106 Ch 21 Practice Test + EAQ

Which supplemental vitamins may be required for patients taking bile acid-sequestering resins?

Fat-soluble vitamins Absorption of fat-soluble vitamins may be decreased in long-term therapy with bile acid-sequestering resins. Therefore, patients taking this medication may need supplemental vitamins. Water-soluble vitamins; vitamin B5; and vitamins C, B6, and B12 are not affected by bile acid-sequestering resins.

Which potential effect of cholestyramine can cause bleeding gums, bruising, or dark tarry stools?

Deficiency of vitamin K Cholestyramine is a bile acid-sequestering resin that, if taken on a long-term basis, can cause a deficiency of fat-soluble vitamins. Vitamin K is a fat-soluble vitamin essential to blood clotting. Vitamin K deficiency results in abnormal bleeding often manifested by bleeding gums, easy bruising, and melena (blood in the stool). Cholestyramine does not affect platelet aggregation, the Christmas factor, or thromboplastin.

Which medication has the greatest effect on increasing high-density lipoprotein (HDL) levels?

Niacin Niacin increases HDL levels by 15% to 30%, offering the greatest effect of the four choices. Ezetimibe has a minimal effect on raising HDL levels. Gemfibrozil increases HDL levels by 10% to15%, but another medication has a higher effect. Pravastatin increases HDL levels by 5% to 10%, but another medication has a higher effect.

A patient is taking warfarin (Coumadin) and cholestyramine. Which instruction should the nurse provide?

Take warfarin 1 hour before or 4 hours after taking cholestyramine. When cholestyramine and warfarin are taken at the same time, cholestryamine binds with the warfarin, which reduces its absorption. Taking warfarin 1 hour before or 4 hours after taking cholestyramine is a way to avoid this effect. Cholestyramine and warfarin should not be taken at the same time; they can be taken at intervals closer than morning and bedtime.

Which question must be answered before a 40-year-old woman can begin statin therapy?

"Are you pregnant?" Statins are contraindicated for pregnant women; it is critical to determine whether the patient is pregnant before beginning statin therapy. Experiencing symptoms of menopause, a family history of breast cancer, and a history of having a blood clot are irrelevant to statin therapy.

The nurse is instructing a patient about the management of hyperlipidemia. Which statement by the patient indicates the need for further teaching?

"By taking my antilipemic medication, I will not need to modify my diet." Dietary changes and taking an antilipemic medication are important in managing hyperlipidemia. Medication therapy is not to be used as a substitute for diet. An increase in daily exercise with a goal of 30 minutes of moderate intensity exercise most days of the week is strongly recommended to help lower cholesterol levels. The patient should be taught, at minimum, to know the name(s) of the medication he or she is taking, dosage, route, times of administration, and common and serious adverse effects. The patient should have blood studies done regularly to monitor serum levels (e.g., lipid profile values, liver studies, bleeding times). This helps to track progress, identify the need for modifications in therapeutic interventions, and detect possible adverse effects to the medications.

A patient taking a statin reports muscle aches and soreness. Which statement by the nurse correctly explains why this symptom is cause for concern?

"Muscle aches and soreness may be early signs of myopathy." Symptoms of muscle aches and soreness may be an early sign of myopathy. A serum creatinine phosphokinase level of more than 10 times the upper limit of normal range confirms the diagnosis. Muscle pain is not dose related when taking statins. Muscle aches and soreness are not signs of drug toxicity. Muscle aches and soreness are not an indication of muscle breakdown.

A patient has been prescribed ezetimibe (Zetia) for the management of hyperlipidemia. Which adverse effect should be monitored?

Abdominal pain Common gastrointestinal adverse effects of ezetimibe include abdominal pain and diarrhea. Insomnia and urinary retention are not reported adverse effects of ezetimibe.

Which medication has received US Food and Drug Administration (FDA) approval for reducing blood glucose and glycosylated hemoglobin (A1c) in adult patients with type 2 diabetes?

Colesevelam Colesevelam is an FDA-approved drug for reducing blood glucose and glycosylated hemoglobin (A1c) in adult patients with type 2 diabetes. It may be used alone or in combination with metformin, sulfonylureas, or insulin. Cholestyramine, colestipol, and cyclosporine do not reduce blood glucose.

Which instruction does the nurse give to a patient beginning lovastatin (Mevacor) therapy?

Do not drink grapefruit juice. Grapefruit juice inhibits the metabolism of lovastatin, increasing its plasma concentration and increasing the risk of myopathy. If signs of myopathy, such as muscle aches, soreness, and weakness occur, they must be reported immediately. Muscle aches are a symptom of myopathy and should not be treated with OTC pain relievers. Lovastatin must be taken with food, but it is best taken at night, which is the peak production time for cholesterol. Ongoing liver function tests are necessary but not needed weekly.

Which instruction does the nurse include when teaching a patient with hyperlipidemia about how to take the powdered form of cholestyramine?

Mix the powder with 2 to 6 ounces of water or juice. The powdered form of cholestyramine must be mixed with 2 to 6 ounces of water, juice, soup, applesauce, or crushed pineapple, and it should be allowed to stand for a few minutes to allow absorption and dispersion before administration. Cholestyramine powder should not be taken with a sip of water. Cholestyramine does not stain the teeth, so a straw is not needed. The dry powder form of cholestyramine should not be swallowed because this could cause the patient to aspirate.