PrepU Pharm 1301 - Chap 47,48

The nurse determines teaching has been effective about warfarin when the client makes which of the following statements?

"I will check with my provider before taking any herbal supplements."

What should the nurse teach an older adult client about the potential adverse effects of atorvastatin?

"The most common side effects of atorvastatin involve some mild gastrointestinal upset." Explanation: 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.

The nurse is caring for a client taking ezetimibe and monitors the client for what common adverse effects?

Abdominal pain and diarrhea

Which would be classified as a bile acid sequestrant?

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.

A client asks the nurse what the atorvastatin (Lipitor) prescribed for the client will do. What is an expected outcome for this client?

Decrease in serum cholesterol and LDL levels Explanation: Atorvastatin is a HMG-CoA reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevent a first MI and slow the progression of CAD. 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 client taking atorvastatin presents to the clinic reporting acute muscle pain not associated with exercise or injury. Which substance is contraindicated for this medication?

Grapefruit juice

Which anticoagulant is approved for pediatric use for a child needing anticoagulation therapy for blood clots?

Heparin

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 Explanation: High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect.

What lab test will a client taking warfarin be required to complete to evaluate therapeutic effects of the medication?

International normalized ratio

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. Explanation: If renal insufficiency exists, lower doses of heparin are required. An infusion pump is used for all patients receiving an IV infusion of heparin.

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

Smoking cessation Explanation: Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not 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 Explanation: Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.

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. Explanation: Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Appropriate lifestyle changes should be maintained, but there will not assure guaranteed success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. While nonpharmacologic interventions may be less expensive, that is not the basis for the recommendation.

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

aPTT Explanation: Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. D-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.

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. Explanation: Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.

A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:

intake of vitamin K. Explanation: It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.

Which risk factors can be controlled or modified in a client at risk for coronary artery disease?

obesity, inactivity, and smoking

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." Explanation: 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.

Which client would be the best candidate to receive alteplase recombinant therapy?

A 68-year-old male who has had an ischemic stroke that resulted in neurological deficits Explanation: Alteplase recombinant is the only drug approved for treating ischemic stroke. After a CT scan rules out intracranial bleeding or hemorrhagic stroke, treatment should be initiated within 3 hours after the onset of the stroke. The drug can be used only for patients who have a clinical diagnosis of stroke with clinically meaningful neurologic deficit because its adverse effects can be fatal. Alteplase recombinant may also be used to treat massive pulmonary embolism, but caution is necessary in patients with significant hepatic impairment.

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 Explanation: Cholestyramine is administered to clients to reduce LDL cholesterol in clients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.

Which lipid lowering medication would be appropriate for a client in her second trimester of pregnancy with extremely high serum cholesterol levels?

Colesevelam

Which of the following best reflects the action of ezetimibe?

Decreases the absorption of dietary cholesterol from the small intestine Explanation: Ezetimibe is a cholesterol absorption inhibitor that works in the brush border of the small intestine to decrease absorption of dietary cholesterol from the small intestine. HMG-CoA reductase inhibitors 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.

Which medication is prescribed for a client with coronary artery disease that inhibits peripheral breakdown of lipids, reduces low-density lipoproteins (LDL), and increases high-density lipoprotein (HDL) concentrations.

Gembfibrozil

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 Explanation: Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.

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 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.

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

Increased risk for bleeding Explanation: The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.

What values are used to monitor the effectiveness of warfarin therapy?

PT and INR Explanation: Warfarin dose is regulated according to the international normalized ratio (INR), which is based on prothrombin time (PT). PT and INR are assessed daily until a stable daily dose is reached. Thereafter, PT and INR are determined every few weeks for the duration of warfarin therapy.

The nurse administers clopidogrel appropriately to the client for what purpose?

Treating peripheral artery disease

A client receiving warfarin is bleeding. What is the antidote that will counteract warfarin?

Vitamin K

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT. Explanation: Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.