Pharm Ch.47 PrepU
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."
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 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 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."
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.
*Eating a high-fiber diet *Walking for 30 minutes several times a week *Avoiding tobacco products *Adhering to a low-fat diet *Maintaining a healthy weight
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 information would be included in a lipoprotein profile? Select all that apply:
*Total *cholesterol *Triglycerides *LDL
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
Bleeding
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 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 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
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
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
In addition to being synthesized in the liver and intestine, from where are blood lipids derived?
Diet
As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?
Elevated LDL levels
The nurse is caring for an obese client with hyperlipidemia, where diet modification has not helped the client to lose weight or control serum lipid levels. The client is currently taking a combination of medications, which has not helped to reduce the total cholesterol. What future therapy will most likely benefit this client?
Endocannabinoid blocker
The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:
Enhanced drug effectiveness
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor 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
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 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
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
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
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X
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 is developing a plan of care for a male client who has been admitted to the hospital after a myocardial infarction. The client begins lovastatin to lower his LDL levels and increase his HDL levels. Based on the adverse reaction of this medication, what would be the most appropriate nursing diagnosis?
Risk for injury to skeletal muscles related to adverse effects of drug therapy
Which single class drug is known to be most effective in reducing the major types of dyslipidemia?
Statins
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.
A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important for the nurse to teach this client?
The administration of ezetimibe (Zetia) is four hours after cholestyramine.
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.
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 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.
A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:
carbonated beverages.
Which category of blood lipids is involved in the formation of atherosclerotic plaques?
cholesterol
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 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.
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.
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
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
During ongoing assessment of a client receiving an antihyperlipidemic drug, what should the nurse collect? (Select all that apply.)
*Vital signs *Assessment of bowel function
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
A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?
Digoxin
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
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
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 are expensive. *Statins require regularly scheduled blood work.
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the modifiable factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
*Weight *Diet