Module 3

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

A client with hypertriglyceridemia is prescribed an omega 3-acid ester medication. Which teaching about this medication would the nurse emphasize with this client?

"Do not use any aspirin products when taking this medication."

After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement?

"I can take the drug with grapefruit juice."

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective?

"I will change positions slowly if I feel dizzy."

A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?

"You will lose less potassium with spironolactone than with furosemide."

An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level?

<200 mg/dL

A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?

Administer the drug early in the day.

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?

At breakfast and midafternoon

What sign is most indicative of dehydration in a patient taking diuretics?

Body weight

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet

As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?

Elevated LDL levels

A client with a diagnosis of hypertension has been prescribed a regimen of ramipril and hydrochlorothiazide. In the nurse's most recent assessment, the client reports weakness and leg cramps. In addition to reporting this finding to the health care provider, the nurse will perform which action?

Ensure the client's potassium level is promptly evaluated.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitor blood cholesterol.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic?

Furosemide

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?

Gemfibrozil

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?

Heart disease

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?

High

A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?

Hyperkalemia

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?

Hyperkalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

Hypokalemia

A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus. Which assessment should the nurse prioritize?

Increased blood glucose levels

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

Intravenously

Which lipid level would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL

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

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?

Liver panel

When describing where bumetanide acts, what would the nurse include?

Loop of Henle

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

Mannitol

Which would the nurse expect to find in a client receiving acetazolamide?

Metabolic acidosis

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

Oral

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

Osmotic diuretic

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?

Physical activity raises HDL cholesterol levels.

The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?

Potassium losses are greater with hydrochlorothiazide than with spironolactone.

What would contraindicate the use of indapamide?

Renal disease

The client presents for a routine clink visit to evaluate the long-term use of cholestyramine. The health care provider determines vitamin A and D should be prescribed at this time. The nurse determines which nursing diagnose is most appropriate at this time?

Risk for imbalanced nutrition: less than body requirements

What should the nurse suggest to assist a client to improve his cholesterol levels?

Smoking cessation

Diuretics can either block the reabsorption of components of the urine or block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a patient on loop diuretics?

The amount of sodium and chloride reabsorption that it blocks

A nurse is analyzing the chemistry profile of a client diagnosed with hyperlipidemia. Which measurement(s) will the nurse prioritize on the lipid profile? Select all that apply. Total cholesterol Triglycerides LDL ALT AST

Total cholesterol Triglycerides LDL

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic?

Triglyceride level above 150 mg/dL

A nurse is providing care to a client who is to receive acetazolamide for epilepsy. Before administering this drug, the nurse would assess which of the following?

Vital signs and weight

A nurse is caring for several clients. Which client would have the greatest chance of developing CAD as determined by total cholesterol?

a 62-year-old White client with total cholesterol of 260 mg/dl

A client with a high body mass index who has an elevated triglyceride level and reduced high-density lipoprotein (HDL) cholesterol is seen by the primary health care provider. The nurse should focus education on lifestyle modifications to prevent which disorder?

atherosclerosis

Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?

decreases target serum LDL level

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

eat potassium-rich foods.

A client with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route?

furosemide IV

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.

The nurse is caring for a client with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client?

mannitol

A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:

muscle pain.

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 drug achieves its therapeutic effect by:

oxidizing cholesterol to bile acids.

What substance is reabsorbed in the ascending limb of the loop of Henle?

sodium

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client?

spironolactone

To which client should the nurse anticipate administering mannitol?

the client with increased intracranial pressure secondary to a subarachnoid hemorrhage

A client has been receiving a diuretic as prescribed. Which finding(s) on the ongoing assessment should the nurse prioritize? Select all that apply. Dry mouth Diaphoresis Muscle cramps Hypertension Tachycardia

Dry mouth Muscle cramps Tachycardia

Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?

HMG-CoA reductase inhibitors