311 - Quiz 4: Ch 10 & ATI 24

The nurse practiioner adds cholestyramine to statin therapy in a patient with markedly elevated serum levels of LDL cholesterol. Which of the following if stated by the patient indicates that patient teaching has been successful? (Select all that apply) a. "I need to mix the powder with water or other fluids before I take it." b. " I should wait 1 hour after I eat to take the medication." c. " I need to maintain good oral hygiene as the medication can damage my teeth." d. "If I notice an increased bleeding tendency, I need to notify the nurse practitioner." e. "I might have some GI effects, including constipation or abdominal pain."

A,C,E. It is necessary to mix cholestyramine with water or other fluids, soups, cereals, or fruits such as applesauce, and to follow with more fluid. Good dental hygiene is important because holding the mixture by mouth can damage teeth. Chloestyramine is not absorbed systematically, so the main adverse effects are gastrointestinal ones such as abdominal fullness, flatulence, diarrhea, and constipation.

The primary focus for prevention and management of metabolic syndrome and its sequelae is... a. elevated HDL, depressed LDL, and low total cholesterol b. low HDL, low LDL, and low total cholesterol c. low triglycerides d. high HDL, low LDL, and low triglycerides

A. elevated HDL, depressed LDL, and low total cholesterol overall, the most effective blood lipid profile for prevention or management of metabolic syndrome and it sequelae is high HDL cholesterol , low cholesterol and low total cholesterol - LDL = bad cholesterol ( < 130) - HDL = god cholesterol ( 40 or above) - Total Cholesterol ( < 200) - Triglycerides ( < 150)

A 48 yr old man visits his health care provider for his annual checkup. He is otherwise in good health, but assessment findings reveal the new onset of a slight increase in BP and total serum cholesterol of 240 mg/dL. What can the nurse anticipate as the preferred treatment for this patient? a. low-lipid diet and an exercise program b. low-lipid diet and a cholesterol synthesis inhibitor c. exercise program and a fibrate d. low-lipid diet, exercise program, and niacin

A. low-lipid diet and exercise program Unless lipid levels are severely elevated, it may be appropriate to try 6 MONTHS OF INTENSIVE DIET and lifestyle modification BEFORE CONSIDERING DRUG THERAPY . It is essential that therapeutic lifestyle changes continue during drug therapy bc because the benefits of diet, exercise, and drug therapy are additive

A man has not been able to decrease his LDL levels with lifestyle management, and his nurse practitioner has prescribed atorvastatin, a hydroxymethylglutaryl-coenzyme A [HMG-CoA] reductase inhibitor. The nurse explains to him that atorvastatin is best administered... a. w/o regard for the time of day b. at noon, taken w grapefruit juice c. w/ a snack in the early afternoon d. every other day w/ a dose of red yeast rice

A. w/o regard for time of day ( lol this makes no sense, NEEDS TO BE TAKEN AT NIGHT) however it has a long half-life and evidence suggest that atorvastatin can be given without regard of time of day

A nurse is caring for a client who has a new prescription for alirocumab to reduce cholesterol. The nurse should monitor which of the following findings as an adverse effect of alirocumab? (Select all that apply) a. muscle aches b. vasculitis c. hearing loss d. urticaria e. jaundice

B,D,E: vasculitis, urticaria, and jaundice Severe hypersensitivity reaction to alirocumab can result in vasculitis, urticaria; and, statins can cause liver disorders, so the nurse should monitor for jaundice, abdominal, pain, and anorexia.

A nurse is completing a nursing history for a client who takes simvastatin The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? a. history of severe constipation b. history of HTN c. active hepatitis C d. type 2 diabetes mellitus

C. active hepatitis C. Ezetimibe is contraindication in clients who have an active moderate-severe liver disorder, especially if the client is already taking a statin (simvastatin)

A nurse is collecting data from an older adult client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse effect of this medication? a. mental status changes b. tremor c. jaundice d. pneumonia

C. jaundice. Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil.

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? a. "take digoxin w your morning dose of colesevelam." b. " your sodium/potassium levels will be monitored periodically while taking colesevelam." c. "watch for bleeding or bruising while taking colesevelam." d. "take colesevelam w food and at least one glass of water."

D. "take colesevelam w food and at least one glass of water." Colesevelam should be taken w food and at least 8 oz of water; (lol no other explanation)

Karen James, a 32 yr old accountant w type 1 diabetes mellitus, is taking gemfibrozil to reduce her serum triglyceride level. She asks why she could not take niacin, as her husband doses. the nurse responds... a. "Either drug reduces triglycerides. Why don't you ask your nurse practitioner if the drug therapy could be changed?" b. "gemfibrozil is the only drug recommended for use to lower cholesterol" c. "Niacin therapy is not recommended for use in women" d. "Niacin increases blood glucose levels and is not preferred for people w diabetes"

D. Gemfibrozil, rather than niacin, is usually preferred for people with diabetes because niacin increases blood sugar.

John Jones, a 47 yr old teacher, now takes cholestyramine, and the nurse teaches him about the medication and its use. The nurse should be concerned if, after the teaching session, Mr. Jones states a. "I should take the medicine w a full glass of water when I take my other medications" b. "I am taking this medication to decrease my LDL level" c. "I should swallow the tablets whole" d. "I may need to supplement my intake of the fat-soluble vitamins A, D, E, and K"

D. It is essential that cholestyramine not be given with other drugs; clients should take the other drugs 1 hour before or 4 hours to 6 hours after cholestyramine to minimize altered absorption. Because cholestyramine binds bile acids, cholestyramine may interfere with normal fat digestion and absorption and therefore may prevent absorption of the fat-soluble vitamins A,D,E,K; supplementation may be required. The drug can bind with vitamin K; therefore, it is used with caution in people with any coagulopathy.

A 36 yr old woman has been taking atorvastatin 20 mg PO daily for 6 months to treat mild dyslipidemia. At a clinic appointment, she tells the nurse she is 6 weeks pregnant. The nurse counsels the pt that it is likely that her midwife will counsel her... a. to increase the dose of prenatal vitamins b. to reduce the dosage of her lovastatin to 20 mg PO daily c. to increase the dosage to 40 mg PO twice daily d. about discontinuing the drug during pregnancy

D. Statins are potentially teratogenic medications (pregnancy category X). Careful consideration should be given if potential benefits warrant use of the drug class in pregnant women despite potential risks.

A person w type 1 diabetes mellitus and HTN has the following lipid profile: total serum cholesterol - 288 mg/dL LDL - 200 mg/dL HDL - 48 mg/dL triglycerides - 200 mg/dL How would you evaluate the results of the lipid profile? a. LDL cholesterol is elevated b. HDL cholesterol is within normal limits c. triglyceride level is elevated d. total cholesterol is within normal limits

D. Total cholesterol is within normal limits The total cholesterol-to-HDL cholesterol ratio is a number that is useful in predicting the risk of developing atherosclerosis ( total cholesterol value is divided by the value of the HDL cholesterol) The ideal ration is less than 4. This person is at significant risk for atherosclerosis. Even with a favorable ratio, it is still important to try to obtain an LDL less than 800 to 100, particularly in the presences of multiple risk factor. Total cholesterol Desirable: < 200 Borderline: 200-239 Undesirable- 240- above LDL Desirable: < 130 Borderline: 130-159 Undesirable: 160 or above HDL Desirable: 40 or above Boderline: under < 40 Triglycerides Desirable: < 150 Borderline: 150- 199 undesirable: 200 or above

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? a. take this med in the evening b. change position slowly when rising fr a chair c. maintain a steady intake of green leafy vegetables d. consume no more than 1 L/day of fluid

a. take this medication in the evening. the client should take simvastatin in the evening bc nighttime is when the most cholesterol is synthesized in the body. taking statin medications in the evening increases medication effectiveness