Chapter 47: course point

The nursing instructor has completed a teaching session on bile acids with a group of nursing students. The instructor determines the session is successful when the students correctly choose which fact(s) as true about bile? Select all that apply.

Emulsifies fat and lipids Secreted by the liver

An 8-year-old male client requires treatment for dyslipidemia. What would the nurse expect the health care provider to order?

Pravastatin

A nurse is preparing to administer lovastatin to a client. The nurse should question this order if which disorder(s) is noted in the client's history? Select all that apply.

Pregnancy Serious hepatic disease Lactation

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

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

Pregnancy Category X

The health care provider has prescribed fenofibrate for a client discovered to have very high serum triglyceride levels. The nurse should question this order if the client has a history of which additional disorder?

Primary biliary cirrhosis

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

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

diet

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."

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis

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 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

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

What might a client report of during treatment with an atorvastatin (Lipitor)? (Select all that apply.)

Headache Insomnia Constipation

The nurse is providing education to the client who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The client has asked the nurse if there are any "bad side effects". Which statements should underlie the nurse's response?

Most clients tolerate statins well, with minor muscle aches being among the most common adverse effects.

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class correctly chooses which point as true?

Physical activity raises HDL cholesterol levels.

A client has begun taking cholestyramine. Which action by the nurse best addresses likely adverse effects?

Promoting fiber and fluid intake

A 25-year-old female client has been told that a statin (HMG-CoA reductase inhibitor) drug would help in the management of their elevated cholesterol levels. Which question should the nurse prioritize when conducting the client's history?

"Are you now or do you plan to become pregnant in the near future?"

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"

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."

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 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."

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."

A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give?

"Take the thiazide diuretic about 1 hour before the colestipol."

The nurse is teaching a client about a peroxisome proliferator receptor alpha activator named fenofibric acid. The client asks what this drug does. What is the nurse's best response?

"The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels."

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."

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 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?

3 capsules

An adult client's total cholesterol level is 220 mg/dl (5.7 mmol/L). What information will the nurse provide concerning appropriate treatment?

Adopt a low-fat diet and have levels reevaluated in 6 months.

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

Bleeding

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

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

The nurse is doing teaching about cholesterol and its role in cardiovascular disease. In addition to promoting cessation of cigarette smoking and a healthy lifestyle with diet and exercise to correct cholesterol abnormalities, the nurse explains that there are two modifiable conditions that have been cited as major risk factors for CAD and its complications. What are these two conditions?

Cholesterol abnormalities and hypertension

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

Which would be classified as a bile acid sequestrant?

Cholestyramine

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

Constipation

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

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

Which of the following best reflects the action of ezetimibe?

Decreases the absorption of dietary cholesterol from the small intestine

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

Diet

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

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?

Digoxin

A client has been prescribed cholestyramine powder to decrease cholesterol levels. What information should the nurse include when educating the client how to administer the medication to increase effectiveness?

Do not take within 1 hour before or 4-6 hours after taking other drugs.

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

Enhanced drug effectiveness

The nurse has completed a teaching session with a client who is prescribed nicotinic acid. The nurse determines the session is successful when the client correctly chooses which reaction(s) as a normal response to this drug? Select all that apply.

Flushing Sensations of warmth Tingling

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

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

Frequently monitor blood cholesterol.

The health care provider has prescribed ezetimibe for a client diagnosed with hyperlipidemia. The nurse is prepared to prioritize which assessment to evaluate the drug's effectiveness?

Frequently monitoring blood cholesterol

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

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

Greater drug effectiveness is achieved at this time.

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

After reviewing information about lipoproteins, a group of students demonstrate understanding of the information when they identify which of the following as being loosely packed?

HDLs

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

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

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

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

The nurse is preparing to administer cholestyramine to a client. On preadministration assessment, the nurse discovers the client is currently taking propranolol, glipizide, and acetaminophen. Which potential interaction(s) should the nurse prioritize? Select all that apply.

Increase in blood pressure Hyperglycemia

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.

Which lipid level would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL

The nurse is caring for a client who takes fluvastatin . Which laboratory value should be assessed regularly in this client?

LFT

The health care provider prescribes fibrate for a client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the provider to order?

LFTs

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

A nurse is preparing to administer colesevelam to a client with hyperlipidemia. The nurse determines cautious administration is warranted after noting which condition in the client's history?

Liver disease

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

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

A client with hyperlipidemia is prescribed cholestyramine. Which possible adverse reaction(s) will the nurse point out when teaching the client about this drug? Select all that apply.

Malabsorption of vitamin K Aggravation of hemorrhoids Flatulence

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

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?

Obesity, inactivity, diet, and smoking

When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?

Oral

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

The client presents for a routine clink visit to evaluate the long-term use of cholestyramine. The health care provider determines vitamin A and D should be prescribed at this time. The nurse determines which nursing diagnose is most appropriate at this time?

Risk for imbalanced nutrition: less than body requirements

A client has been diagnosed with moderately increased LDL, and the primary care provider wishes to start statin therapy. What is a potential disadvantage of statins that the health care provider should consider? Select all that apply.

Statins may lead to muscle pain Statins require regularly scheduled blood work.

A client is questioning the new prescription for a statin. The nurse should point out the statin will reduce the risk of which disorder(s) for the client? Select all that apply.

Stroke Transient ischemic attack

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.

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 nurse is analyzing the chemistry profile of a client diagnosed with hyperlipidemia. Which measurement(s) will the nurse prioritize on the lipid profile? Select all that apply.

Total cholesterol Triglycerides LDL

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

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

True

Strong evidence exists that atheroma development occurs more quickly in patients with elevated cholesterol and lipid levels.

True

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 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication:

at bedtime.

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

chronic renal failure liver disease

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

A nurse is caring for a client who has been prescribed lovastatin to control blood lipid levels. While teaching the client about the medication, the nurse should caution against consuming large amounts of which?

grapefruit juice.

A client's spouse has brought in a number of healthy foods and snacks to keep at the client's bedside. Knowing that the client's medication regimen includes simvastatin, the nurse should instruct the client not to consume what item?

grapefruit segments

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

headache and flatulence.

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

higher amount of protein

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 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'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 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.

A client is taking lovastatin. The nurse will teach the client about which potential adverse effects?

nausea and constipation

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

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.

The nurse is preparing to teach a client about the antihyperlipidemic drug which the health care provider has prescribed. Which instruction(s) should the nurse point out during the teaching session? Select all that apply.

Measures to minimize gastrointestinal upset Consultation with a dietitian for assistance with diet teaching Focus on the importance of taking drug exactly as prescribed Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider

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

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

Smoking cessation

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

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

Statins