Pharm: Chap 47 PrepU

A patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important?

Call his physician if he develops muscle pain

A nurse would caution a client receiving cholestyramine to avoid mixing the drug with which of the following?

Carbonated beverages

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

A male client's triglycerides are still elevated despite lifestyle changes. What does the nurse expect the physician to order for this client?

Fenofibrate

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 which of the following?

Increase in plasma concentration of lovastatin

A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that it does which of the following?

It decreases the absorption of cholesterol in the small intestine.

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

LFTs

After reviewing the various agents used to lower lipid levels, the students demonstrate understanding of the information when they identify which agents as stimulating the breakdown of lipoproteins from the tissues and their removal from the plasma? Select all that apply.

• Fenofibrate • Gemfibrozil

Which of the following would the nurse suggest to use when administering cholestyramine? Select all that apply.

• Fruit juices • Soups • Cereals • Water

Gemfibrozil (Lopid) lowers cholesterol via which of the following mechanisms? Select all that apply:

• Increases excretion of cholesterol. • Reduces production of triglycerides.

Which of the following might a client complain of during treatment with an atorvastatin (Lipitor)? Select all that apply:

• Insomnia • Headache • Constipation

During ongoing assessment of a client receiving an antihyperlipidemic drug, the nurse should collect the following? Select all that apply:

• Vital signs • Assessment of bowel function

A patient who is receiving cholestyramine also takes digoxin. The nurse teaches the patient about the drug and administration. The patient demonstrates understanding of the teaching when he states which of the following?

"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 patient?

"It's a good idea to keep your intake of saturated fat to a bare minimum."

A female patient 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 of the following would be an appropriate response by the nurse?

"This is an expected adverse effect of the drug. It should subside in time."

A patient with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a physician. The physician 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 the patient during the entire therapy?

3 capsules

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

The patient 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

Which of the following activities increases high-density lipoproteins?

All of these (Weight loss, regular aerobic exercise, and smoking cessation)

A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver

The clinic nurse has been assigned to a 43-year-old man who is obese and loves to eat. He has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which of the following dietary instructions would be a priority for the nurse to discuss with the patient?

Avoid drinking grapefruit juice and decrease intake of fatty acids

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units?

Bile acids

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for which of the following?

Bleeding

A nurse is caring for a patient who is receiving lovastatin. Which of the following assessments 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

What drug or drug class decreases the delivery of intestinal cholesterol to the liver?

Cholesterol absorption inhibitor

Which of the following would be classified as a bile acid sequestrant?

Cholestyramine

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

A patient is taking cholestyramine (Questran) to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which of the following medications?

Digoxin (Lanoxin)

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote which of the following?

Enhanced drug effectiveness

You are teaching your client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should you mention to the client?

Flushing of the skin

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

Frequently monitor blood cholesterol.

After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify which of the following as the storage location of bile acids?

Gallbladder

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which of the following is a fibrate?

Gemfibrozil

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 of the following drug classes would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors

The most common adverse effects of lovastatin include which of the following?

Headache and flatulence

Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition? (Choose one)

Heart Disease

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 does which of the following?

Inhibits the production of cholesterol

Which of the following lipid levels would the nurse interpret as being high?

LDL cholesterol of 180 mg/dL

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

LFT

The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any "bad side effects" that she should be aware of. Which of the following statements should underlie the nurse's response?

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

A patient is taking lovastatin (Mevacor). Which of the following is noted as the most common adverse effects?

Nausea, flatulence, and constipation

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

Niacin

A patient is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this patient?

The administration of ezetimibe (Zetia) is 2 hours before cholestyramine.

A patient who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by her primary care physician. What do these laboratory tests indicate in this patient?

The development of metabolic syndrome

Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. You explain the rationale for this regimen as:

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

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

True

Cholesterol is the base unit for the formation of steroid hormones.

True

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

True

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

at bedtime.

A patient has been prescribed lovastatin for a high cholesterol level. 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 because it

inhibits cholesterol syntheses.

Which of the following classes of medications are used to treat hyperlipidemia? (Select all that apply)

• HMG-CoA reductase inhibitors • Fibric acid derivatives • Bile acid resins

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

• Total cholesterol • Triglycerides • LDL

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

Which of the following are examples of modifiable risk factors for hyperlipidemia? (Select all that apply)

• Weight • Diet

A patient who has been taking lovastatin (Mevacor) 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 (Questran)

A patient is taking cholestyramine. The nurse will assess for which of the following common adverse effects of the drug?

Constipation

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the physician to do?

Decrease the dosage of his medication

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

Niacin

What is the most serious side effect of lovastatin?

Rhabdomyolysis

A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for which of the following?

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

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

As part of a routine physical examination, a 60-year-old patient's primary care provider has ordered blood work that includes cholesterol levels. What result would most strongly suggest the need for treatment with an antihyperlipidemic drug?

Elevated LDL levels

Which agent would the nurse identify as inhibiting triglyceride synthesis in the liver resulting in a reduction of LDL levels.

Fenofibrate

Which of the following medications is classified as a fibric acid derivative (fibrate)? (Choose one)

Gemfibrozil (Lopid)

The nurse instructs a client to take the prescribed pravastatin at bedtime based on the understanding about which of the following?

Greater drug effectiveness is achieved at this time.

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

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 of the following conditions were noted in the client's history?

Liver disease

A female client presents to the physician's office with complaints of a 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 tells the client that hyperlipidemia has many risk factors. The nurse knows that which of the following 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

An 8-year-old male client requires treatment for dyslipidemia. What would the nurse

Pravastatin

HMG-CoA reductase inhibitors (statins) are in which pregnancy category? (Choose one)

Pregnancy Category X

The client has been taking rosuvastatin for hyperlipidemia. She now presents with complaints of severe weakness. She states she can barely move her extremities because she is so weak. The nurse suspects the client has which of the following?

Rhabdomyolysis

The nurse is developing a plan of care for a patient who has been admitted to the hospital after a myocardial infarction. The patient 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

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

Smoking cessation

A patient has an elevated total serum cholesterol of 260. Which of the following aspects of patient teaching of lifestyle changes is most important for the patient?

Stop smoking

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

Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. You explain the rationale for this regimen as:

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

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

Which drug will be most effective in reducing the major types of dyslipidemia?

HMG-CoA reductase inhibitors

Statin drugs help lower cholesterol, LDL, and triglycerides by which of the following mechanisms? Select all that apply:

• Promoting the breakdown of cholesterol. • Inhibiting the manufacturing of cholesterol.

The nurse knows that part of the education plan for a patient 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

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

• Runny nose • Respiratory infections

A client is currently taking propranolol (Inderal) for migraines, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client which of the following would likely result? Select all that apply:

• The client would experience an increase in migraines due to decreased absorption of propranolol. • The client would experience hyperglycemia from decreased absorption of glipizide.

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

Blocking the enzyme that is involved in cholesterol synthesis

A nurse is caring for a patient prescribed nicotinic acid for hyperlipidemia. Which of the following are experienced by patients taking nicotinic acid?

Flushing of the skin

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 being prescribed fluvastatin. The nurse reviews the client's medical record to ensure that the client has attempted lifestyle changes for at least a minimum of which amount of time?

12 weeks

Which of the following might occur in a patient receiving colestipol?

Vitamin A deficiency

How should the nurse instruct the client to take his lovastatin?

With food

A male client presents to the physician's office for his annual visit. He takes statins to control his hyperlipidemia. When the physician reviews the client's laboratory results and notes that there is an unexplained elevation in the serum aspartate, what would the nurse expect the physician to do?

Discontinue the statin

The administration of cholestyramine (Questran) with warfarin (Coumadin) would most likely cause a client to present with which of the following? Select all that apply:

• Subtherapeutic INR • Calf pain and warmth