insoluble complexes for excretion in the feces. Fibrates stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma. Cholesterol absorption inhibitors work in the brush border of the small intestine to decrease absorption of dietary cholesterol from the small intestine.

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? a)Decreased gastrointestinal absorption b)Inhibition of hepatic enzymes c)Induction of hepatic enzymes d)Increased renal excretion

a)Decreased gastrointestinal absorption

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.) a)Low triglycerides b)High HDL cholesterol c)Low LDL cholesterol d)High total cholesterol e) low total cholesterol

a)Low triglycerides b)High HDL cholesterol c)Low LDL cholesterol e) low total cholesterol 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.

Which agent would the nurse identify as inhibiting the release of free fatty acids from adipose tissue? a)Niacin b)Fenofibrate c)Gemfibrozil d)Fenofibric acid

a)Niacin Explanation: Niacin acts to inhibit the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from the plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Fenofibrate inhibits triglyceride synthesis in the liver, resulting in a reduction of LDL levels. Gemfibrozil inhibits the peripheral breakdown of lipids, reduces the production of triglycerides and LDLs, and increases HDL concentrations. Fenofibric acid activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production to an enzyme that naturally inhibits lipid breakdown.

What information would be included in a lipoprotein profile? Select all that apply: a)Total cholesterol b)Triglycerides c)LDL d)ALT e)AST

a)Total cholesterol b)Triglycerides c)LDL A lipoprotein profile is a laboratory test which reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be found reported from liver function test.

A client is diagnosed with hyperlipidemia and is to receive drug therapy as part of the treatment plan. When reviewing the client's laboratory test results, which findings would the nurse identify as supporting the client's diagnosis? Select all that apply. a)Total cholesterol 250 mg/dL b)LDL cholesterol 165 mg/dL c)HDL cholesterol 60 mg/dL d)Total cholesterol 150 mg/dL e)LDL cholesterol 90 mg/dL

a)Total cholesterol 250 mg/dL b)LDL cholesterol 165 mg/dL Explanation: Test results would most likely show elevated levels of total cholesterol above 240 mg/dL (6.22 mmol/L) and LDL greater than 100 mg/dL (2.59 mmol/L). Normal HDL levels should be greater than 40 (1.04 mmol/L). An HDL level less than 40 mg/dL (1.04 mmol/L) would be a major risk factor for heart disease. The higher the LDL level, the greater the risk for heart disease is. Total cholesterol should be less than 200 mg/dL (5.18 mmol/L).

What factor determines the "preferred" density of the cholesterol? a)higher amount of protein b)higher amount of plasma c)higher amount of lipids d)higher amount of carbohydrates

a)higher amount of protein Explanation: The "preferred" or healthier configuration for a lipoprotein is to have a higher density of protein than lipids. None of the other factors are relevant.

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: a)muscle pain. b)dry mouth. c)pruritus (itching) d)increased thirst.

a)muscle pain. Feedback:Myopathy is an important adverse effect of statins. Statins can injure muscle tissue,resulting in muscle ache or weakness; this should be reported promptly. Dry mouth,pruritus, and thirst are not reported adverse effects of statins.

Which single class drug is known to be most effective in reducing the major types of dyslipidemia? a)statins b)bile acid sequestrants c)fibrates d)niacin

a)statins Feedback:For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lowercholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, afibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil,ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

The nurse is administering lidocaine to a client with ventricular tachycardia. The nurse will need to observe for adverse effects, including

adverse effects of lidocaine include hypotension, aggravation of existing dysrhythmia, bradycardia, drowsiness, agitation, and muscle twitching.

An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The woman 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? a)"atorvastatin 150 mg PO BID" b)"atorvastatin 10 mg PO OD" c)"atorvastatin 50 mg PO TID with meals" d)"atorvastatin 75 mg PO BID"

b)"atorvastatin 10 mg PO OD" Ans: BFeedback:Lipitor is normally administered PO 10 to 80 mg daily in a single dose.

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? a)Glucose level b)AST and ALT c)BUN and creatinine d)TSH

b)AST and ALT

The nurse is doing teaching about cholesterol and its role in cardiovascular disease. In addition to promoting cessation of cigarette smoking and a healthy lifestyle with diet and exercise to correct cholesterol abnormalities, the nurse explains that there are two modifiable conditions that have been cited as major risk factors for CAD and its complications. What are these two conditions? a)Obesity and hypertension b)Cholesterol abnormalities and hypertension c)Bradycardia and hypertension d)Depression and hypertension

b)Cholesterol abnormalities and hypertension Cholesterol abnormalities and hypertension Explanation: Four modifiable risk factors include cholesterol abnormalities, cigarette smoking, diabetes, and hypertension and have been cited as major risk factors for CAD and its complications.

The physician is caring for a client who is a 2-year kidney transplant survivor. The nurse would expect the physician to order what drug for the client's hyperlipidemia? a)Atorvastatin b)Fluvastatin c)Lovastatin d)Pravastatin

b)Fluvastatin

A client being initiated on cholestyramine for the treatment of hyperlipidemia should be counseled that what can occur? (Select all that apply.) a)Diarrhea b)Malabsorption of vitamin K c)Aggravation of hemorrhoids d)Flatulence e)Myopathy

b)Malabsorption of vitamin K c)Aggravation of hemorrhoids d)Flatulence

A male client has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply. a)Statins are nephrotoxic. b)Statins are expensive. c)Statins are contraindicated in clients with a history of myocardial infarction. d)Statins require regularly scheduled blood work. e)Statins have an immunosuppressive effect.

b)Statins are expensive. d)Statins require regularly scheduled blood work. Feedback:Because liver enzymes may be elevated during atorvastatin use, patients need liverfunction tests and repeat lipid profile testing on a routine basis. These drugs are alsoexpensive. They are not nephrotoxic and do not suppress the immune system. PreviousMI is an indication for their use, not a contraindication.

How does the nurse providing medication education describe how the drug atorvastatin achieves its desired therapeutic effect? a)increasing the direct administrationrate of renal excretion of LDL b)reducing the amount of cholesterol synthesized by the liver c)inhibiting the absorption of dietary cholesterol in the small intestine d)binding with LDL molecules and eliminating their potential for atherosclerosis

b)reducing 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.

A Nurse administered Atenolol to a Diabetic patient that present with ventricular tachycardia without heartblock. Which of the following would be a priority intervention. a. Access for weight gain b. Closely monitor blood sugar c. Assess the patient's intake and outputs d. Assess for signs of bone fractures.

b. Closely monitor blood sugar Rationale; Beta blockers have been found to be responsible for raising blood sugars.

24 hours after administrating 100g of Amiodarones, the serum level of the drug was checked and the concentration was still 95g. What should the nurse recognize as the cause of this high serum level. a. Renal failure have affected excretion of the drug b. The Drug half life is 10 days, so it's understandable c. Liver impairment could have affected the metabolism of the drug d. This is unexplainable and unexpected.

b. The Drug half life is 10 days, so it's understandable

A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important?

bleeding

Which of the following adverse effects would a nurse expect to assess in a patient taking ezetimibe? a) Flatulence b) Constipation c) Mild abdominal pain d) Bloating

c) Mild abdominal pain Explanation: Mild abdominal pain is a common adverse effect. Ezetimibe is not associated with bloating. Ezetimibe is not associated with flatulence. Diarrhea is a common adverse effect.

A charge nurse is teaching a nursing student about class I dysthymia medications. Which statement made by the student requires further teaching a. The therapeutic serum level for quinidine is between 2 - 6 mcg/ml b. Lidocaine is contraindicated in patients with heartblock unless they have pacemaker c. The therapeutic level for Lidocaine is 2 - 6.5mcg/ml d. Quinidine is should not be given with digoxin and grapefruit

c. The therapeutic level for Lidocaine is 2 - 6.5mcg/ml Rationale; The normal therapeutic value for Lidocaine is 1.5 to 5 mcg/ml.

Which category of blood lipids is involved in the formation of atherosclerotic plaques? triglycerides nitroglycerin phospholipids cholesterol

cholesterol Explanation: 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.

A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give? a)"Take the colestipol at the same time as the thiazide diuretic." b)"Take the thiazide diuretic about 4 hours before the colestipol." c)"Take the colestipol first and then take the diuretic a half hour later." d)"Take the thiazide diuretic about 1 hour before the colestipol."

d)"Take the thiazide diuretic about 1 hour before the colestipol." Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.

A client is being prescribed fluvastatin. The nurse reviews the client's medical record to ensure that the client has attempted lifestyle changes for at least a minimum of which amount of time? a)2 weeks b)4 weeks c)8 weeks d)12 weeks

d)12 weeks

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for: a)Abdominal pain b)Cataract development c)Liver failure d)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: a)Blood in urine or stool b)Abdominal pain c)Yellowing of the skin d)Blurred vision

d)Bleeding a)Blood in urine or stool

A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy? a)BUN b)CBC c)aPTT d)LFT

d)LFT

The nurse is caring for a client who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly in this client? a)BUN b)CBC c)aPTT d)LFT

d)LFT Feedback:Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. Liver function studies should be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course of therapy. The other tests would not be pertinent to this specific drug.

An older adult client, who leads a sedentary lifestyle, has recently been diagnosed with dyslipidemia. The client is disappointed to learn about this condition, stating, "First it was the diabetes and then the arthritis, now this." The nurse has performed health education with the client and has described metabolic syndrome. In addition to the elevated cholesterol levels, what aspect of the client's health is congruent with a diagnosis of metabolic syndrome? a)sedentary lifestyle b)age over 65 c)arthritis d)diabetes mellitus

d)diabetes mellitus Feedback:Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascularrisk factors linked with obesity: increased waist circumference, elevated triglycerides,reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevatedfasting glucose. Age, gender, and joint disorders are not among these criteria.

A client with a diagnosis of cardiovascular disease is taking atorvastatin calcium to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a client taking atorvastatin calcium? a)100 to 115 mg/dL (2.59 to 2.98 mmol/L) b)75 to 85 mg/dL (1.94 to 2.20 mmol/L) c)less than 60 mg/dL (1.55 mmol/L) d)less than 100 mg/dL (3.37 mmol/L)

d)less than 130 mg/dL (3.37 mmol/L) Feedback:In patients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 100 mg/dL.

A nurse should exercise caution when administering Lidocaine to which of the following patients. a. A lactating mother who also presents with heartblock b. A patient with bradycardia or Hypotension c. A patient who exhibit electrolyte imbalance (Hypernatremia) d. A patient with renal/liver dysfunction

d. A patient with renal/liver dysfunction Rationale: The other three are contraindications, Lidocaine should not be administered at all. Lactation is also a contraindication.

A charge nurse is teaching a newly grad nurse about Amiodarone, The newly grad nurse asked "what are the contraindications of Amiodarones?" What is the nurse best response? a. Amiodarone is contraindicated with AV heartblock b. It is contraindicated with pregnancy and lactation c. It is contraindicated with respiratory depressions d. Amiodarones are typically given during life threatening situations, therefore it has no contraindications.

d. Amiodarones are typically given during life threatening situations, therefore it has no contraindications. Rationale: It is typically used in life threatening situations like V-fib, v-tach and advanced cardiac life support. Therefore, there are no contraindications when giving it.

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 faster excretion increased metabolism increased first-pass effect

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

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 the statin tolerance level. increase in plasma concentration of lovastatin. decrease in LDL. decrease in plasma concentration of lovastatin.

increase in plasma concentration of lovastatin. Explanation: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.

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 they are fabric acid derivatives destroy bile salts

inhibits cholesterol syntheses Explanation: Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.

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: decreases absorption of cholesterol. inhibits the production of cholesterol. promotes the breakdown of HDL. promotes excretion of cholesterol in the feces.

inhibits the production of cholesterol. Explanation: Statin drugs inhibit the production of cholesterol and promote the breakdown of cholesterol. Bile acid resins bind to bile acids to form insoluble substances that cannot be absorbed.

The nurse is caring for a client who has been taking atorvastatin for several weeks. The nurse should teach the client to expect decreases in what values? Select all that apply. low-density lipoprotein (LDL) levels sitosterol levels high-density lipoprotein (HDL) levels serum cholesterol campesterol levels

serum cholesterol low-density lipoprotein (LDL) levels Explanation: Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels. It should also aid in the prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL. A decrease in HDL levels is neither desired nor expected.