Chapter 47
The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum cholesterol levels. What lipid lowering medication would be appropriate for the nurse to administer to this patient? A) Colesevelam (Welchol) B) Pravastatin (Pravachol) C) Simvastatin (Zocor) D) Atorvastatin (Lipitor)
A
The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor as inhibiting what? A) An enzyme that controls the final step in production of cellular cholesterol B) An enzyme used immediately for energy C) An enzyme that combines with proteins to become chylomicrons D) An enzyme used to make bile acids
A
The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD). What condition does the nurse encourage the patient to control in order to reduce CAD risk? (Select all that apply.) A) Obesity B) Hypertension C) Bradycardia D) Depression E) High stress levels
A,B,E
The nurse is caring for a 35-year-old woman taking a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching this patient about her medications what priority teaching point will the nurse include in the teaching plan? A) Need for frequent ophthalmic examinations B) Information about a cholesterol-lowering diet C) Use of barrier contraceptives D) Calling her doctor with any respiratory symptoms
C
The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with diet cola twice per day. What is an appropriate nursing diagnosis for this patient? A) Acute pain related to central nervous system and GI effects B) Constipation related to GI effects C) Noncompliance related to how the drug is taken D) Deficient knowledge regarding drug therapy
D
A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what? A) Fatty streaks B) White blood cells (WBCs) C) Foam cells D) Platelets and fibrin
A
A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug would the nurse suspect is most likely to contribute to this adverse effect? A) Bile acid sequestrants B) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors C) Cholesterol absorption inhibitor D) Fibrates
A
The nurse conducts a review of research related to Beta-hydroxy-beta-methylglutaryl coenzyme A inhibitors and finds the only one associated with data to show a reduction in coronary artery disease and incidence of myocardial infarction is what drug? A) Pravastatin (Pravachol) B) Lovastatin (Mevacor) C) Atorvastatin (Lipitor) D) Fluvastatin (Lescol)
A
The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his diet to lose weight and control serum lipid levels without success. He is currently taking a combination of medications but his total cholesterol remains above 200. What future therapy might help this patient? A) Endocannabinoid blocker B) Bile acid sequestrant with niacin C) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and gemfibrozil D) Peroxisome proliferator receptor alpha activator
A
The nurse is providing medication teaching to a patient who will begin taking niacin with a bile acid sequestrant. How does the nurse instruct the patient to take these two medications? A) "Both medications should be taken 4 to 6 hours apart." B) "Both medications should be taken in the morning." C) "One medication should be taken in the morning but the other is taken at bedtime." D) "Both medications can be taken at once just before going to bed."
A
The nurse is taking a health history on a 38-year-old man who is taking atorvastatin (Lipitor) for high cholesterol. What will the nurse question specifically related to the safe use of this drug? A) Alcohol B) Nicotine C) Caffeine D) Herbal therapy
A
The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and explains that exercise has what effect? A) Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL) B) Increases LDL and decreases triglycerides C) Decreases HDL and increases LDL D) Decreases both HDL and LDL
A
What are the most common adverse effects of lovastatin (Mevacor)? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Confusion and mental disorientation D) Hiccups, sinus congestion, and dizziness
A
When providing patient teaching to a patient beginning therapy with a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? (Select all that apply.) A) Renal function tests B) Liver function tests C) Lipid panel D) Hemoccult of stool E) Albumin level
A,B,C
The patient receives a prescription for a lipid lowering medication from the health care provider and, before discharge, asks the nurse what else he or she can do to improve his or her lipid levels besides just taking medication. What recommendation will the nurse make? (Select all that apply.) A) Quitting smoking B) Exercising C) Following a low sodium diet D) Reducing stress E) Avoiding alcohol
A,B,D
The nurse provides patient teaching related to medication and lifestyle changes the patient can make to reduce serum lipid levels. One month later, the nurse evaluates the patient teaching as having been effective based on what data? (Select all that apply.) A) Total cholesterol 184 B) High density lipoprotein (HDL) cholesterol 84 C) Low density lipoprotein (LDL) cholesterol 164 D) Triglycerides 184 E) Weight loss of 8 pounds
A,B,E
A patient is being discharged on cholestyramine (Questran). Patient teaching should include what about this medication? A) Should be administered with other medications B) Should be administered 1 hour before or 4 to 6 hours after other medications C) Should be administered 1 hour after other medications D) Should be administered on an empty stomach
B
The nurse is preparing a patient for discharge who will receive a prescription for an beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that they have a clear understanding of the teaching provided by the nurse? A) "I will not need to follow that low-fat diet anymore because this drug will take care of my lipids." B) "I should plan to take this drug before bedtime, because my body makes lipids mostly at night." C) "After I start taking this drug, I will not have to worry about the exercise routine the doctor prescribed." D) "I should take this drug first thing in the morning and make sure I drink a full glass of water."
B
The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What expected outcome will the nurse describe? A) Decrease in serum cholesterol only B) Decrease in serum cholesterol and low density lipoprotein (LDL) levels C) Decrease in sitosterol and serum cholesterol D) Decrease in campesterol and LDL levels
B
The patient receives a prescription for niacin and the nurse is teaching his or her about the medication. The nurse instructs the patient to call the provider if what common adverse effect of niacin occurs? A) Hypotension B) Abdominal pain C) Vomiting D) Diarrhea
B
When planning patient care the nurse recognizes what patient is at greatest risk of developing coronary artery disease? A) A 32-year-old Asian American with total cholesterol of 120 mg/dL B) A 62-year-old white American with total cholesterol of 260 mg/dL C) A 48-year-old African American with total cholesterol of 198 mg/dL D) A 26-year-old Native American with total cholesterol of 150 mg/dL
B
A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse categorize this serum concentration of cholesterol? A) Optimal B) Desirable C) High D) Very high
C
A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for genetically linked hyperlipidemia. In preparation for patient teaching concerning this drug, what initial action will the nurse take? A) Ask the parents to be present for the teaching session. B) Determine the appropriate time to discuss the drug with the patient. C) Question the doctor concerning the ordered dosage. D) Review the child's normal daily dietary intake of fatty foods.
C
A patient taking atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury. The nurse will ask questions to determine if this patient has been taking what contraindicated substance? A) Over-the-counter (OTC) medications B) Ginseng C) Grapefruit juice D) Saw palmetto
C
The nurse cares for a 10-year-old child brought to the clinic for an annual checkup who is diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children? A) Gender B) Diet C) Familial connection D) Exercise
C
The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for what common adverse effects? A) Bloating and flank pain B) Neuropathy and flatulence C) Mild abdominal pain and diarrhea D) Constipation and flank pain
C
The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse describing? A) Cholestyramine (Questran) B) Colesevelam (Welchol) C) Colestipol (Colestid) D) Ezetimibe (Zetia)
C
The nurse is preparing to teach the patient about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important teaching point will the nurse include in the teaching plan? A) Increasing carbohydrate intake B) Reducing protein intake C) Increasing fiber intake D) Reducing fluid intake
C
The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include? A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity
C
Which drug is most effective in reducing serum triglyceride levels? A) Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors B) Bile acid sequestrants C) Fibrates D) Niacin
C
The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly on this patient? A) Blood urea nitrogen (BUN) B) Complete blood count (CBC) C) Activated partial thromboplastin time D) Liver function studies
D
The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse explains that the desired goal for cholesterol levels is what? A) High high density lipoprotein (HDL) values and high triglyceride values B) Low soluble fiber C) Elevated blood lipids, fasting glucose less than 100 D) Low low density lipoprotein (LDL) values and high HDL values
D
The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurse's best response? A) "Micelles are absorbed into the intestinal wall and combined with proteins to become chylomicrons." B) "The drug makes the liver use cholesterol to produce more bile acids." C) "The drug works in the brush border of the small intestine to prevent the absorption of dietary cholesterol." D) "The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels."
D
The patient is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the nursing history the patient reveals he was taking Pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient complains of muscle pain. What does the nurse suspect caused this patient's renal failure? A) Gastric ulceration B) Rhabdomyolysis C) Congestive heart failure D) Drug Toxicity
D
The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL) concentrations. What is the correct answer? A) Fenofibrate (Tricor) B) Niacin (Niaspan) C) Atorvastatin (Lipitor) D) Gemfibrozil (Lopid)
D