Pharm Chapter 22
The patient is taking a statin drug. Which assessment data would be a priority for the nurse to report immediately to the physician? 1. My calves hurt, and I had a hard time walking to the bathroom. 2. I know I just started this medicine yesterday, but my stomach really is upset. 3. Will you call my doctor? I have a really bad headache. 4. My heart rate really went up this morning.
Correct Answer: 1 Rationale 1: The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. The statin drugs do not affect heart rate. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. Headache is considered a minor side effect and is easily remedied by analgesic medications.
The patient tells the nurse that his doctor wants him to take a medication for his high cholesterol, but he doesnt know which one would be best. What is (are) the best response(s) by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The best drugs to raise your high density lipoprotein (HDL) levels are the fibric acid drugs. 2. The statin drugs are good, but will cause a lot of flushing if you swallow them with warm fluids. 3. The bile resins keep cholesterol from being absorbed, but have some side effects. 4. The statin drugs inhibit the making of cholesterol and are considered the best choice. 5. Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high.
Correct Answer: 3,4,5 Rationale 1: Fibric acid agents are effective, but will not reduce low density lipoprotein (LDL) levels. Statin drugs inhibit HMG-CoA reductase which is necessary for the biosynthesis of cholesterol and are the drugs of first choice in reducing serum lipid levels. Bile resins are effective, but numerous side effects limit their usefulness. Niacin, not statins, will cause flushing, which is worse with warm fluids. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs.
Which statement correctly identifies why simply restricting dietary intake of cholesterol generally will not result in a significant reduction of blood cholesterol? 1. Most people are not compliant with the dietary restriction. 2. Cholesterol is found in nearly all foods, and it is not possible to eliminate it from the diet. 3. Cholesterol is made within the body, and cannot be absorbed via external sources. 4. The liver reacts to a low-cholesterol diet by making more cholesterol.
Correct Answer: 4 Rationale 1: Patients wishing to lower their blood cholesterol levels should restrict their intake of cholesterol and saturated fats. The liver will react to a low-cholesterol diet by making more cholesterol when saturated fats are present.
Which of the following patients would be at the greatest risk of developing heart disease? 1. Total 200, LDL 140, HDL 30 2. Total 220, LDL 135, HDL 68 3. Total 198, LDL 162, HDL 20 4. Total 186, LDL 125, HDL 54
Correct Answer: 3 Rationale 1: A patient with these cholesterol levels would be at the greatest risk of developing heart disease.
The nurse is providing group education about lipids to patients who have been diagnosed with hyperlipidemia. What does the best instruction include? 1. High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver. 2. High density lipoprotein (HDL) is called good cholesterol because it increases the oxygen content in the arteries and reduces the amount of plaque build-up. 3. High density lipoprotein (HDL) decreases the bad cholesterol (low density lipoprotein [LDL]), and promotes excretion of it through the kidneys. 4. High density lipoprotein (HDL) decreases low density lipoprotein (LDL) and prevents it from converting to very low density lipoprotein (VDRL), which is the worst kind of cholesterol in the body.
Correct Answer: 1 Rationale 1: High density lipoprotein (HDL) assists in the transport of cholesterol away from body tissues and back to the liver in a process called reverse cholesterol transport. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. High density lipoprotein (HDL) does not increase oxygen content in the arteries. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL).
The patient says to the nurse, My doctor says I have heart disease and I need to decrease cholesterol in my diet. How did this happen? What is the best response by the nurse? 1. The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them. 2. Low density lipoprotein (LDL) cholesterol is converted to saturated fat, which is stored in your coronary arteries. 3. It is a good idea to decrease low density lipoprotein (LDL) cholesterol in your diet, although current research has not proven a correlation yet. 4. Too much low density lipoprotein (LDL) cholesterol narrows all the arteries in your body so your heart does not receive enough blood to be healthy.
Correct Answer: 1 Rationale 1: Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. Coronary artery disease is caused by plaque build-up in the coronary arteries, not the peripheral arteries. For several years, research has demonstrated a correlation between high low density lipoprotein (LDL) levels and coronary artery disease.
Which lipid type is associated with the highest risk of atherosclerosis development? 1. Phospholipids 2. Lecithins 3. Steroids 4. Triglycerides
Correct Answer: 3 Rationale 1: Cholesterol is a steroid, and is known for its role in promoting atherosclerosis. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.
The patient has serum cholesterol levels of the following: Low density lipoprotein (LDL) = 105mg/dl High density lipoprotein (HDL) = 37mg/dl Low density lipoprotein (LDL)/high density lipoprotein (HDL) ratio = 4.1 In planning care with this patient, what is the best outcome? 1. The patient will maintain normal lipid levels without the use of medications. 2. The nurse will educate the patient about diet and exercise. 3. The nurse will validate that the patient understands the importance of lifestyle changes. 4. The patient will achieve normal lipid levels through compliance with medications.
Correct Answer: 1 Rationale 1: The patient has borderline laboratory levels; patients with borderline laboratory values can control their dyslipidemia entirely through nonpharmacological means. To the extent possible, maintaining normal lipid values without pharmacotherapy should be a therapeutic goal as all medications have side effects. The nurse educating the patient about diet and exercise is a nursing intervention, not a patient outcome. The best outcome with borderline serum lipids is to maintain normal levels without the use of medications. The nurse validating that the patient understands the importance of lifestyle changes is a nursing intervention, not a patient outcome.
A nursing student is preparing a presentation on the different types of lipids. The student will include which classification of lipids in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Triglycerides 2. Phospholipids 3. Steroids 4. Lecithins 5. Bile acids
Correct Answer: 1,2,3 Rationale 1: Triglycerides are the most common classifications of lipids. Rationale 2: Phospholipids are a class of lipids essential to building plasma membranes. Rationale 3: Steroids are a diverse classification of lipids. Rationale 4: Lecithins are not a classification of lipids. Lecithin is the best known phospholipid. Rationale 5: Bile acids are not a classification of lipids. Cholesterol is a building block of bile acids.
A student is discussing lipid transport through the blood with a nursing instructor. The student asks the educator which apoproteins are important to lipid transport. Which responses by the educator are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A-I 2. A-II 3. A-III 4. A-IV 5. B-100
Correct Answer: 1,2,4,5 Rationale 1: A-I is an apoprotein important to lipid transport.
The nurse is teaching a patient regarding therapeutic lifestyle changes that can be implemented to control cholesterol levels in the blood. The nurse knows the patient has understood the teaching when the patient states, Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I will maintain an optimal weight. 2. I will implement a medically supervised exercise plan. 3. I will increase saturated fat in my diet. 4. I will increase insoluble fiber in my diet. 5. I will eliminate tobacco use.
Correct Answer: 1,2,5 Rationale 1: Maintaining an optimal weight is a nonpharmcological therapeutic lifestyle change that can control cholesterol levels in the blood. Rationale 2: A medically supervised exercise plan is a nonpharmacological therapeutic lifestyle change that can control cholesterol levels in the blood. Rationale 3: This statement indicates that the patient requires further education, as the patient should decrease dietary saturated fats and cholesterol in the diet. Rationale 4: It is recommended to increase soluble fiber, not insoluble fiber, in the diet. The examples included are soluble fiber. Rationale 5: Eliminating tobacco use is a nonpharmacological therapeutic lifestyle change that can decrease cholesterol levels in the blood.
A seasoned nurse is reviewing the different classifications of medications that are used to decrease blood cholesterol levels with a new nurse on a medical-surgical unit. The seasoned nurse knows the new nurse has comprehended the information when she cites these medications as fibric acid agents. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Atromid-S 2. Zetia 3. Lopid 4. Colestid 5. Zocor
Correct Answer: 1,3 Rationale 1: Atromid-S is a fibric acid agent used to decrease blood cholesterol levels. Rationale 2: Zetia is an unclassified agent used to decrease blood cholesterol levels. Rationale 3: Lopid is a fibric acid agent used to decrease blood cholesterol levels. Rationale 4: Colestid is a Bile Acid Sequestrant used to decrease blood cholesterol levels. Rationale 5: Zocor is an HMG-CoA Reductase medication used to decrease blood cholesterol levels.
The patient is receiving cholestryamine (Questran). When assessing for side effects, what will be the primary focus of the nurse? 1. Auscultation of heart sounds 2. Auscultation of bowel sounds in all four abdominal quadrants 3. Assessment of 24-hour urine output 4. Palpation for peripheral edema in the lower extremities
Correct Answer: 2 Rationale 1: Assessment of bowel sounds is a priority because cholestryamine (Questran) could cause obstruction of the intestines. Cholestryamine (Questran) does not affect cardiac status. Cholestryamine (Questran) does not cause peripheral edema. Cholestryamine (Questran) does not cause rhabdomyolysis, so the nurse would not assess for 24-hour urine output.
The patient is receiving gemfibrozil (Lopid). The nurse has completed discharge instructions about this medication. The nurse recognizes that teaching has been effective when the patient makes which statement? 1. I should take this medication on an empty stomach to help it absorb better. 2. I must take this medication with food or I can have heartburn. 3. My doctor said it really doesnt matter how I take this medication. 4. Taking this medication with yogurt will help it to absorb better.
Correct Answer: 2 Rationale 1: Gemfibrozil (Lopid) should be administered with food to decrease gastrointestinal (GI) distress. Taking gemfibrozil (Lopid) on an empty stomach can cause gastrointestinal (GI) distress; food will decrease the gastrointestinal (GI) distress. Gemfibrozil (Lopid) should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil (Lopid). It is highly unlikely the physician would say that it doesnt matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal (GI) distress.
Which statement is accurate regarding the use of nicotinic acid (Niacin) for lowering blood cholesterol levels? 1. It works primarily by lowering LDL and HDL levels. 2. Due to adverse effects, niacin should not be used with statins. 3. Hot flashes are a common side effect when niacin is used in high doses. 4. High doses of 2530 mg per day are often necessary.
Correct Answer: 3 Rationale 1: Niacin is used as a vitamin supplement in doses of 25 mg/day. The usual dose of 23 grams/day for lowering blood cholesterol levels often results in hot flashes. Niacin lowers LDL levels and increases HDL levels. It is often used with other drugs like the statins.
Which type of lipoprotein is often referred to as the good type, and why? 1. Triglycerides are good because they are used for energy. 2. HDL is good, because it carries cholesterol away from tissues and to the liver for metabolism and excretion. 3. LDL is good because it contains the most cholesterol that will be excreted in the feces. 4. VLDL is good because it contains the lowest amount of cholesterol.
Correct Answer: 2 Rationale 1: HDL is considered good because it carries cholesterol away from tissues and to the liver for metabolism and excretion. High levels of HDL are useful for lowering the risk of heart disease. Triglycerides are not lipoproteins; they make up lipoproteins. LDL does contain the most cholesterol, but it does not carry it to the liver for excretion. Through several steps, VLDL is converted to LDL.
The patient tells the nurse, My doctor says I have high levels of fat in my blood. Is that like big pieces of fat floating around? What is the best response by the nurse? 1. No, fats in your blood are carried inside small molecules called phospholipids. 2. No, actually fats travel in the blood on little proteins called lipoproteins. 3. No, that is not a good description of fat transport; ask your doctor again. 4. No, the fats are encapsulated inside little bags known as lecithins.
Correct Answer: 2 Rationale 1: Lipids are carried through the blood as lipoproteins. Phospholipids are a class of lipids that is essential to building plasma membranes. Lecithins are phospholipids found in egg yolks and soybeans. The nurse can answer this question; it does not need to be referred to the physician.
The patient is receiving cholestryamine (Questran), and complains of constipation. The physician orders bisacodyl (Ducolax) tablets. When is the best time for the nurse to administer the bisacodyl (Ducolax) tablets? 1. The drugs can be administered together. 2. Four hours after administration of cholestryamine (Questran) 3. Bisacodyl (Ducolax) can be given any time, but must be taken with food. 4. One hour after administration of cholestryamine (Questran)
Correct Answer: 2 Rationale 1: Other drugs must be administered more than 2 hours before, or 4 hours after, the patient takes cholestryamine (Questran) because it can bind to other drugs and interfere with their absorption. These drugs cannot be administered together because cholestryamine (Questran) can bind to other drugs and interfere with their absorption. A minimum of 4 hours administration time between drugs is needed to be sure cholestryamine (Questran) does not interfere with absorption of other drugs. Bisacodyl (Ducolax) cannot be administered with cholestryamine (Questran) as it will not be absorbed; Bisacodyl (Ducolax) does not need to be given with food.
The patient is receiving niacin. Although this drug is effective in lowering lipid levels, the patient complains of uncomfortable flushing. What is the best education by the nurse? 1. Be sure to take your niacin on an empty stomach as soon as you arise. 2. Take one aspirin 30 minutes before you take your niacin. 3. Take your niacin tablet with food and at least one full glass of water. 4. It may be time to ask your doctor about switching to another drug.
Correct Answer: 2 Rationale 1: Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients because aspirin decreases the prostaglandin release that may cause a flushing effect. Taking niacin with food and water will not have any effect on flushing. Taking niacin on an empty stomach early in the morning will not have any effect on flushing. Switching to another drug is premature, because the niacin is effective.
Which statement provides the best rationale for monitoring HDL and LDL as opposed to total cholesterol? 1. HDL and LDL monitoring is much cheaper than measuring total cholesterol. 2. Total cholesterol measurements include cholesterol that will be destroyed as well as transported to tissues and stored. 3. HDL and LDL measurements are more general, and frequently are used in patients not at risk for heart disease. 4. Total cholesterol measurements are often inaccurate and not as reliable as HDL and LDL.
Correct Answer: 2 Rationale 1: Total cholesterol tests include the good and bad cholesterol, the good being the type that is destroyed and excreted while the bad is the type stored inside blood vessels. Total, LDL, and HDL tests are as accurate as the equipment and technicians that complete them. HDL and LDL are more specific tests, not more general. Gaining more specific information, not associated costs, is the primary reason for monitoring the HDL and LDL.
Which type of lipid serves as fuel for the body when energy is needed? 1. Phospholipids 2. Triglycerides 3. Steroids 4. Lecithins
Correct Answer: 2 Rationale 1: Triglycerides account for 90% of the lipids in the body, and serve as an important energy source. There are three types of lipids important for humans: triglycerides, phospholipids, and steroids. Lecithins are a phospholipid.
The patient tells the nurse she is confused about what she has been reading about lipids. What is (are) the best response(s) by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Phospholipids will help prevent Alzheimers disease. 2. Phospholipids are essential to building plasma membranes. 3. Cholesterol is a building block for estrogen and testosterone. 4. Triglycerides are the major form of fat in the body. 5. Cholesterol in the diet is unnecessary as the liver synthesizes it.
Correct Answer: 2,3,4,5 Rationale 1: Triglycerides are the major form of fat in the body, phospholipids are essential to building plasma membranes, cholesterol is a building block for estrogen and testosterone, and cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. There is no evidence to support that phospholipids will prevent Alzheimers disease.
The nurse has completed nutritional teaching with the patient who has a high low density lipoprotein (LDL) level. The nurse recognizes that teaching has been effective when the patient makes which menu choice? 1. Beef tenderloin with gravy and noodles, fruit salad with apples and grapefruit, slice of rye bread, and apple pie 2. Grilled chicken salad with strawberries and pecans, baked macaroni and cheese, and low-fat brownie 3. Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, and low-fat chocolate pudding 4. Low-fat hamburger with whole-wheat bun, tossed salad with walnuts and olive oil, and raisin-oatmeal cookie
Correct Answer: 3 Rationale 1: A lipid-reducing diet should include soluble fiber, plant sterols, and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. The menu that includes low-fat hamburger has some healthy choices, but the low-fat hamburger is too high in fat, as is a raisin-oatmeal cookie. The menu that includes the grilled chicken salad has no healthy choices except for the pecans; the baked macaroni and cheese would be high in fat.
The patient is receiving a statin drug. Which assessment data would be a priority for the nurse to report to the physician? 1. Bowel sounds markedly increased in all four quadrants of the abdomen 2. Urine output of 200 mL/hour 3. Urine output of 20 mL/hour 4. Moderate elevation in liver function tests (LFTs)
Correct Answer: 3 Rationale 1: Rhabdomyolysis is a rare, but serious side effect of statin drugs. Contents of muscle cells spill into the systemic circulation causing potentially fatal, acute renal failure. Urine output of less than 30 mL/hour is considered renal failure. A urine output of 200 mL/hour does not indicate renal failure, which occurs with rhabdomyolysis. Elevation of liver function tests (LFTs) may occur during statin therapy, but this is not as high a priority as acute renal failure. Increased bowel sounds will be heard with diarrhea, but diarrhea is a common side effect of statin therapy and is not considered a serious side effect initially.
The patient is receiving a statin drug. The nurse notes an increase in creatine phosphokinase (CPK) levels. What is the nurses priority action? 1. Hold the drug and obtain another creatine phosphokinase (CPK) level in 6 hours. 2. Administer the drug and continue to assess for muscle pain. 3. Administer the drug and obtain another creatine phosphokinase (CPK) level in 6 hours. 4. Hold the drug and notify the physician.
Correct Answer: 4 Rationale 1: Elevated creatine phosphokinase (CPK) levels could indicate myopathy; if this is suspected, hold the drug and notify the physician. The physician must be notified when myopathy is suspected, so the nurse would not hold the drug and obtain another creatine phosphokinase (CPK) level. If myopathy is suspected, the drug must be held, not administered, and the physician notified. The nurse should not administer the drug, the physician must be notified.
Atorvastatin (Lipitor) is a statin that can be used to lower blood cholesterol levels by 1. binding exogenous cholesterol and excreting it in the feces. 2. increasing excretion by activating enzymes within the hepatic system. 3. preventing dietary absorption within the GI tract. 4. inhibiting an enzyme that is essential for cholesterol synthesis.
Correct Answer: 4 Rationale 1: Statins work by inhibiting the enzyme HMG-CoA reductase. HMG-CoA reductase is essential for cholesterol biosynthesis. Bile acid resins bind cholesterol and promote its excretion in the feces.
The nurse is reviewing the adverse effects associated with statins with a patient who has recently been started on this classification of medication to reduce blood cholesterol levels. The nurse knows the patient has understood the teaching when the patient states that serious adverse effects associated with statins include Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. headache. 2. abdominal pain. 3. myopathy. 4. muscle or joint pain. 5. rhabdomyolysis.
orrect Answer: 3,5 Rationale 1: A headache is an example of a minor adverse effect associated with statins. Rationale 2: Abdominal pain is an example of a minor adverse effect associated with statins. Rationale 3: Severe myopathy is a rare but serious adverse effect associated with statins. Rationale 4: Muscle or joint pain is an example of a minor adverse effect associated with statins. Rationale 5: Rhabdomyolysis is an example of a rare but serious adverse effect associated with statins.
