PN119 PrepU Chapter 34
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 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 patient?
"It's a good idea to keep your intake of saturated fat to a bare minimum."
A patient calls the clinic and talks to the nurse. The patient tells the nurse the patient has been taking colesevelem (Welchol) for six months and that the patient is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be?
"The bleeding may be coming from hemorrhoids. We should check this out."
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 would be an appropriate response by the nurse?
"This is an expected adverse effect of the drug. It should subside in time."
The client wants to know the difference between triglycerides and cholesterol. Which response by the nurse would be correct?
"Triglycerides and cholesterol are fatlike substances found in your blood."
The client with a new diagnosis of hyperlipidemia states that he is concerned because the physician believes he has vision changes. He tells the nurse the physician checked both of his eyes. What is the nurse's best response?
"Yellow deposits on the eyelids can indicate severe hyperlipidemia."
A patient is going home on cholestyramine (Questran). Patient teaching should state that this medication should be administered:
1 hour after other medications.
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 to the patient during the entire therapy?
3 capsules
It has been found that some populations/ethnicities have a higher incidence of hyperlipidemia than others. The nurse knows that which of the following client's would have the greatest chance of developing hyperlipidemia as determined by total cholesterol?
A white American 62 years of age with total cholesterol of 260 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
A client is taking cholestyramine (Questran) 4 grams by mouth once daily in the morning and is to begin taking glipizide (Glucotrol XL) 5mg once daily for diabetes. How should the nurse administer these medications? (Select all that apply)
Administer the glipizide in the evening Administer the glipizide 1 hour before the cholestyramine Administer the glipizide 4 hours after the cholestyramine
Which activity increases high-density lipoproteins?
All of these
You are teaching a client at your clinic about non-pharmacologic methods of controlling serum cholesterol levels. What lifestyle change may help increase high-density lipoprotein (HDL) levels?
All the above changes may help increase HDL levels.
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 patient?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
The client is admitted with hyperglycemia. The nurse evaluates the client for which of the following medications?
Atorvastatin
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 dietary instruction would be a priority for the nurse to discuss with the patient?
Avoid drinking grapefruit juice and decrease intake of fatty acids
When describing the action of atorvastatin, which would the nurse include?
Blocking the enzyme that is involved in cholesterol synthesis
A patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which aspect of patient teaching is most important?
Call the physician if you develop muscle pain
A nurse is caring for a female patient who breastfeeds her 3 month old infant. The patient tells the nurse that she has been taking garlic to reduce serum cholesterol levels. Which of the following is an adverse effect of garlic that the nurse should inform the patient of?
Can cause colic in infants
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 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)
The nurse is engaged in patient teaching with a male patient who has just been prescribed a bile acid sequestrant. The nurse teaches the patient that he may mix his lipid-lowering agent with a carbonated beverage. What bile acid sequestrant is the patient taking?
Colestipol (Colestid)
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 patient is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
Constipation
A patient asks the nurse what will the atorvastatin (Lipitor) prescribed for the patient will do. What is an expected outcome for this patient?
Decrease in serum cholesterol and LDL levels
Bile acid resins can decrease serum levels of several medications, primarily via this mechanism? (Choose one)
Decreased gastrointestinal absorption
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
What intervention may help the client increase HDL levels?
Exercise
Which agent would a nurse identify as a cholesterol absorption inhibitor?
Ezetimibe
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
Niacin is prescribed to a patient to increase HDL levels. What are the most common adverse effects of this therapy? (Select all that apply.)
Flushing of the face Nausea and stomach upset
A nurse is caring for a patient prescribed nicotinic acid for hyperlipidemia. What is experienced by patients taking nicotinic acid?
Flushing of the skin
The nurse is teaching a client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should the nurse mention to the client?
Flushing of the skin
Which of the following would the nurse suggest to use when administering cholestyramine? Select all that apply.
Fruit juices Soups Cereals Water
Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one)
Garlic
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
Which medication is classified as a fibric acid derivative (fibrate)?
Gemfibrozil (Lopid)
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
Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition?
Heart disease
A 54-year-old patient has a cholesterol level of 240 mg/dL. What serum concentration of cholesterol would this patient have?
High
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.
A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?
LFT
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
A client experiencing rhabdomyolysis may present with which of the following symptoms? (Select all that apply)
Malaise Fever Unexplained muscle pain
Which of the following adverse effects would a nurse expect to assess in a patient taking ezetimibe?
Mild abdominal pain
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". Which 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 are noted as the most common adverse effects?
Nausea, flatulence, and constipation
The client presents to the physician's office complaining of ringing in her ears. Upon review of the client's medication list, the nurse identifies that it may be caused by which of the following medications?
Niacin
When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?
Oral
HMG-CoA reductase inhibitors (statins) are in which pregnancy category?
Pregnancy Category X
A 9-year-old child has received an order for pravastatin (Pravachol) 40 mg/d PO for genetically linked hyperlipidemia. In preparation for patient teaching concerning this drug, the nurse's initial action will be to:
Question the doctor concerning the order.
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
What is the most serious side effect of lovastatin?
Rhabdomyolysis
A patient has an elevated total serum cholesterol of 260. Which aspect of patient teaching of lifestyle changes is most important for the patient?
Stop smoking
A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this client?
The administration of ezetimibe (Zetia) is four hours after cholestyramine.
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.
Which might occur in a patient receiving colestipol?
Vitamin A deficiency
What are examples of modifiable risk factors for hyperlipidemia? (Select all that apply.)
Weight Diet
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 patient's use of:
alcohol.
A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to
avoid prolonged exposure to sunlight.
A nurse is caring for a patient who has been prescribed lovastatin to control blood lipid levels. While teaching the patient about the medication, the nurse should caution the patient against consuming large amounts of:
grapefruit juice
The most common adverse effects of lovastatin include:
headache and flatulence.
The nurse is caring for a patient who has high levels of total cholesterol and triglycerides. When discussing management of dyslipidemia with the patient, the nurse will describe the desired blood lipid profile as
high HDL cholesterol, low LDL cholesterol, low total cholesterol, and low triglyceride.
The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels, as they are elevated. One method to lower cholesterol levels is to exercise, which:
increases HDL and decreases triglycerides.
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.
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.
The nurse is taking care of a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is:
low LDL values and high HDL values.
The most common adverse effects of lovastatin (Mevacor) include:
nausea, flatulence, and constipation.
The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness. The client states barely being able to move the extremities because of weakness. The nurse suspects the client has:
rhabdomyolysis.
The nurse is discharging a patient home on HMG-CoA inhibitor therapy. What statement by the patient 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."
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 nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly in this patient?
LFT
A nurse is caring for a patient who has been prescribed cholestyramine powder for pruritus treatment. What instructions should the nurse include in the teaching plan for the patient? Select all that apply.
Mix the drug in 2 to 6 fluid ounces of water Mix the drug with fluid soups or pulpy fruits Do not ingest the drug in the dry form
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 risk factors can be controlled or modified?
Obesity, inactivity, diet, and smoking
The nurse is developing a plan of care for a male 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