PrepU Ch 10 Drug Therapy Dyslipidemia
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? a. decreased absorption b. faster excretion c. increased first-pass effect d. increased metabolism
a
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? a. decreases target serum LDL level b. has no effect on either LDL or HDL levels c. decreases target serum triglyceride level d. increases target serum high-density lipoproteins (HDL) level
a
What health problems contraindicate the use of fibrates for the treatment of dyslipidemia? Select all that apply. a. chronic renal failure b. liver disease c. diabetes mellitus d. history of venous thromboembolism e. ischemic heart disease
a, b
A nurse is caring for a client who has been prescribed cholestyramine powder for pruritus treatment. What instructions should the nurse include in the teaching plan for the client? Select all that apply. a. Mix the drug with fluid soups or pulpy fruits. b. Do not ingest the drug in the dry form. c. Mix the drug in 2 to 6 fluid ounces (56 to 168 grams) of water d. Take other drugs 4 to 6 hours before cholestyramine. e. Take other drugs 1 hour after cholestyramine.
a, b, c
When providing client teaching to a client beginning therapy with a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? Select all that apply a. Lipid panel b. Liver function tests c. Hemoccult of stool d. Albumin level e. Renal function tests
a, b, e
What information would be included in a lipoprotein profile? Select all that apply: a. Triglycerides b. ALT c. LDL d. AST e. Total cholesterol
a, c, e
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? a. Desirable b. High c. Very high d. Optimal
b
In addition to being synthesized in the liver and intestine, from where are blood lipids derived? a. exercise b. diet c. medications d. kidneys
b
Which would be classified as a bile acid sequestrant? a. Ezetimibe b. Cholestyramine c. Lovastatin d. Gemfibrozil
b
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."I'll give you the names of some salt substitutes that you can start using to season your food." b. "Try to get most of your food energy from protein sources rather than carbohydrates." c. "It's a good idea to keep your intake of saturated fat to a bare minimum." d. "A low-fat diet is a good idea, and the animal sources of fat are always preferable to plant sources."
c
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? a. Hypertension b. Asthma c. Liver disease d. Renal disease
c
The nurse is teaching a 45-year-old client about ways to lower cholesterol level. What effects of exercise does the nurse describe? a. Decreases both HDL and LDL b. Decreases HDL and increases LDL c. Increases high-density lipoproteins (HDLs) and decreases low- density lipoproteins (LDL) d. Increases LDL and decreases triglycerides
c
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? a. Continued therapeutic lifestyle changes during drug therapy will guarantee success. b. Nonpharmacologic interventions are cheaper than using medications. c. Therapeutic lifestyle changes are the preferred method for lowering blood lipids. d. Therapeutic lifestyle changes are easier to comply with than medication therapies.
c
A client taking atorvastatin presents to the clinic reporting acute muscle pain not associated with exercise or injury. The nurse asks questions to determine if this client has been taking what contraindicated substance? a. Ginseng b. Over-the-counter (OTC) medications c. Saw palmetto d. Grapefruit juice
d
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? a. Increased neutrophil levels b. Decreased hemoglobin and hematocrit c. Decreased serum potassium levels d. Increased liver enzyme levels
d
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? a. Increased liver metabolism b. the kidneys c. Increased absorption of his drugs d. Decreased absorption of his drugs e. Decreased excretion of the drug through the kidneys
d
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? a. Liver b. Small intestine c. Stomach d. Gallbladder
d
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? a. fatigue and mental disorientation. b. hiccups, sinus congestion, and dizziness. c. increased appetite and blood pressure. d. headache and flatulence.
d
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? a. "It's important that you stop taking atorvastatin before you stop using contraception." b. "Atorvastatin can be taken safely throughout your pregnancy since it does not cross through the placenta." c. "Atorvastatin is approved to be taken during pregnancy, but you would have to stop taking it if you chose to breastfeed." d. "There's no evidence that atorvastatin is either safe or unsafe during pregnancy, so it's best to err on the side of caution."
a
A client with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be best determined? a. Reviewing the client's laboratory blood work results b. Performing a focused cardiac assessment c. Assessing the client's resting heart rate and postural blood pressures d. Assessing the client's exercise tolerance and activities of daily living
a
A client with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a health care provider. The provider has instructed the nurse to continue the drug therapy for 3 days. The drug is available in 10-mg capsules. How many capsules of the drug should the nurse administer to the client during the entire therapy? a. 3 capsules b. 4 capsules c. 2 capsules d. 1 capsule
a
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? a. Patients with primary biliary cirrhosis b. Patients with respiratory depression c. Patients with arterial bleeding d. Patients with endocrine disorder
a
After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement? a. "I can take the drug with grapefruit juice." b. "I need to be careful when I'm out in the sun." c. "I should report any problems with muscle pain or weakness." d. "I should take the dose around bedtime."
a
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? a. Triglyceride level above 150 mg/dL b. Blood pressure below 130/85 mm Hg c. Fasting blood glucose below 110 mg/dL d. Waist measurement over 35 inches in men
a
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? a. Elevated LDL levels b. Elevated HDL levels c. A high ratio of HDL to LDL d. Low VLDL levels
a
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived? a. Diet b. Medications c. Kidneys d. Exercise
a
The nurse has completed a comprehensive assessment of a new client. What assessment findings would support a diagnosis of metabolic syndrome? Select all that apply. a. blood pressure 148/93 mm Hg b. fasting blood glucose 7.2 mmol/L (121 mg/dL) c. waist measurement 107 cm (42 in) d. resting heart rate 77 beats/min e. high-density lipoprotein (HDL) 1.29 mmol/L (50 mg/dL)
a, b, c, e
What cardiac risk factors are related to metabolic syndrome? (Select all that apply.) a. Reduced high density lipoprotein cholesterol b. Elevated triglycerides c. Postural hypotension d. Central adiposity
a, b, d
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.
a, b, d
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. at bedtime. c. in the afternoon. d. in the early morning.
b
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? a. Vertigo b. Constipation c. Cholelithiasis d. Rash
b
The nurse cares for a 10-year-old child who has been diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children? a. diet b. familial connection c. sedentary lifestyle
b
The nurse explains to a client the action of a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. What enzyme does the nurse state this drug inhibits? a. An enzyme used immediately for energy b. An enzyme that controls the production of cellular cholesterol c. An enzyme used to make bile acids d. An enzyme that combines with proteins to become chylomicrons
b
The nurse is assessing a client who reports taking cholestyramine mixed with diet cola twice per day. What is the most appropriate nursing diagnosis for this client? a. Risk for infection related to inappropriate medication use b. Deficient knowledge regarding drug therapy c. Imbalanced nutrition: less than body requirements related to decreased caloric intake d. Constipation related to GI effects
b
The nurse is preparing a client for discharge who will receive a prescription for a hydroxymethylglutaryl-coenzyme A (HMG-CoA) inhibitor. What statement by the client demonstrates a clear understanding of the teaching provided by the nurse? a. "After I start taking this drug, I can scale back the exercise routine the doctor prescribed." b. "I should plan to take this drug before bedtime, because my body makes lipids mostly at night." c. "I will not need to follow that low-fat diet anymore because this drug will take care of my lipids." d. "I should take this drug first thing in the morning and make sure I drink a full glass of water."
b
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? a. Niacin b. HMG-CoA reductase inhibitors c. Bile acid sequestrants d. Fibrates
b
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 sedentary lifestyle b. His dietary intake of saturated fat c. His alcohol intake d. His waist size
b
Which lipid level would the nurse interpret as being high? a. HDL cholesterol of 48 mg/dL b. LDL cholesterol of 190 mg/dL c. Total cholesterol of 200 mg/dL d. Triglyceride level of 160 mg/dL
b
Which of the following best reflects the action of ezetimibe? a. Blocks the enzyme involved in cholesterol synthesis b. Decreases the absorption of dietary cholesterol from the small intestine
b
To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.) a. High total cholesterol b. Low triglycerides c. Low LDL cholesterol d. High HDL cholesterol e. High VLDL cholesterol
b, c, d
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? a. is a bile-acid resin. b. is a hormone. c. inhibits cholesterol syntheses. d. consists of a fibric acid derivative.
c
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? a. Inspect skin and eyelids for evidence of xanthomas. b. Take a dietary history of the patient. c. Frequently monitor blood cholesterol. d. Obtain reports of fasting blood sugar levels.
c
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)? a. Niacin b. Colesevelam c. Gemfibrozil d. Ezetimibe
c
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? a. Pregnancy Category C b. Pregnancy Category B c. Pregnancy Category X d. Pregnancy Category A
c
The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that: a. Adverse effects are less likely during the night. b. Compliance is enhanced with nighttime administration. c. Greater drug effectiveness is achieved at this time. d. Lack of dietary intake during sleep increases absorption.
c
The nurse is caring for a client taking ezetimibe and monitors the client for what common adverse effects? a. Bloating and flank pain b. Constipation and flank pain c. Mild abdominal pain and diarrhea d. Neuropathy and flatulence
c
The nurse is providing teaching to a client who is at risk for hyperlipidemia. The nurse knows that which risk factors can be controlled or modified? a. Gender, obesity, family history, and smoking b. Stress, family history, and obesity c. Obesity, inactivity, diet, and smoking d. Inactivity, stress, gender, and smoking
c
The client wants information about triglycerides and cholesterol. Which response by the nurse would be correct? a. "Triglycerides are found in your blood. Cholesterol is found in the gallbladder." b. "Triglycerides are found in your blood. Cholesterol is how the fat is transported." c. "Triglycerides transport cholesterol throughout the body." d. "Triglycerides and cholesterol are fatlike substances found in your blood."
d
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 78 LDL 115 Cholesterol 189 b. HDL 82 LDL 96 Cholesterol 240 c. HDL 58 LDL 115 Cholesterol 210 d. HDL 58 LDL 96 Cholesterol 178
d
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. "Most people who experience side effects from atorvastatin report stiffness in their joints." b. "The more serious side effects of atorvastatin involve a risk of bleeding." c. "Some clients experience mild chest pain initially." d. "The most common side effects of atorvastatin include some mild gastrointestinal upset."
d
