NUR 2092 Pharm Ch 47 Lipid lowering agents
An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The client 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?
"Atorvastatin 10 mg PO daily"
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 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:
"I will take the digoxin about an hour before the cholestyramine."
A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this client?
"It's a good idea to keep your intake of saturated fat to a bare minimum."
A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give?
"Take the thiazide diuretic about 1 hour before the colestipol."
A client calls the clinic and talks to the nurse. The client tells the nurse the client has been taking colesevelam (Welchol) for six months and that the client is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be?
"The bleeding may be coming from hemorrhoids. We should check this out."
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."
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.
Adhering to a low-fat diet Walking for 30 minutes several times a week Eating a high-fiber diet Avoiding tobacco products Maintaining a healthy weight
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?
Brownish colored urine
Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?
Cholesterol
What drug or drug class decreases the delivery of intestinal cholesterol to the liver?
Cholesterol absorption inhibitor
A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?
Cholestyramine
Which would be classified as a bile acid sequestrant?
Cholestyramine
Which would a nurse identify as a carrier for small units of fats?
Chylomicrons
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
Constipation
Which of the following best reflects the action of ezetimibe?
Decreases the absorption of dietary cholesterol from the small intestine
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?
Diet
What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.)
Dosage form Frequency of administration Reason for taking the prescribed drug Drug name Correct dose
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 nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility?
Flushing of the skin
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?
Gemfibrozil
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
Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?
HMG-CoA reductase inhibitors
A 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 client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:
It decreases the absorption of cholesterol in the small intestine.
Which lipid level would the nurse interpret as being high?
LDL cholesterol of 190 mg/dL
A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?
LFT
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
A client is taking lovastatin. Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation
Which agent would the nurse identify as inhibiting the release of free fatty acids from adipose tissue?
Niacin
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X
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?
Reduction in LDL cholesterol levels
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.)
Reduction of the intake of saturated fats Weight loss Increased physical activity
What is the most serious side effect of lovastatin?
Rhabdomyolysis
Which of the following would the nurse suggest to use when administering cholestyramine? Select all that apply.
Soups Fruit juices Water Cereals
Which single class drug is known to be most effective in reducing the major types of dyslipidemia?
Statins
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?
T His dietary intake of saturated fat
A client is taking cholestyramine and ezetimibe. What administration guideline is most important to teach this client?
The administration of ezetimibe is 1 hour before cholestyramine.
What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia?
Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
What information would be included in a lipoprotein profile? Select all that apply:
Total cholesterol Triglycerides LDL
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic?
Triglyceride level above 150 mg/dL
The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high?
Triglycerides 180 mg/dL
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the modifiable factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
Weight Diet
A nurse 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 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication:
at bedtime.
A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:
carbonated beverages.
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
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 nurse is caring for a client who has been prescribed lovastatin to control blood lipid levels. While teaching the client about the medication, the nurse should caution against consuming large amounts of which?
grapefruit juice.
The nurse is providing education to a client who has been prescribed atorvastatin. In what way will the nurse describe how the drug achieves its desired therapeutic effect?
reduces the amount of cholesterol synthesized by the liver
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?
rhabdomyolysis.
To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.)
Low triglycerides High HDL cholesterol Low LDL cholesterol
What should the nurse suggest to assist a client to improve his cholesterol levels?
Smoking cessation
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence.
What factor determines the "preferred" density of the cholesterol?
higher amount of protein
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 plasma concentration of lovastatin.
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.
The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?
"Some people get very flushed skin when they take this medication."
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?
95 mg/dL
When describing the action of atorvastatin, which would the nurse include?
Blocking the enzyme that is involved in cholesterol synthesis
A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?
Constipation
A 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?
"It's important that you stop taking atorvastatin before you stop using contraception."
The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug?
"The most common side effects of atorvastatin include some mild gastrointestinal upset."
The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:
Greater drug effectiveness is achieved at this time.
The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values?
HDL 58 LDL 96 Cholesterol 178
A patient is receiving atorvastatin. The nurse would anticipate that the maximum effectiveness of the drug would occur within which time frame?
1 to 2 hours
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?
12 weeks
The client has been prescribed lovastatin to treat mixed lipidemia. In addition to monitoring cholesterol levels, what other laboratory test value needs to be monitored on a routine basis during therapy?
AST and ALT
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
Bleeding
A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the health care provider to do?
Decrease the dosage of his medication
