Adams 6e tif ch23 - test bank PDF

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

Pharmacology for Nurses, 6e (Adams) Chapter 23 Drugs for Lipid Disorders 1) The client states to the nurse, "My healthcare provider says I have heart disease and I need to decrease the cholesterol in my diet. I don't understand how this happened." Which response should the nurse provide the client? 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." Answer: 1 Explanation: 1. Storage of cholesterol in the lining of coronary blood vessels contributes to plaque buildup and atherosclerosis; this contributes significantly to coronary artery disease. 2. Low density lipoprotein (LDL) cholesterol is not converted to saturated fat and stored in the coronary arteries. 3. For several years, research has demonstrated a correlation between high levels of low density lipoprotein (LDL) and coronary artery disease. NURSINGTB.COM 4. Coronary artery disease is caused by plaque buildup in the coronary arteries, not the peripheral arteries. Page Ref: 307-308 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-1 Summarize the link between high blood cholesterol, low density lipoprotein levels, and cardiovascular disease. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

2) The nurse is providing education about lipids for a client with hyperlipidemia. Which information should the nurse include in the education? 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 buildup. 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. Answer: 1 Explanation: 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. 2. High density lipoprotein (HDL) does not increase oxygen content in the arteries. 3. High density lipoprotein (HDL) does not reduce low density lipoprotein (LDL), which is excreted in the feces, not the kidneys. 4. Very low density lipoprotein (VDRL) reduces to become low density lipoprotein (LDL). Page Ref: 307 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation NURSINGTB.COM Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-2 Compare and contrast the different types of lipids. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

3) Which information about the dietary intake of lipids should the nurse provide a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Phospholipids will help prevent Alzheimer's 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." Answer: 2, 3, 4, 5 Explanation: 1. There is no evidence to support that phospholipids will prevent Alzheimer's 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 is not needed in the diet as the liver synthesizes adequate amounts from other chemicals. Page Ref: 307-308 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge NURSINGTB.COM from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-4 Compare and contrast the different types of lipoproteins. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

4) The nurse reviewing a client's serum cholesterol levels notes the following: Low density lipoprotein (LDL) = 105 mg/dl High density lipoprotein (HDL) = 37 mg/dl Low density lipoprotein (LDL)/high density lipoprotein (HDL) ratio = 4.1 Which should the nurse identify as the priority outcome in the client's plan of care? 1. Maintenance of normal lipid levels without the use of pharmacotherapy 2. Education about diet and exercise 3. Validate that the client understands the importance of lifestyle changes 4. The client's achievement of normal lipid levels through compliance with medications Answer: 1 Explanation: 1. The client has borderline laboratory levels; clients with borderline laboratory values can control their dyslipidemia through nonpharmacological interventions. Maintenance of normal lipid values without pharmacotherapy should be a therapeutic goal. 2. Educating the patient about diet and exercise is a nursing intervention not an outcome. 3. Validation of the understanding of the importance of lifestyle changes is a nursing intervention, not an outcome. 4. The best outcome for a client with borderline serum lipids is to maintain normal levels without the use of prescriptions. Page Ref: 309 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential NURSINGTB.COM Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled through nonpharmacologic means. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

5) The nurse has completed nutritional teaching for a client with a high low density lipoprotein (LDL) level. Which menu choice made by the client indicates an understanding of the teaching? 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 Answer: 3 Explanation: 1. The menu that includes beef tenderloin has some healthy choices, but the gravy is too high in fat, as is the apple pie. 2. 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. 3. A lipid-reducing diet should include soluble fiber and plant sterols and stanols in the diet. The best menu choice includes rice, broccoli, walnuts, apples, and whole-wheat bread. 4. 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. NURSINGTB.COM Page Ref: 309 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Nutrition and Oral Hydration Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled through nonpharmacologic means. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

6) The patient is receiving cholestyramine (Questran) and complains of constipation. The physician orders bisacodyl (Dulcolax) tablets. When is the best time for the nurse to administer the bisacodyl (Dulcolax) tablets? 1. The drugs can be administered together. 2. Four hours after administration of cholestyramine (Questran). 3. Bisacodyl (Dulcolax) can be given any time but must be taken with food. 4. One hour after administration of cholestyramine (Questran). Answer: 2 Explanation: 1. These drugs cannot be administered together because cholestyramine (Questran) can bind to other drugs and interfere with their absorption. 2. Other drugs must be administered more than 2 hours before, or 4 hours after, the patient takes cholestyramine (Questran) because it can bind to other drugs and interfere with their absorption. 3. Bisacodyl (Dulcolax) cannot be administered with cholestyramine (Questran) as it will not be absorbed; Bisacodyl (Dulcolax) does not need to be given with food. 4. A minimum of 4 hours administration time between drugs is needed to be sure cholestyramine (Questran) does not interfere with absorption of other drugs. Page Ref: 314 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in NURSINGTB.COM care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

7) The nurse has completed the education for a client prescribed gemfibrozil (Lopid). Which statement made by the client indicates an understanding of the information? 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 physician said it really doesn't matter how I take this medication." 4. "Taking this medication with yogurt will help it to absorb better." Answer: 2 Explanation: 1. Taking gemfibrozil on an empty stomach can cause gastrointestinal distress; food will decrease the gastrointestinal distress. 2. Gemfibrozil should be administered with food to decrease gastrointestinal distress. 3. It is highly unlikely the physician would say that it doesn't matter how the medication is taken; the medication must be taken with food to decrease gastrointestinal distress. 4. Gemfibrozil should not be taken with yogurt because fatty foods may decrease the efficacy of gemfibrozil. Page Ref: 315 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing NURSINGTB.COM management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 23-8 Use the nursing process to care for patients receiving pharmacotherapy for lipid disorders. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

8) A client tells the nurse they will need a prescription for high cholesterol but does not know which would be best. Which information should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The best drugs to raise the 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." Answer: 3, 4, 5 Explanation: 1. The best drugs to raise high density lipoprotein (HDL) levels are statins, not fibric acid drugs. 2. Niacin, not statins, will cause flushing, which is worse with warm fluids. 3. Bile resins are effective, but numerous side effects limit their usefulness. 4. 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. 5. Fibric acid agents are effective but will not reduce low density lipoprotein (LDL) levels. Page Ref: 313 NURSINGTB.COM Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

9) A client asks the nurse how fat is carried in the blood. Which response should the nurse provide? 1. "Fats in your blood are carried inside small molecules called phospholipids." 2. "Fats travel in the blood on little proteins called lipoproteins." 3. "Fats are free floating in your circulatory system." 4. "Fats are encapsulated inside little bags known as lecithin." Answer: 2 Explanation: 1. Phospholipids are a class of lipids that is essential to building plasma membranes. 2. Lipids are carried through the blood as lipoproteins. 3. The nurse can answer this question; it does not need to be referred to the physician. 4. Lecithins are phospholipids found in egg yolks and soybeans. Page Ref: 307 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-3 Illustrate how lipids are transported through the blood. MNL Learning Outcome: 23.1 Examine the etiology, pathophysiology, clinical manifestations, NURSINGTB.COM and diagnosis of lipid disorders.

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PHARMACOLOGY FOR NURSES A PATHOPHYSIOLOGICAL APPROACH 6TH EDITION ADAMS TEST BANK

10) Which assessment data obtained from a client receiving a statin is a priority for the nurse to report to the healthcare provider? 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 healthcare provider? I have a really bad headache." 4. "My heart rate really went up this morning." Answer: 1 Explanation: 1. The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. 2. Gastrointestinal (GI) distress is a common occurrence with the statin drugs and is easily remedied by taking the drug with food. 3. Headache is considered a minor side effect and is easily remedied by analgesic medications. 4. The statin drugs do not affect heart rate. Page Ref: 310-311 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment: Collaboration with Interdisciplinary Team Standards: QSEN Competencies: I.B...