Pharm 47 & 48
A client with a history of trans-ischemic attacks (TIAs) was prescribed aspirin several weeks ago. Which assessment question should the nurse ask to monitor the client for the medication's adverse effects? (Select all that apply.)
"Have you experienced any dizziness?" "Have you been testing your stool for occult blood?" "Would you say your hearing has been affected?" Are you experiencing any heartburn or indigestion?"
While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?
"I should use aspirin to control my arthritis pain."
The nurse educates a client diagnosed with atrial fibrillation about the prescribed warfarin. Which client statements establish the need for further clarification?
"I will stop eating green leafy vegetables, broccoli, yogurt, or cheese."
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 is receiving low-molecular-weight heparin (LMWH) to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin."
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 is being administered heparin IV and has been started on warfarin. The client asks the nurse why both medications have been prescribed. What is the nurse's most accurate response?
"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."
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
When administering tirofiban, the nurse would administer the drug intravenously over which time frame?
30 minutes
A client asks the nurse what dose of acetylsalicylic acid (aspirin) is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?
300mg
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
An older adult client with a history of mild renal failure has experienced two different transient ischemic attacks (TIAs) and has been prescribed clopidogrel therapy. What statement should be the basis of the nurse's response when asked why aspirin (ASA) wasn't prescribed as the drug of choice?
Clopidogrel is believed to be more effective than aspirin in treating TIAs.
A nurse is preparing a teaching plan for a client who is prescribed cholestyramine. Which information would the nurse include as a possible adverse reaction associated with this drug? Select all that apply.
Constipation Abdominal cramping Bruising
Which of the following best reflects the action of ezetimibe?
Decreases the absorption of dietary cholesterol from the small intestine
A 50-year-old client has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the client's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis?
Diagnosis of ulcerative colitis
The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:
Enhanced drug effectiveness
A 57-year-old female client is postmenopausal. Lifestyle changes have not made a significant impact on her lipids. What would the nurse expect the physician to suggest?
Estrogen replacement therapy
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
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 (statins)
A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?
Heparin is administered parenterally, while warfarin is administered orally.
Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?
Hypercoagulation
What are situations in which the nurse would hold the drug and notify the health care provider? (Select all that apply.)
INR is greater than 3.0 There is evidence of bleeding PT exceeds 1.5 times the control value
A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?
MI
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDs
A client is receiving heparin. Which would the nurse use to monitor the effects of the drug?
PTT
A nurse should be aware that use of statin drugs is contraindicated in clients with which conditions? (Select all that apply.)
Pregnancy Serious hepatic disease Lactation
The client is admitted to the hospital after a suicide attempt. The nurse discovers that the client overdosed on aspirin. What does the nurse expect the health care provider to do?
Prescribe a transfusion of platelets.
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stools
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
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
A male client's laboratory results indicate that both cholesterol and triglycerides are elevated. Which medications may be ordered? (Select all that apply.)
Statin (Atorvastatin) Ezetimibe Gemfibrozil
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.
A client is receiving antihemophilic factor. The nurse understands that this drug is which factor?
VIII
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 nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:
aPTT
To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?
administering a one-time loading dose that is higher than the maintenance dose
A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?
aspirin
A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:
carbonated beverages
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 nurse is preparing to administer an antiplatelet drug. Which medication would the nurse likely administer?
clopidogrel
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
constipation
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
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?
decreased GI absorption
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
Treatments for clients with dyslipidemia are determined according to blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on treatment recommendations?
decreases target serum LDL level
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?
diet
In addition to being synthesized in the liver and intestine, from where are blood lipids derived?
diet
A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?
digoxin
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease.
Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety?
hemophilia
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
heparin
What factor determines the "preferred" density of the cholesterol?
higher amount of protein
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?
his dietary intake of saturated fat
A client is prescribed alteplase as treatment for acute coronary arterial thromboembolism. For which conditions in the client's medical history will the nurse question giving this medication? Select all that apply.
history of severe hypertension arteriovenous malformation cranial surgery 1 month ago closed head injury 3 months ago
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.
A client is to receive abciximab. The nurse would expect to administer the drug by which route?
intravenous
A female client presents to the health care provider's office with recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia?
niacin
A client is receiving warfarin. The nurse would expect to administer this drug by which route?
oral
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
protamine sulfate
A client accidentally ingested extra doses of warfarin at home and now presents with an elevated INR and bleeding. Which medication will the nurse prepare as prescribed to administer along with vitamin K?
prothrombin complex concentrate
The pharmacology instructor is discussing clopidogrel (Plavix). According to the instructor, this drug is frequently used for
reduction of myocardial infarction in clients with atherosclerosis.
What should the nurse suggest to assist a client to improve his cholesterol levels?
smoking cessation
A client has an elevated total serum cholesterol of 260 mg/dL (14.4 mmol/L). Which aspect of client teaching of lifestyle changes is most important for the client?
stop smoking
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?
tarry stools
The client is diagnosed with hepatitis A, diabetes type 1, and portal hypertension. The client develops a DVT, and the health care provider prescribes warfarin. The nurse is concerned for what reason?
the client is more likely to experience bleeding
The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?
vitamin K
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."
A nurse will use extreme caution when administering heparin to which patient?
A 38-year-old male with peptic ulcer disease
The nurse is preparing to administer a thrombolytic drug to a client. The nurse understands that this class of drugs would be contraindicated in clients with which conditions? Select all that apply.
Active bleeding History of aneurysm History of stroke
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 female client is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, the client reports bleeding from her gums when she brushes her teeth. What orders can the nurse anticipate receiving from the health care provider to reverse the effects of the heparin?
Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg.
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A 55-year-old client has been diagnosed with coronary artery disease and begun antiplatelet therapy. The client has asked the nurse why a "blood thinner like warfarin" hasn't been prescribed. What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?
Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis.
A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?
By inactivating clotting factors and thus stopping the coagulation cascade
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol.
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 client is to receive eptifibatide. The nurse would expect to administer this drug by which route?
IV
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.
A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?
LFT
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
The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?
Prevent extension of clots already present
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.)
Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form
After teaching a group of students about antiplatelet agents, the instructor determines that the teaching was successful when the students identify which drug as blocking the production of platelets in the bone marrow?
anagrelide
A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of the medications and the report of pain, what should the nurse suspect is the cause of the pain?
bleeding
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
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:
blood in urine or stool
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
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
A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered?
enoxaparin inhibits the formation of additional clots
Which agent would a nurse expect to administer to a patient with Christmas disease?
factor IX complex
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
An obese client who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by the primary health care provider. What do these data suggest in this client?
the development of metabolic syndrome
When describing the clotting process, which step would the nurse identify as the first reaction to occur with injury to a blood vessel?
vasoconstriction
A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?
vitamin K
A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
vitamin K
A client recovering from joint replacement surgery is prescribed subcutaneous heparin injections. Which response will the nurse make when the client asks if the medication can be taken orally?
"The gastrointestinal tract does not absorb the drug, so it cannot be given by mouth."
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding."
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."
A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic?
2.4
A male client who is experiencing the signs and symptoms of an acute myocardial infarction says that his symptoms started at 10:00 AM this morning. It is now 11:15 AM. The nurse understands that the latest time that the client could receive a thrombolytic agent would be:
4:00pm
The nurse is reviewing the coagulation studies of a client who is receiving a heparin infusion. The client's baseline partial thromboplastin time is 32 seconds. Which result would indicate therapeutic effectiveness?
64 seconds
A client is started on enoxaparin immediately after hip surgery. The nurse would explain to the client that this drug will be continued for how long?
7-10 days
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 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 client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
giving IM injections
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence
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
The nurse instructs a client with a history of atrial fibrillation on warfarin. Which client statement indicates that teaching about the medication has been effective?
i will avoid walking barefoot in the house and outdoors
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 nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that they are also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?
increased risk for bleeding
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:
inhibits the production of cholesterol.
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 condition was noted in the client's history?
liver disease
The nurse is caring for a patient who is on thrombolytic therapy. The patient has a co-morbidity of renal insufficiency. What does the nurse know about the amount of heparin required to treat this patient?
lower doses are required
A nurse is caring for a client undergoing warfarin therapy for the treatment of venous thrombosis. The nurse suspects that the client is experiencing an overdose based on which finding?
melena
A nurse is caring for a client undergoing warfarin therapy for the treatment of venous thrombosis. The nurse suspects that the client is experiencing an overdose based on which finding? You Selected:
melena (blood in the stool)
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
What is the most serious side effect of lovastatin?
rhabdomolysis
