Chapter 19: Book Qs & Evolve Qs

Question 1

1. Which group of antihyperlipidemic drugs works best to lower triglycerides?

A. Statins B. Fibrates C. Cholesterol absorption inhibitors D. Nicotinic acid

Answer 1

B

Question 2

2. Which drug is a cholesterol absorption inhibitor?

A. Ezetimibe B. Simvastatin C. Gemfibrozil D. Colestipol 3. When should you teach

Answer 2

A

Question 3

3. When should you teach a patient to take a fibrate drug?

A. At bedtime B. 1 hour after breakfast C. 30 minutes before meals D. 1 hour before lunch

Answer 3

C

Question 4

4. What are the most common side effects of nicotinic acid drugs?

A. Nausea and vomiting B. Dizziness and confusion C. Bleeding and bruising D. Itching and nasal inflammation

Answer 4

D

Question 5

5. An older adult patient who is prescribed atorvastatin (Lipitor) tells you that she is experiencing more muscle aches and states, “I’m just getting old.” What should you do?

A. Give the drug because this is expected as a person ages. B. Offer the patient acetaminophen as needed. C. Suggest a physical therapy consult for an exercise program. D. Hold the drug and notify the prescribed immediately.

Answer 5

D

Question 6

6. A patient asks you how ezetimibe (Zetia) lowers blood lipid levels. What is your best response?

A. “They eliminate cholesterol in the stool.” B. “They decrease production of cholesterol by the liver.” C. “They bind with cholesterol bile acids.” D. “They decrease the absorption of cholesterol by the body.”

Answer 6

D

Question 7

7. A patient taking a statin drug has elevated liver function tests. What is your best first action?

A. Ask the patient if he or she has a history of kidney disease. B. Assess the patient for signs of liver failure. C. Ask the patient if he or she has experienced pale gray-colored stools. D. Hold the drug and notify the prescriber immediately.

Answer 7

D

Question 8

8. Which question would you be sure to ask a patient before giving a bile acid sequestrant drug?

A. “Have you experienced any constipation?” B. “Have you experienced any muscle soreness?” C. “Have you experienced any facial swelling?” D. “Have you experienced any difficulty breathing?”

Answer 8

A

Question 9

9. A patient’s LDL level is very high. Which drug and drug dosage would you teach the patient is best to correct the very high LDL level?

A. simvastatin (Zocor) 5mg by mouth every evening B. ezetimibe (Zetia) 10mg by mouth every day C. gemfibrozil (Lopid) 600mg twice a day D. nicotinic acid (Niacor) 1g three times a day

Answer 9

A

Question 10

10. An older adult prescribed atorvastatin (Lipitor) for familial hyperlipidemia tells you that he is having leg cramps. What is your best action?

A. Administer acetaminophen (Tylenol) 650mg as ordered. B. Instruct the patient to exercise his calf muscles to resolve the cramp. C. Suggest that he begin a regular walking exercise program. D. Hold the drug and notify the prescriber immediately.

Answer 10

D

Question 11

11. The outpatient prescribed niacin 1 gram three times a day experiences flushing and hot flashes when taking this drug. What is your best action?

A. Hold the drug and notify the prescriber. B. Ask the prescriber to order an antiemetic drug. C. Instruct the patient to take aspirin 325mg 15 to 60 minutes before taking the drug. D. Reassure the patient that this is an expected side effect.

Answer 11

C

Question 12

12. What action should you take for a patient prescribed niacin (Niacor) who needs dental surgery?

A. Instruct the patient to take the niacin every day except the day of surgery. B. Notify the dental surgeon that the patient is taking niacin on a daily basis. C. Check the patient’s blood pressure and heart rate. D. Monitor the patient for signs of rapid clotting.

Answer 12

B

Question 13

13. You are providing teaching to a patient who has been prescribed nicotinic acid (Niacor). What information should you be sure to include in the teaching plan?

A. “Nicotinic acid doses are usually started low and gradually increased.” B. “Drink lots of water with Niacor to prevent upset stomach.” C. “Avoid taking Niacor for at least 1 hour after antacids.” D. “Mix Niacor with juice or water before taking your dose.”

Answer 13

A

Question 14

14. What do you teach a woman prescribed niacin (Niacor) who is planning to become pregnant and breastfeed her baby?

A. This drug is safe for use during pregnancy. B. This drug is safe for use during breastfeeding. C. This drug should not be taken while breastfeeding. D. This drug has a low likelihood of increasing the risk for birth defects or fetal damage.

Answer 14

C

Question 15

A patient in the clinic was just given a prescription for a lipid-lowering drug by the prescriber and was told not to drink grapefruit juice. Grapefruit juice should be avoided with which class of lipid-lowering drugs?

Statins

Bile acid sequestrants

Nicotinic acid agents

Fibrates

Answer 15

Fibrates

Patients should not drink grapefruit juice while taking fibrates because it interferes with the metabolism (breakdown) of fibrates in the body, making them less effective. Grapefruit juice does not have to be avoided with statins, bile acid sequestrants, or nicotinic acid agents.

Question 16

Which type of cholesterol-lowering drug may be prescribed with a cholesterol absorption inhibitor?

Statin

Fibrate

Bile acid sequestrant

Nicotinic acid

Answer 16

Statin

A statin drug may be prescribed with a cholesterol absorption inhibitor to increase the cholesterol-lowering effects.

Question 17

Which statement made by a patient about when he or she takes prescribed colestipol (Colestid) granules indicates a need for further teaching?

“This medication may cause constipation.”

“I take it with 4 to 6 ounces of fruit juice or water.”

“I take it along with breakfast and my morning medications.”

“I take it 2 hours before or after my antacids.”

Answer 17

“I take it along with breakfast and my morning medications.”

Remind patients not to take other drugs for at least 2 hours before or 4 to 6 hours after bile acid sequestrants, because bile acid sequestrants may interfere with absorption of other drugs. Teach patients to take bile acid sequestrants with meals because they bind with cholesterol in the intestine. Constipation is a very common side effect of the drug. Tell patients to mix the powder forms of bile acid sequestrants with 4 to 6 ounces of fruit juice or water. Take tablet forms with large amounts of water (at least 12 to 16 ounces) to prevent stomach and intestinal problems such as bowel obstruction. Bile acid sequestrants should be taken 2 hours before or 2 hours after antacids. Check whether the patient is prescribed warfarin (Coumadin).

Question 18

A patient is being discharged with a prescription for a lipid-lowering drug. What class of lipid-lowering drugs may require a daily vitamin supplement to be taken along with them?

Statins

Bile acid sequestrants

Cholesterol absorption inhibitors

Nicotinic acid agents

Answer 18

Bile acid sequestrants

The class of lipid-lowering drugs called bile acid sequestrants helps the body lose cholesterol. They also inhibit fat-soluble vitamins (A, D, E, and K), so patients may need to take a daily vitamin supplement. Statins do not affect vitamin absorption. Cholesterol absorption inhibitors do not affect vitamin absorption. Nicotinic acid agents are a special type of vitamin B and do not affect vitamin absorption.

Question 19

Which point must be included in a teaching plan for a diabetic patient who has been prescribed nicotinic acid to lower cholesterol?

“The dosage of your blood glucose control drug will need to be decreased.”

“The dosage of your blood glucose control drug may need to be increased.”

“You will not need to check your glucose as often.”

“The dosage of your nicotinic acid will need to be increased.”

Answer 19

“The dosage of your blood glucose control drug may need to be increased.”

Nicotinic acid may increase blood glucose levels, so blood glucose control drug dosages may need to be increased.

Question 20

A pediatric nurse is caring for a child prescribed a lipid-lowering medication. What lipid-lowering medication can cause intestinal obstructions in children?

Cholestyramine (Questran)

Gemfibrozil (Lopid)

Ezetimbe (Zetia)

Nicotinic acid (Niacor)

Answer 20

Cholestyramine (Questran)

Cholestyramine (Questran) and colestipol (Colestid) should be avoided in children because they can cause intestinal obstructions. Safe use of colesevelam (Welchol) has not been established in children. Gemfibrozil is not known to cause intestinal obstructions in children. Ezetimbe is not known to cause intestinal obstructions in children, but the safe use of cholesterol absorption inhibitors in children younger than age 10 years has not been established. Nicotinic acid is not known to cause intestinal obstructions in children; however, safe use of these drugs in children younger than age 10 years has not been established.

Question 21

The nurse is performing discharge teaching for a patient who is going to take a statin medication. What symptom, indicating an adverse effect, is most important for the nurse to tell the patient and should be reported immediately to the prescriber?

Constipation

Brown urine

Bleeding

Flushing

Answer 21

Brown urine

Brown urine may be one symptom of rhabdomyolysis (muscle breakdown) which is an adverse effect of taking statins. Signs and symptoms include general muscle soreness, muscle pain and weakness, vomiting, stomach pain, and brown urine. The urine turns brown because small reddish-brown pieces of broken-down muscle are removed from the body through the urine. Renal failure can occur if rhabdomyolysis develops because protein released from broken-down muscle can block urine flow through the kidneys. Constipation is a symptom specific to bile acid sequestrants and does not need immediate attention. Bleeding is a symptom specific to bile acid sequestrants. Flushing is a symptom specific to nicotinic acid agents and does not need immediate attention.

Question 22

The nurse is reviewing different classes of lipid-lowering drug. What class works directly on fats in the intestines?

Statins

Bile acid sequestrants

Nicotinic acid agents

Fibrates

Answer 22

Bile acid sequestrants

Bile acid sequestrants are a class of cholesterol-lowering drugs that bind with cholesterol in the intestine, preventing fats from being absorbed into the blood. This action then eliminates the cholesterol from the body through the stool. Statins, nicotinic acid, and fibrates do not work directly on fats in the intestines. Statins inhibit HMG CoA reductase, an enzyme that controls cholesterol production in the body, which lowers blood lipid levels by slowing the production of cholesterol and increasing the ability of the liver to remove low-density lipoprotein cholesterol from the blood. The drug action leading the lipid-lowering effects of nicotinic acid agents is not known. Fibrates activate cell lipid receptors that bind to and collect cholesterol and other lipids from the blood and break them down for elimination.

Question 23

Which type of lipid-lowering drug inhibits the production of cholesterol and triglycerides by the body?

Fibrates

Bile acid sequestrants

Cholesterol absorption inhibitors

Statins

Answer 23

Statins

Statins lower LDL cholesterol and triglycerides by inhibiting their production by the body.

Question 24

The nurse is discharging a patient with a prescription for an immediate-release form of niacin (Niacor). What instruction is most important to teach this patient?

“Call your prescriber if you have brown urine.”

“Notify your surgeon or dentist that you are taking Niacor before any surgery or dental work.”

“Watch for flushing right after taking the medication.”

“Be sure to take the medication on an empty stomach.”

Answer 24

“Notify your surgeon or dentist that you are taking Niacor before any surgery or dental work.”

Before any surgery or dental work, the surgeon or dentist should be notified that the patient is taking niacin because this drug can slow the clotting process and excessive bleeding can occur. These problems are made worse if the patient also takes aspirin or an NSAID daily along with a niacin. Brown urine is a symptom that is important to report when taking statin drugs, because it may indicate serious liver problem. Flushing is a normal side effect of niacin. GI side effects can be decreased by giving niacin with food.

Question 25

The nurse is giving a cholesterol absorption inhibitor to a patient who is also taking a statin. Which cholesterol absorption inhibitor can be taken with statins, but at least 2 hours before or 4 hours after bile acid sequestrants?

Simvastatin (Zocor)

Colestipol (Colestid)

Ezetimbe (Zetia)

Gemfibrozil (Lopid)

Answer 25

Ezetimbe (Zetia)

Ezetimbe, a cholesterol absorption inhibitor, can be taken at the same time as a statin drug but should be given at least 2 hours before or 4 hours after bile acid sequestrants.Simvastatin is a statin drug. Colestipol is a bile acid sequestrant and should not be given with statins. Gemfibrozil is a fibrate drug.

Question 26

A patient prescribed a lipid-lowering drug is being discharged. Which important information is essential for the nurse to teach this patient?

Make positive lifestyle changes.

Take these drugs with a full glass of water.

Take these drugs with food.

Regularly have blood glucose levels checked.

Answer 26

Make positive lifestyle changes.

Teach patients receiving any antihyperlipidemic drug to continue positive lifestyle changes that help lower cholesterol such as a low-fat diet, exercise, and weight control. Remind them to check with their prescriber before using any over-the-counter drugs. Instruct patients not to eat or drink for 8 hours before having follow-up laboratory tests drawn (lipid profile, liver function tests). These test results can be changed by substances in some foods and fluids and also must be repeated every 3 to 6 months to monitor the effectiveness of lipid-lowering drugs. Advise female patients to tell their prescriber if they plan to become pregnant or are at risk of becoming pregnant. Teach that all lipid-lowering drugs reduce high blood lipid levels but that they do not cure the problem. Treatment is long term, and these drugs must be taken even after blood fat levels are normal. Also, remind patients to take the drug exactly as prescribed to see best results.It is not necessary to take all lipid-lowering drugs with a full glass of water. It is not necessary to take all lipid-lowering drugs with food or monitor blood glucose levels when taking lipid-lowering drugs.

Question 27

A patient who has been diagnosed with high cholesterol asks the nurse “besides the foods we eat, from where does our body get cholesterol”? What response by the nurse is correct?

Gallbladder

Heart

Kidney

Liver

Answer 27

Liver

Cholesterol is produced by the liver. It is a fatty, waxy material that the body needs to function and is present in cell membranes everywhere in the body. Cholesterol is used to produce hormones, vitamin D, and bile acids that help digest fat. The gallbladder, heart, and kidney do not produce cholesterol.

Question 28

A patient who has recently become pregnant asks why she must stop taking her prescribed statin drugs. What is your best response?

“Your lipid level normalizes when you are pregnant.”

“Fats are necessary in the development of the fetus.”

“All medications are harmful to the fetus during pregnancy.”

“This medication is known to cause missing limbs in the fetus.”

Answer 28

“Fats are necessary in the development of the fetus.”

Statins decrease the amount of fat in the body. They are pregnancy category X and should not be given to women who are pregnant, plan to become pregnant, or are breastfeeding. Fat is essential to brain development in the fetus and infant and when there is not enough fat in the body during pregnancy and infancy, the fetus can suffer poor brain development and mental retardation. High lipid levels do not normalize with pregnancy. All medications are not harmful to take during pregnancy. Missing fetal limbs are not associated with statins.