Unit6: Chapter 47 (Karch 7th Ed) - Lipid-Lowering Agents

Question 1

1. When planning patient care the nurse recognizes what patient is at greatest risk of 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

Answer 1

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.

Question 2

2. The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with 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

Answer 2

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

Question 3

3. A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug would the
   nurse suspect is most likely to contribute to this adverse effect?
   A) Bile acid sequestrants
   B) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors
   C) Cholesterol absorption inhibitor
   D) Fibrates

Answer 3

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.

Question 4

4. 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 describing?
   A) Cholestyramine (Questran)
   B) Colesevelam (Welchol)
   C) Colestipol (Colestid)
   D) Ezetimibe (Zetia)

Answer 4

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.

Question 5

5. The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What 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

Answer 5

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.

Question 6

6. 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 use of this drug?
   A) Alcohol
   B) Nicotine
   C) Caffeine
   D) Herbal therapy

Answer 6

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.

Question 7

7. 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 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.

Answer 7

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.

Question 8

8. The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for what common
adverse effects?
A) Bloating and flank pain
B) Neuropathy and flatulence
C) Mild abdominal pain and diarrhea
D) Constipation and flank pain

Answer 8

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.

Question 9

9. The nurse is preparing a patient for discharge who will receive a prescription for an beta-hydroxy-betamethylglutaryl
   coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that
   they have a clear understanding of the teaching provided by the nurse?
   A) I will not need to follow that low-fat diet anymore because this drug will take care of my lipids.
   B) I should plan to take this drug before bedtime, because my body makes lipids mostly at night.
   C) After I start taking this drug, I will not have to worry about the exercise routine the doctor
   prescribed.
   D) I should take this drug first thing in the morning and make sure I drink a full glass of water.

Answer 9

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

Question 10

10. 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 this patient has been
    taking what contraindicated substance?
    A) Over-the-counter (OTC) medications
    B) Ginseng
    C) Grapefruit juice
    D) Saw palmetto

Answer 10

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

Question 11

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

Answer 11

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.

Question 12

12. 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 effect of niacin occurs?
    A) Hypotension
    B) Abdominal pain
    C) Vomiting
    D) Diarrhea

Answer 12

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

Question 13

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

Answer 13

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.

Question 14

14. 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 best response?
    A) Micelles are absorbed into the intestinal wall and combined with proteins to become chylomicrons
    B) The drug makes the liver use cholesterol to produce more bile acids.
    C) The drug works in the brush border of the small intestine to prevent the absorption of dietary
    cholesterol.
    D) The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and
    reduction in triglyceride levels.

Answer 14

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.

Question 15

15. 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 coronary artery disease and
    incidence of myocardial infarction is what drug?
    A) Pravastatin (Pravachol)
    B) Lovastatin (Mevacor)
    C) Atorvastatin (Lipitor)
    D) Fluvastatin (Lescol)

Answer 15

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

Question 16

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

Answer 16

Ans: C
Feedback:
Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing
serum triglycerides. The other options are incorre

Question 17

17. The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value 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

Answer 17

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.

Question 18

18. The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-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

Answer 18

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

Question 19

19. A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse categorize this serum
concentration of cholesterol?
A) Optimal
B) Desirable
C) High
D) Very high

Answer 19

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.

Question 20

20. The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low
    density lipoproteins (LDLs), and increases high density lipoprotein (HDL) concentrations. What is the
    correct answer?
    A) Fenofibrate (Tricor)
    B) Niacin (Niaspan)
    C) Atorvastatin (Lipitor)
    D) Gemfibrozil (Lopid)

Answer 20

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.

Question 21

21. A patient is being discharged on cholestyramine (Questran). Patient teaching should 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

Answer 21

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.

Question 22

22. 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 complains of muscle pain. What does the nurse
    suspect caused this patient’s renal failure?
    A) Gastric ulceration
    B) Rhabdomyolysis
    C) Congestive heart failure
    D) Drug Toxicity

Answer 22

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.

Question 23

23. 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 make? (Select all that apply.)
    A) Quitting smoking
    B) Exercising
    C) Following a low sodium diet
    D) Reducing stress
    E) Avoiding alcohol

Answer 23

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.

Question 24

24. A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that 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

Answer 24

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.

Question 25

25. The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and explains that
    exercise has what effect?
    A) Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL)
    B) Increases LDL and decreases triglycerides
    C) Decreases HDL and increases LDL
    D) Decreases both HDL and LDL

Answer 25

Ans: A
Feedback:
Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases
triglyceride levels.

Question 26

26. The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk 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

Answer 26

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

Question 27

27. 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 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

Answer 27

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.

Question 28

28. The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum
    cholesterol levels. What lipid lowering medication would be appropriate for the nurse to administer to
    this patient?
    A) Colesevelam (Welchol)
    B) Pravastatin (Pravachol)
    C) Simvastatin (Zocor)
    D) Atorvastatin (Lipitor)

Answer 28

Ans: A
Feedback:
Bile acid sequestrants are the drug of choice for pregnant women if a lipid-lowering agent is needed.
Women of child-bearing age should not take beta-hydroxy-beta-methylglutaryl coenzyme A (HMGCoA)
reductase inhibitors because they are in Pregnancy Category X. Pravastatin, simvastatin, and
atorvastatin are all HMG-CoA reductase inhibitors.

Question 29

29. The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD). What condition
    does the nurse encourage the patient to control in order to reduce CAD risk? (Select all that apply.)
    A) Obesity
    B) Hypertension
    C) Bradycardia
    D) Depression
    E) High stress levels

Answer 29

Ans: A, B, E
Feedback: Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing
dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on
serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of
type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating
hypertension, diabetes, and gout. Depression and bradycardia have not been linked to CAD.

Question 30

30. The nurse cares for a 10-year-old child brought to the clinic for an annual checkup who is diagnosed
    with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children?
    A) Gender
    B) Diet
    C) Familial connection
    D) Exercise

Answer 30

Ans: C
Feedback:
Familial hypercholesterolemia may be seen in children. Because of the importance of lipids in the
developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and
calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are
not the most common causes.

Question 31

31. The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his diet to lose
    weight and control serum lipid levels without success. He is currently taking a combination of
    medications but his total cholesterol remains above 200. What future therapy might help this patient?
    A) Endocannabinoid blocker
    B) Bile acid sequestrant with niacin
    C) Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and gemfibrozil
    D) Peroxisome proliferator receptor alpha activator

Answer 31

Ans: A
Feedback:
Blocking the endocannabinoid system results in feelings of satiety and decreased appetite, leading to
weight loss; decreased release of growth hormone, increased oxygen and glucose use in the muscle,
decreased fat synthesis in the liver, decreased levels of triglycerides and low density lipoproteins, and
increased levels of high density lipoproteins, improving the lipid profile; increased sensitivity of insulin
receptor sites, leading to decreased blood glucose levels; decreased fat production and storage; increased levels of adiponectin; and decreased activity of tumor necrosis factor, a proinflammatory
agent, and decreased activity of C-reactive protein, which is associated with proinflammatory and
prothrombotic states. Combining bile acid sequestrant with niacin or HMG-CoA with gemfibrozil is
contraindicated. Peroxisome proliferator receptor alpha activators help to control lipid levels but do not
contribute to dietary changes and appetite suppression.

Question 32

32. The nurse provides patient teaching related to medication and lifestyle changes the patient can make to
    reduce serum lipid levels. One month later, the nurse evaluates the patient teaching as having been
    effective based on what data? (Select all that apply.)
    A) Total cholesterol 184
    B) High density lipoprotein (HDL) cholesterol 84
    C) Low density lipoprotein (LDL) cholesterol 164
    D) Triglycerides 184
    E) Weight loss of 8 pounds

Answer 32

Ans: A, B, E
Feedback:
Serum lab levels within the desirable level would indicate the teaching was effective; they include a
total cholesterol level of less than 200, an HDL cholesterol level of higher than 40, an LDL cholesterol
level of less than 129, and a triglyceride level of less than 50. Weight loss is also a positive outcome.

Question 33

33. The nurse is caring for a 35-year-old woman taking a beta-hydroxy-beta-methylglutaryl coenzyme A
    (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching this patient about her
    medications what priority teaching point will the nurse include in the teaching plan?
    A) Need for frequent ophthalmic examinations
    B) Information about a cholesterol-lowering diet
    C) Use of barrier contraceptives
    D) Calling her doctor with any respiratory symptoms

Answer 33

Ans: C
Feedback:
It is important to teach a woman of childbearing age taking HMG-CoA reductase inhibitors to use
barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. She should have routine ophthalmic examinations but does not need more
frequent examinations. Cholesterol lowering diet should have been initiated before beginning
medications to lower lipid levels. There are no associated respiratory risks with these medications so
she would call the doctor with respiratory symptoms as she normally would.

Question 34

34. When providing patient teaching to a patient beginning therapy with a beta-hydroxy-betamethylglutaryl
    coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular
    monitoring of what laboratory studies? (Select all that apply.)
    A) Renal function tests
    B) Liver function tests
    C) Lipid panel
    D) Hemoccult of stool
    E) Albumin level

Answer 34

Ans: A, B, C
Feedback:
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.

Question 35

35. The nurse is preparing to teach the patient about diet therapy when beginning bile sequestrant
    medication to lower lipid levels. What important teaching point will the nurse include in the teaching
    plan?
    A) Increasing carbohydrate intake
    B) Reducing protein intake
    C) Increasing fiber intake
    D) Reducing fluid intake

Answer 35

Ans: C
Feedback:
The nurse would want to teach this patient to increase fiber intake to avoid constipation that often
occurs with this medication. Protein intake does not need to be reduced, but the patient 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.