NUR 3420 Pharmacology PrepU Chapter 10

A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.

- Diet - Weight - physical inactivity - (Non modifiable risk factors include : age, gender, and family history)

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

True

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

brownish colored urine Explanation: Prolonged use of lovastatin may damage skeletal muscle; the increased bilirubin from the dead cells changes the color of the urine from amber to brown. Tanned and reddish color skin indicates photosensitivities caused by the drug and are general adverse effects.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet

he nurse is preparing to teach the client about bile sequestrant medication to lower lipid levels, and diet therapy. What important instruction will the nurse include in the teaching plan?

increasing fiber intake Explanation: The nurse would want to teach this client to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the client should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

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 condition was noted in the client's history?

liver disease Explanation: Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy

The nurse is discharging a client home on HMG-CoA inhibitor therapy. What statement by the client demonstrates that they have a clear understanding of the teaching?

"I should take this drug at bedtime, since my body makes lipids mostly at night."

What should the nurse teach an older adult client about the potential adverse effects of atorvastatin?

"The most common side effects of atorvastatin involve some mild gastrointestinal upset."

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

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet

Dyslipidemia is associated with atherosclerosis, myocardial ischemia, and stroke. It can have many causes, including:

Dyslipidemia may be primary (eg, genetic or familial) or secondary to dietary habits, other diseases (eg, diabetes mellitus, alcoholism, hypothyroidism, obesity, obstructive liver disease), or medications (eg, beta-blockers, cyclosporine, oral estrogens, glucocorticoids).

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

bile acids

Which would be classified as a bile acid sequestrant?

cholestyramine

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

discontinue the statin

A 10-year-old is brought into the clinic for an annual check-up and is diagnosed with hypercholesterolemia. What type of hypercholesterolemia is most often seen in children?

familial

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:

"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 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." Explanation: Statins like atorvastatin are potentially teratogenic (pregnancy category X). In a very few cases, potential benefits warrant use of these drugs in pregnant women, but this is exceptional. It is also contraindicated during breastfeeding. None of the other statements describe accurate educational information about atorvastatin and conception.

A female client 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 would be an appropriate response by the nurse?

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

A client with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a health care provider. The provider 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 to the client during the entire therapy?

3 capsules

What is HMG-CoA reductase?

An enzyme that controls the final step in production of cellular cholesterol

he 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

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

Which lipid level would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL Explanation: LDL level of 190 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.

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

LFTs Explanation: Niacin may cause hepatotoxicity, especially with doses greater than 2 g daily, with timed-release preparations, and if given in combination with a statin or a fibrate.

The nurse is providing education to the client who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The client has asked the nurse if there are any "bad side effects". Which statements should underlie the nurse's response?

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

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."

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

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

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

at bedtime

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 presents to the health care provider's office with symptoms of hyperglycemia. He is taking his oral antidiabetic medication and has not modified his diet or exercise program in any way. When the nurse interviews the client, he states that he now takes flax seed to reduce his cholesterol level. What may occur as a result of taking flax seed?

decreased absorption of the drugs Explanation: Flax or flax seed is used internally as a laxative and a dyslipidemic agent. Absorption of all medications may be decreased when taken with flax, resulting in a less than therapeutic effect.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?

headache and flatulence

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 Explanation: ncreased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.

What factor determines the "preferred" density of the cholesterol?

higher amount of protein

A student asks the nursing instructor what the most common adverse effects of ezetimibe (Zetia) are. What would be the instructor's best response?

mild abdominal ain and diarrhea Explanation: The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea. Bloating and flatulence are associated with bile acid sequestrants and the fibrates. Constipation is usually not associated with lipid-lowering agents. Neuropathy and flank pain are usually not associated with lipid-lowering agents and were provided as a distraction

A client with hyperlipidemia has been taking atorvastatin for several months. The therapeutic effect of the medication can be best determined by:

reviewing the client's laboratory blood work results.

A patient presents at the clinic after one week of taking pravastatin (Pravacol) with reports of "just not feeling well." The nurse asks what liquid the patient has been taking their medication with, and the patient reports drinking a lot of grapefruit juice. The nurse should know that grapefruit juice increases the risk of which adverse effect?

toxicity

What intervention may help the client increase HDL levels?

Exercise

A patient has been prescribed atorvastatin (Lipitor) comes to the clinic with acute muscle pain not associated with exercise or injury, which indicates potential rhabdomyolysis. The nurse knows that the use of atorvastatin with which products places the patient at risk for rhabdomyolysis?

Grapefruit juice consumption Explanation: Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic effects, including rhabdomyolysis. Patients on this drug should be cautioned to avoid grapefruit juice. OTC drugs, ginseng, and saw palmetto are not associated with increased toxicity.

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 taking a health history on a 38-year-old male who is taking atorvastatin (Lipitor) for high cholesterol. The nurse will be sure to ask a specific group of questions regarding the client's use of:

alcohol Explanation: HMG-CoA reductase inhibitors are contraindicated with liver disease or a history of alcoholic liver disease. Nicotine, caffeine, or herbal therapies are usually not identified as producing any drug-to-drug interactions with atorvastatin.

The nurse is doing teaching about cholesterol and its role in cardiovascular disease. In addition to promoting cessation of cigarette smoking and a healthy lifestyle with diet and exercise to correct cholesterol abnormalities, the nurse explains that there are two modifiable conditions that have been cited as major risk factors for CAD and its complications. What are these two conditions?

cholesterol abnormalities and hypertension Explanation: Four modifiable risk factors include cholesterol abnormalities, cigarette smoking, diabetes, and hypertension and have been cited as major risk factors for CAD and its complications.

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?

high

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

When providing teaching to a client beginning therapy with a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of which laboratory studies? Select all that apply.

- renal function tests - liver function tests - lipid panel Explanation: It is important to monitor renal and liver function to identify early signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG-CoA reductase inhibitors.

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

frequently monitor blood cholesterol Explanation: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.

A client asks the nurse about herbal products that can help to lower serum cholesterol and triglycerides. Which herbal product would the nurse include in the response?

garlic Explanation: Research has shown that garlic is helpful in lowering serum cholesterol and triglyceride levels. Ginseng is used to enhance memory. Feverfew is used in the herbal treatment of migraine headaches. Black cohosh is beneficial in the menopause and hot flashes.

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 Explanation: emfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.

The nurse is providing care for a client who has been prescribed cholestyramine for the treatment of hyperlipidemia. During the client's latest clinic visit, the client states, "It seems like I bruise from the lightest little bumps or scrapes. What is the nurse's best action?

inform the care provider so laboratory testing can be performed

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

smoking cessation Explanation: Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.