Ch47 - Focus on Nursing Pharmacology 6e Instructor Test Bank PDF

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Focus on Nursing Pharmacology 6e
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Chapter 47- Lipid-Lowering Agents When planning patient care the nurse recognizes what patient is at greatest risk of 1. developing coronary artery disease? A) A 32-year-old Asian American with total cholesterol of 120 mg/dL B) A 62-year-old white American with total cholesterol of 260 mg/dL C) A 48-year-old African American with total cholesterol of 198 mg/dL D) A 26-year-old Native American with total cholesterol of 150 mg/dL Ans:

B

Feedback: White Americans have the highest incidence of coronary artery disease (CAD). This patient has total cholesterol of 260 mg/dL, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three patients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range. The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with 2. diet cola twice per day. What is an appropriate nursing diagnosis for this patient?

A) Acute pain related to central nervous system and GI effects B) Constipation related to GI effects C) Noncompliance related to how the drug is taken D) Deficient knowledge regarding drug therapy Ans:

D

Feedback: Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the patient is experiencing any adverse effects from the drug so that pain and constipation would not be optimal nursing diagnoses. Until the nurse assesses the patient’s understanding of how to take the drug, it would be incorrect to assume noncompliance when it may actually be lack of understanding. A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug 3. would the nurse suspect is most likely to contribute to this adverse effect? A) Bile acid sequestrants Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors B)

C) Cholesterol absorption inhibitor D) Fibrates Ans:

A

Feedback:

Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates. The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse 4. describing? A) Cholestyramine (Questran) B) Colesevelam (Welchol) C) Colestipol (Colestid) Ezetimibe (Zetia) D)

Ans:

C

Feedback: Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. The other two options are bile acid sequestrants, but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug. The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What 5. expected outcome will the nurse describe? A) Decrease in serum cholesterol only B) Decrease in serum cholesterol and low density lipoprotein (LDL) levels C) Decrease in sitosterol and serum cholesterol D) Decrease in campesterol and LDL levels Ans:

B

Feedback:

Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL. The nurse is taking a health history on a 38-year-old man who is taking atorvastatin (Lipitor) for high cholesterol. What will the nurse question specifically related to the safe 6. use of this drug? A) Alcohol B) Nicotine C) Caffeine D) Herbal therapy Ans:

A

Feedback: Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are

contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the patient’s use of alcohol. Nicotine, caffeine, and herbal therapies are usually not identified as producing any drug drug interactions with atorvastatin. A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for genetically linked hyperlipidemia. In preparation for patient teaching concerning this 7. drug, what initial action will the nurse take? A) Ask the parents to be present for the teaching session. B) Determine the appropriate time to discuss the drug with the patient. C) Question the doctor concerning the ordered dosage. D) Review the child’s normal daily dietary intake of fatty foods. Ans:

C

Feedback:

The nurse should question the order initially. The dosage is twice the dose for a 9-year-old is expected to receive. The other options are appropriate and would be done. However, out of safety concerns, the nurse would clarify the dosage first. The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for what 8. common adverse effects?

A) Bloating and flank pain B) Neuropathy and flatulence C) Mild abdominal pain and diarrhea D) Constipation and flank pain Ans:

C

Feedback: 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 associated with bile acid sequestrants. Neuropathy and flank pain are usually not associated with lipid-lowering agents. The nurse is preparing a patient for discharge who will receive a prescription for an betahydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that they have a clear understanding of the teaching provided by the 9. nurse?  I will not need to follow that low-fat diet anymore because this drug will take A) care of my lipids.  I should plan to take this drug before bedtime, because my body makes lipids B) mostly at night.

 After I start taking this drug, I will not have to worry about the exercise routine C) the doctor prescribed.  I should take this drug first thing in the morning and make sure I drink a full D) glass of water. Ans:

B

Feedback: HMG-CoA inhibitors should be taken at bedtime because the body produces lipids mostly at night. Diet and exercise are still important when taking these drugs because the drug is most effective in combination with other lipid-lowering actions. A patient taking atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury. The nurse will ask questions to determine if 10. this patient has been taking what contraindicated substance? A) Over-the-counter (OTC) medications B) Ginseng C) Grapefruit juice D) Saw palmetto Ans:

C

Feedback: Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Patients on this drug should be cautioned to avoid drinking grapefruit juice. OTC drugs, ginseng, and saw palmetto are not associated with increased toxicity. 11. What are the most common adverse effects of lovastatin (Mevacor)? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Confusion and mental disorientation D) Hiccups, sinus congestion, and dizziness Ans:

A

Feedback: GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin but patients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this

drug. Hiccups, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy. The patient receives a prescription for niacin and the nurse is teaching his or her about the medication. The nurse instructs the patient to call the provider if what common adverse 12. effect of niacin occurs? A) Hypotension B) Abdominal pain C) Vomiting D) Diarrhea Ans:

B

Feedback: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. It also increases serum levels of uric acid and may predispose patients to the development of gout. Hypotension, vomiting, and diarrhea are not normally associated with the drug. The nurse is providing medication teaching to a patient who will begin taking niacin with a bile acid sequestrant. How does the nurse instruct the patient to take these two 13. medications?

A)  Both medications should be taken 4 to 6 hours apart. B)  Both medications should be taken in the morning.  One medication should be taken in the morning but the other is taken at C) bedtime. D)  Both medications can be taken at once just before going to bed. Ans:

A

Feedback: When niacin is prescribed with a bile acid sequestrant, the patient should be told to take the two medications 4 to 6 hours apart in the evening, with the niacin normally taken first. The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurse’s 14. best response?  Micelles are absorbed into the intestinal wall and combined with proteins to A) become chylomicrons. B)  The drug makes the liver use cholesterol to produce more bile acids.  The drug works in the brush border of the small intestine to prevent the C) absorption of dietary cholesterol.  The drug activates a specific hepatic receptor, resulting in increased breakdown D) of lipids and reduction in triglyceride levels.

Ans:

D

Feedback: Fenofibric acid is the first drug in this class. It activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma and reduction in the production to an enzyme that naturally inhibits lipid breakdown. The result is seen as a decrease in triglyceride levels, changes in low density lipoprotein production, which makes them more easily broken down in the body, and an increase in high density lipoprotein levels. The nurse conducts a review of research related to Beta-hydroxy-beta-methylglutaryl coenzyme A inhibitors and finds the only one associated with data to show a reduction in 15. coronary artery disease and incidence of myocardial infarction is what drug? A) Pravastatin (Pravachol) B) Lovastatin (Mevacor) C) Atorvastatin (Lipitor) D) Fluvastatin (Lescol) Ans:

A

Feedback:

Pravastatin is the only statin with outcome data to show effectiveness in decreasing coronary artery disease and incidence of myocardial infarction (MI); it prevents a first MI even in patients who do not have a documented elevated cholesterol level. The other medications do not have any evidence of effectiveness for this patient. 16. Which drug is most effective in reducing serum triglyceride levels? A) Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors B) Bile acid sequestrants C) Fibrates D) Niacin Ans:

C

Feedback:

Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing serum triglycerides. The other options are incorrect. The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value 17. should be assessed regularly on this patient?

A) Blood urea nitrogen (BUN) B) Complete blood count (CBC) C) Activated partial thromboplastin time D) Liver function studies Ans:

D

Feedback: Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. Liver function studies should be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course of therapy. The other tests would not be pertinent to this specific drug. The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG18. CoA) reductase inhibitor as inhibiting what? A) An enzyme that controls the final step in production of cellular cholesterol B) An enzyme used immediately for energy C) An enzyme that combines with proteins to become chylomicrons

D) An enzyme used to make bile acids Ans:

A

Feedback: HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids. A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse 19. categorize this serum concentration of cholesterol? A) Optimal B) Desirable C) High D) Very high Ans:

C

Feedback: High is rated at or exceeding 240 mg/dL. Levels below 200 mg/dL are considered desirable, although lower levels may be preferred if the patient has a history of coronary artery disease. Low density lipoprotein (LDL) cholesterol below 100 mg/dL is considered optimal, whereas LDL levels above 190 or triglycerides above 500 mg/dL is considered very high. The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL) 20. concentrations. What is the correct answer? A) Fenofibrate (Tricor) B) Niacin (Niaspan) C) Atorvastatin (Lipitor) D) Gemfibrozil (Lopid) Ans:

D

Feedback: Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI)

and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations. A patient is being discharged on cholestyramine (Questran). Patient teaching should 21. include what about this medication? A) Should be administered with other medications B) Should be administered 1 hour before or 4 to 6 hours after other medications C) Should be administered 1 hour after other medications D) Should be administered on an empty stomach Ans:

B

Feedback: Cholestyramine should be administered 1 hour before or 4 to 6 hours after other medications, because it may prevent the absorption of other drugs. Therefore, the other options are incorrect. The patient is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the nursing history the patient reveals he was taking Pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient 22. complains of muscle pain. What does the nurse suspect caused this patient’s renal failure? Gastric ulceration A)

B) Rhabdomyolysis C) Congestive heart failure D) Drug Toxicity Ans:

D

Feedback: Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity would cause liver damage, whereas the breakdown of muscle that occurs with rhabdomyolysis results in kidney damage and acute renal failure. The patient identified no symptoms related to gastric ulceration or congestive heart failure. The patient receives a prescription for a lipid lowering medication from the health care provider and, before discharge, asks the nurse what else he or she can do to improve his or her lipid levels besides just taking medication. What recommendation will the nurse 23. make? (Select all that apply.) A) Quitting smoking B) Exercising

C) Following a low sodium diet D) Reducing stress E) Avoiding alcohol Ans:

A, B, D

Feedback: Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels. Although a low sodium diet is a healthy choice, it is not associated with elevating lipid levels. A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that 24. plaque on the inner lumen of arteries begins as what? A) Fatty streaks B) White blood cells (WBCs) C) Foam cells D) Platelets and fibrin

Ans:

A

Feedback: Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of characteristic foam cells, containing fats and WBCs that further injure the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting blood flow. The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and 25. explains that exercise has what effect? Increases high density lipoproteins (HDLs) and decreases low density lipoproteins A) (LDL) B) Increases LDL and decreases triglycerides C) Decreases HDL and increases LDL D) Decreases both HDL and LDL Ans:

A

Feedback: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels. The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk 26. factors can be controlled or modified. What modifiable factors would the nurse include? A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity Ans:

C

Feedback: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled. The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the 27. nurse explains that the desired goal for cholesterol levels is what?

A) High high density lipoprotein (HDL) values and high triglyceride values B) Low soluble fiber C) Elevated blood lipids, fasting glucose less than 100 D) Low low density lipoprotein (LDL) values and high HDL values Ans:

D

Feedback: The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. HDL serves as a protective mechanism to reduce cholesterol so higher levels are desirable. High LDL levels increase plaque formation. Fiber does not contribute to risk for coronary artery disease (CAD) although a diet high in fiber is preferable. Elevated blood lipids are never desirable but control of blood sugar levels reduces CAD risk. The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum cholesterol levels....