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" Explanation:Atorvastatin is normally administered PO 10 to 80 mg daily in a single dose. The other options present twice or thrice daily administration and total dosages of 150 mg or 300 mg.

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." Explanation:The client needs additional teaching when stating that they can take the drug with grapefruit juice. Instead, the client should choose juices other than grapefruit juice because of the risk for an enzyme reaction. The client should take the dose in the evening or at bedtime, use sunscreen and protective clothing to reduce the risk of photosensitivity reactions, and report any muscle pain, tenderness, or weakness to the primary health care provider.

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." Explanation:Colesevelem is a bile acid sequestrant and these drugs can aggravate hemorrhoids and cause bright, red bleeding. This is not a serious adverse effect and can be treated. The nurse should not alarm the client by telling her to come in immediately nor should she stop taking the medication until the source of the bleeding is determined.

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." Explanation:Triglycerides and cholesterol are lipids that are found in blood. Cholesterol is produced mostly by the liver.

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 Explanation:Atorvastatin peaks in 1 to 2 hours.

A client is receiving niacin as part of therapy for hyperlipoproteinemia. The nurse would explain that the lipid levels will usually begin to drop in approximately which amount of time?

5 to 7 days Explanation:The initial effect on lipid levels is usually seen within 5 to 7 days of starting niacin therapy.

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 Explanation:In conjunction with an acceptable total cholesterol-to-HDL ratio, it is also important for the LDL reading to be between 80 and 100 mg/dL to further decrease the risk of coronary artery disease.

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 Explanation:During statin therapy with lovastatin, or any other drugs in this class, liver function is usually monitored. AST and ALT are measured to monitor liver function. The BUN and creatinine levels are used to monitor kidney function. The TSH test monitors thyroid function.

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 Explanation:During statin therapy with lovastatin, or any other drugs in this class, liver function is usually monitored. AST and ALT are measured to monitor liver function. The BUN and creatinine levels are used to monitor kidney function. The TSH test monitors thyroid function.

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 Explanation:Metabolic syndrome is a cluster of risk factors that includes central adiposity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated fasting glucose. All the options will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome.

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:

Bleeding Explanation:Increased serum levels and resultant toxicity can occur if a statin is combined with warfarin, an oral anticoagulant. This would increase the client's risk for bleeding. Abdominal pain and cataract development are related to the use of atorvastatin alone. Liver failure also is associated with atorvastatin use alone.

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 Explanation:Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques.

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.

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 Cholestyramine is a bile acid resin that can cause constipation, which can be severe; abdominal cramping; and increased bleeding tendencies as evidenced by bruising. Memory problems and dizziness are more commonly associated with statins.

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 Explanation: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

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 gastrointestinal absorption Explanation:Bile acid resins can decrease the gastrointestinal absorption of several medications. Hepatic enzymes are inhibited by medications such as propranolol, metoprolol, and valproate to name a few by interfering with metabolism of the drugs. Induction of hepatic enzymes can be related to long-term alcohol abuse, use of spironolactone or phenytoin to name a few. Increased renal secretion can occur as a result of poison treatment to alkalize the urine so that it cannot be reabsorbed into the system but expelled via the urinary tract.

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.

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:

Enhanced drug effectiveness Explanation:Simvastatin should be administered at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5 AM and the drug should be taken when it will be most effective

Which drug is most effective in reducing serum triglyceride levels?

Fibrates Explanation:Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing serum triglycerides.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitor blood cholesterol. Explanation:The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient

The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:

Greater drug effectiveness is achieved at this time. Explanation:The drug is administered at bedtime because the highest rates of cholesterol synthesis occur between 12 and 5 AM, and the drug should be taken when it will be most effective.

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 Explanation:Normal HDL should be greater than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.

After teaching a group of students about drugs used to treat hyperlipidemia, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.

HMG-CoA reductase inhibitors Fibric acid derivatives Bile acid resins HMG-CoA reductase inhibitors, fibric acid derivatives, and bile acid resins are classes of medications used to treat hyperlipidemia. Calcium channel blockers and angiotensin II receptor blockers are used to treat hypertension.

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 Explanation:Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.

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 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 client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?

LFT Explanation:Liver function tests (LFT) and serum cholesterol levels should be assessed prior to initiating statin therapy.

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 Explanation:Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.

What drug or drug class inhibits mobilization of free fatty acids from peripheral tissues?

Niacin Explanation:Niacin (nicotinic acid) decreases both cholesterol and triglycerides. It inhibits mobilization of free fatty acids from peripheral tissues, thereby reducing hepatic synthesis of triglycerides and secretion of VLDL, which leads to decreased production of LDL cholesterol.

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 Explanation:Skin flushing may occur with niacin.

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 Explanation: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration as part of a client's discharge counseling.

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 The NCEP ATP IV recommends a multipronged approach in reducing LDL levels. They term this approach therapeutic lifestyle changes. These lifestyle changes include reduced intake of saturated fats, trans fats, and cholesterol; minimum intake of fatty acids; weight reduction; increased physical activity; increased intake of soluble fiber; and possibly increased intake of plant stanols and sterols.

What is the most serious side effect of lovastatin?

Rhabdomyolysis Explanation:One adverse effect with potentially serious consequences is muscle damage, the exact cause of which is not known. The most serious skeletal muscle effect that may result from lovastatin is rhabdomyolysis, although it is very rare (occurring in 0.1% of patients on statins as monotherapy). Rhabdomyolysis is an acute, sometimes fatal disease, in which direct injury to the plasma membrane of the skeletal muscle occurs (manifested by increased levels of CK, also known as creatine phosphokinase [CPK]). The damage to the muscle causes leakage of the skeletal muscle components (myoglobin) into the blood or the urine; brown urine usually results.

Which adverse effects would the nurse include in the teaching plan for a patient receiving fenofibric acid as common? (Select all that apply.)

Runny nose Respiratory infections Explaination: The most common adverse effects that have been reported are headache, back pain, nausea, diarrhea, muscle pain, runny nose, and respiratory infections.

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 taking cholestyramine and ezetimibe. What administration guideline is most important to teach this client?

The administration of ezetimibe is 1 hour before cholestyramine. Explanation: Ezetimibe should be taken 1 hour before or 4 to 6 hours after a bile acid sequestrant. The two medications should not be taken together. Ezetimibe acts in the small intestine to inhibit absorption of cholesterol resulting in reduced hepatic cholesterol stores and increased clearance of cholesterol from the blood. Cholestyramine binds bile acids in the intestinal lumen, causing the bile acids to be excreted in feces, preventing recirculation to the liver. Cholestyramine should not be administered 1 hour after ezetimibe.

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.

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 Explanation:A triglyceride level of 180 mg/dL is considered borderline high (normal or desirable would be less than 150 mg/dL). A total cholesterol of 160 mg/dL and an LDL cholesterol of 110 mg/dL would be considered normal or desirable. An HDL level of 45 mg/dL would be considered normal; levels above 60 mg/dL would be considered high.

A patient with metabolic syndrome usually has increased plasminogen activator levels.

True Explanation:Metabolic syndrome involves increase plasminogen activator levels.

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 Explanation:White clients have the highest incidence of CAD. This client has total cholesterol of 260 mg/dl, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three clients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range.

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 Explanation:Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?

headache and flatulence. Explanation:The most common adverse effects of statins include GI symptoms (including nausea, constipation, flatulence, and abdominal pain), headache, and muscle aches. These effects are usually mild and transient. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.

What factor determines the "preferred" density of the cholesterol?

higher amount of protein Explanation:The "preferred" or healthier configuration for a lipoprotein is to have a higher density of protein than lipids. None of the other factors are relevant.

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. Explanation:Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.

The nurse should be cognizant that niacin therapy is the most effective method of achieving which cardiac-related goal?

increased concentration of HDL cholesterol Explanation:Niacin, the most effective drug for increasing the concentration of HDL cholesterol, is most helpful in preventing heart disease when used in combination with another dyslipidemic drug such as a bile acid sequestrant or a fibrate. None of the other goals are primarily associated with niacin therapy.

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. Explanation:Statin drugs inhibit the production of cholesterol and promote the breakdown of cholesterol. Bile acid resins bind to bile acids to form insoluble substances that cannot be absorbed.

What health problems contraindicate the use of fibrates for the treatment of dyslipidemia? Select all that apply.

liver disease chronic renal failure Explanation:Contraindications to the use of fibrates include a hypersensitivity to fibrates, hepatic or (severe) renal impairment, preexisting gallbladder disease, primary biliary cirrhosis, or persistent liver function abnormalities of unknown origin. Currently fibrate treatment is not contraindicated for clients with a history of venous thromboembolisms, ischemic heart disease, or diabetes mellitus.

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. Explanation:An adverse reaction of rosuvastatin is muscle toxicity, which may cause rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle that can cause pain, weakness, nausea, and even kidney damage. Gallbladder disorders are related to the use of fibric acid derivatives. Any medication can cause pruritis, however, it is not related to weakness manifested by the use of rosuvastatin.

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 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 Explanation:The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving 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 Explanation:HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?

Pregnancy Category X Explanation:HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C, studies have shown adverse effects to the fetus; however, benefit may outweigh the potential harm—the risk has not been ruled out.

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." Explanation:The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.

A female client is taking a large dose of nicotinic acid to treat hyperlipidemia. She calls the clinic and reports that her face, neck, and chest are red. Which would be an appropriate response by the nurse?

"This is an expected adverse effect of the drug. It should subside in time." Explanation:Large doses of nicotinic acid produce peripheral vasodilation, mostly in the cutaneous vessels of the face, neck, and chest. Vasodilation results in flushing of the skin and is usually transient. The vasodilation is due to the histamine release caused by the medication. A nurse would never tell a client not to worry and to stop taking the medication, unless the prescriber told her to. The flushing should subside and will not be present for the duration of the course of the drug.

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 Explanation:Prolonged use of lovastatin may damage skeletal muscle; the increased bilirubin from the dead cells changes the color of the urine from amber to brown. Tanned and reddish color skin indicates photosensitivities caused by the drug and are general adverse effects.

Which would a nurse identify as a carrier for small units of fats?

Chylomicrons Explanation:Chylomicrons are carriers for micelles. Micelles are the small units of broken down fats. Bile acids act like a detergent in the small intestine and break up fats into small units. High levels of cholesterol are part of bile acids.

A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?

Constipation Explanation:Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.

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 Explanation:Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet Explanation:Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. Medications, exercise, and the kidneys do not play a role in synthesis.

Prior to administering an antihyperlipidemic to a client, what information does the nurse need to gather? (Select all that apply.)

Dietary history Vital signs Weight Explanation:The pre-administration assessment for antihyperlipidemic drugs includes a lipid profile, liver function tests, dietary history, vital signs, weight, and an inspection for xanthomas.

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 Explanation:The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

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):A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?

LFT Explanation:Liver function tests (LFT) and serum cholesterol levels should be assessed prior to initiating statin therapy.

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 Overall, the most effective blood lipid profile for prevention or management of metabolic syndrome and its sequelae is high HDL cholesterol, low LDL cholesterol, and low total cholesterol. A low triglyceride level is also desirable.

Which agent would the nurse identify as inhibiting the release of free fatty acids from adipose tissue?

Niacin Explanation: Niacin acts to inhibit the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from the plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Fenofibrate inhibits triglyceride synthesis in the liver, resulting in a reduction of LDL levels. Gemfibrozil inhibits the peripheral breakdown of lipids, reduces the production of triglycerides and LDLs, and increases HDL concentrations. Fenofibric acid activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production to an enzyme that naturally inhibits lipid breakdown.

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 Explanation:Cholestyramine, the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

Statins Explanation:For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

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. Explanation:Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smoking cessation, change in diet, and drug therapy, are recommended to lower serum cholesterol. The client with an elevated serum cholesterol should increase exercise and not increase rest periods. The client should consume low-fat dairy products and avoid whole milk. Organic foods are not specifically recommended.

What information would be included in a lipoprotein profile? Select all that apply:

Total cholesterol Triglycerides LDL Explanation:A lipoprotein profile is a laboratory test which reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be found reported from liver function test.

An instructor is describing the characteristics associated with metabolic syndrome. Which of the following would the instructor include in the description? (Select all that apply.)

Waist measurement over 40 inches in men Triglyceride levels greater than 150 mg/dL Explanation: Characteristics of metabolic syndrome include waist measurement over 40 inches in men; triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women; fasting blood glucose levels greater than 110 mg/dL; blood pressure greater than 130/85 mm Hg; increased plasminogen activator levels; and increased macrophages, levels of interleukin-6, and tumor necrosis factor.

A nurse is responsible for patient education for a 48-year-old woman who has been prescribed colestipol. The nurse will instruct the patient to take the medication

before a meal. Explanation:Colestipol is a bile acid sequestrant that promotes the oxidation of cholesterol to bile acids. Cholesterol is the major precursor to bile acids. Bile acids are secreted from the gallbladder and liver into the intestine during digestion. In the intestine, bile acids emulsify the fat and lipid particles from food, promoting absorption. Much of the bile acid that is secreted is reabsorbed and returned to the liver by hepatic circulation. Colestipol binds with the bile acids in the intestine to make them nonresorbable. The bile acids are then eliminated in the stool. Because of this mechanism of action, the drug should be administered before a meal.

A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:

carbonated beverages. Explanation:Cholestyramine should not be mixed with carbonated beverages. Soups, fruit juices, cereals, liquids, or pulpy fruit are acceptable alternatives.

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 Explanation:Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet Explanation:Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. None of the remaining options are capable of synthesizing or even stimulating the synthesis of blood lipids.

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. Explanation:Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.

Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drug achieves its therapeutic effect by:

oxidizing cholesterol to bile acids. Explanation:Unlike statins, which work by decreasing the synthesis of cholesterol, the bile acid sequestrants such as cholestyramine promote the oxidation of cholesterol to bile acids. Bile acid sequestrants do not promote vasodilation or bind HDL to LDL.

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." Explanation:Statins should be accompanied by a low-cholesterol diet that is also low in saturated fats. Reduction of sodium intake is a useful health-promotion measure but is not particular to treatment with statins. Plant sources of fat are typically lower in saturated fat than animal sources and it is unnecessary to prioritize protein intake over carbohydrates.

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.

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.

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." Explanation:Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.

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." 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. Chest pain, joint stiffness, and bleeding are not common adverse effects.

The nurse is caring for a client newly prescribed rosuvastatin. The nurse should perform which preadministration or ongoing assessments? Select all that apply.

Check the aspartate aminotransferase (AST), and if it is three times the normal, notify the primary care provider. Inspect the skin and eyelids for flat or elevated yellow deposits (xanthomas) and chart, if present. Evaluate for development of fever, muscle weakness or tenderness, or extreme fatigue and report to primary care provider. Determine if dizziness and unsteadiness of gait occurs after administering first dose of rosuvastatin. Explanation:The nurse should make the following assessments when a client begins a statin: for xanthomas, which indicate serious hyperlipidemia; dizziness or unsteady gait after administering the first dose at bedtime, a potential adverse effect. The nurse should assess for fever, malaise, muscle weakness or tenderness signaling rhabdomyolysis, a serious deterioration of muscle cells that can result in renal failure, if not caught early and treated. If the AST is three times the normal, the nurse should call the primary care provider. The provider may discontinue the drug and begin another therapy. Nicotinic acid can lead to generalized flushing of the skin, a warm feeling and tingling and tinnitus, or ringing of the ears.

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 Explanation:HMG-CoA reductase inhibitors are the first drug of choice in the treatment of hypercholesterolemia in patients who are at risk for, or who have already developed, coronary artery disease. HMG-CoA reductase inhibitors (statins) lower LDL cholesterin within 2 weeks and reach maximal effects in approximately 4 to 6 weeks.

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. Explanation:Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.

A client with moderately elevated lipid levels requests immediate pharmacotherapy for dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered based on what rationale?

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. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. Appropriate lifestyle changes should be maintained, but adherence will not guarantee success. Many clients may find lifestyle changes (e.g., smoking cessation) challenging.

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 Explanation:The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.

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 Explanation:Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.

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 Explanation:The statins like atorvastatin inhibit an enzyme (HMG-CoA reductase) required for hepatic synthesis of cholesterol. None of the other options accurately describes the drug's therapeutic effect.