Chapter 50 Prophylaxis of Atherosclerotic Cardiovascular Disease DrugsThat Help Normalize Cholesterol and Triglyceride Levels

Chapter 50: Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels Test Bank MULTIPLE CHOICE 1. A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? a. “Ask your provider about taking an immediate-release form of the medication.” b. “Ask your provider about assessing your serum uric acid levels which may be elevated.” c. “You should stop taking the Niacin immediately since this is a serious adverse effect.” d. “You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect.” ANS: D Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. Patients should be advised to take 325 mg of ASA 30 minutes prior to each dose to minimize this effect or to use an extended-release form of the drug. Serum uric acid levels may increase with Niacin use, but flushing does not indicate elevated levels. This side effect is not serious and does not warrant discontinuation of the drug. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 572 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? a. Elevated cholesterol b. Elevated high-density lipoprotein c. Elevated low-density lipoprotein d. Elevated very-low-density lipoprotein ANS: C Elevated LDL levels make the greatest contribution to coronary atherosclerosis with the probability of developing coronary heart disease (CHD) directly related to the LDL level in the blood. Total cholesterol levels do not have the same direct link. HDL levels cause increased risk when they are low. The relation between elevated very-low-density lipoprotein levels and CHD is not clear. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 557-558 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 3. A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of: a. nausea. b. tiredness. c. muscle pain. d. headache. ANS: C Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis. Daptomycin also can cause myopathy and therefore should be used with caution in patients concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the nurse as much concern as the likelihood of myopathy. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 569 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, “How long will it take until I see an effect on my LDL cholesterol?” The nurse gives which correct answer? a. “It will take 6 months to see a change.” b. “A reduction usually is seen within 2 weeks.” c. “Blood levels normalize immediately after the drug is started.” d. “Cholesterol will not be affected, but triglycerides will fall within the first week.” ANS: B Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months to see a change. The blood level of LDL cholesterol is not reduced immediately upon starting the drug; a reduction is seen within 2 weeks. Blood cholesterol is affected, specifically LDL cholesterol, not triglycerides. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 566-567 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 5. A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor? a. For tendon tenderness b. For a lupus-like syndrome c. The patient’s liver function test results d. The patient’s creatinine kinase levels ANS: D Creatinine kinase levels are the best laboratory indicator of myopathy and/or rhabdomyolysis, which may lead to renal failure. As with the statins, gemfibrozil and other fibrates can cause myopathy. Fibrates must be used with caution in patients taking statins. Concurrent use of gemfibrozil and rosuvastatin does not cause tendon tenderness or a lupus-like syndrome. Liver function levels should be determined at the start of statin therapy and every 6 months thereafter in patients who do not have liver disease. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 569 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient? a. “Consume an increased amount of citrus fruits while taking this drug.” b. “Take vitamin D and coenzyme Q supplements.” c. “Ask your provider about adding a fibrate medication to your regimen.” d. “Have your creatine kinase levels checked every 4 weeks.” ANS: B Patients taking a statin medication may take vitamin D and coenzyme Q supplements to reduce their risk of developing myositis. Citrus fruits can elevate statin levels and increase the risk of myositis. Fibrates also cause myositis in some patients, and adding a fibrate will increase the risk. Creatine kinase levels should be determined at baseline and as needed if symptoms occur but do not need to be monitored every 4 weeks. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 569 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate? a. “Statins reduce the risk of morbidity from influenza.” b. “You should come into the clinic for liver enzymes in 1 month.” c. “Statins reduce the risk of coronary events in people with normal LDL levels.” d. “You should maintain a healthy lifestyle and avoid high-fat foods.” ANS: B Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months. A recent study demonstrated protection against influenza morbidity in patients because of a decrease in proinflammatory cytokine release. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 570 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education? a. “This medication will replace other interventions you have been trying.” b. “It is important for you to double your dose if you miss one to maintain therapeutic blood levels.” c. “Stop taking the medication if you experience constipation.” d. “You should continue your exercise program to increase your HDL serum levels.” ANS: D Regular exercise can reduce LDL cholesterol and elevate HDL cholesterol, thereby reducing the risk of coronary heart disease (CHD). The patient should consider the cholesterol-lowering drug an adjunct to a proper diet and exercise. Drug therapy cannot replace other important interventions, such as diet and exercise. The patient should never be instructed to double the dose. Constipation is a side effect of most cholesterol-lowering agents. The patient should be encouraged to eat a high-fiber diet and increase fluids if not contraindicated. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 561-562 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 9. An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication? a. Higher than usual doses may be necessary for this patient. b. Renal toxicity is a common adverse effect among Asian patients. c. Serum drug levels must be monitored more frequently than with other patients. d. Yellow skin and sclera are more common side effects with Asian patients but are not concerning. ANS: C Rosuvastatin reaches abnormally high levels in people of Asian heritage. Consequently, serum drug levels must be monitored closely. Asian patients may require lower than usual doses. Renal toxicity does not occur. Yellow skin and sclera occur with hepatotoxicity and are a cause for concern. PTS: 1 DIF: Cognitive Level: Application REF: p. 571 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 10. Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? a. “Take lovastatin with your evening meal.” b. “Take this medicine before breakfast.” c. “You may take lovastatin without regard to meals.” d. “Take this medicine on an empty stomach.” ANS: A Patients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 571 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. A nurse is providing discharge teaching instructions for a patient taking cholestyramine [Questran]. Which statement made by the patient demonstrates a need for further teaching? a. “I will take warfarin [Coumadin] 1 hour before my medicine.” b. “I will increase the fluids and fiber in my diet.” c. “I can take cholestyramine with my hydrochlorothiazide.” d. “I will take digoxin 4 hours after taking the cholestyramine.” ANS: C Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 572 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 12. A nurse is providing patient education about colesevelam [Welchol], a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching? a. “Colesevelam will reduce my levels of low-density lipoprotein.” b. “Colesevelam will augment my statin drug therapy.” c. “I will not have to worry about having as many drug interactions as I did when I took cholestyramine.” d. “I will need to take supplements of fatsoluble vitamins.” ANS: D Colesevelam [Welchol] does not reduce absorption of fat-soluble vitamins as do other bile acid sequestrants, so supplements are not needed. Colesevelam reduces the LDL cholesterol level, which is one of its therapeutic uses. Colesevelam augments statin therapy. Colesevelam does not significantly interact with or reduce the absorption of statins, digoxin, warfarin, or most other drugs. PTS: 1 DIF: Cognitive Level: Application REF: pp. 572-573 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 13. A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient? a. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia. b. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hyperglycemia. c. The patient needs to take the insulin at least 3 hours before the colesevelam. d. The patient needs to use an oral antidiabetic agent or agents, not insulin, with colesevelam. ANS: A Colesevelam can help control hyperglycemia in patients with diabetes; therefore, hypoglycemia is a possible risk. Hyperglycemia is not a risk for patients with diabetes who take colesevelam. Insulin and colesevelam do not interact; therefore, the insulin can be taken at the patient’s preferred time or times. Either insulin or oral antidiabetic agents can be taken with colesevelam. PTS: 1 DIF: Cognitive Level: Application REF: pp. 572-573 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 14. A nurse is reviewing a patient’s medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient? a. Increased levels of gemfibrozil b. Decreased levels of gemfibrozil c. Increased anticoagulant effects d. Reduced anticoagulant effects ANS: C Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may have to be reduced. PTS: 1 DIF: Cognitive Level: Application REF: p. 574 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 15. While giving discharge instructions to a patient who will be taking cholestyramine [Questran], the nurse wants to assess the patient’s understanding of the treatment. Which statement made by the patient best demonstrates a need for additional teaching? a. “I will take cholestyramine [Questran] 1 hour before my other medications.” b. “I will increase fluids and fiber in my diet.” c. “I will weigh myself weekly.” d. “I will have my blood pressure checked weekly.” ANS: C Patients need not weigh themselves weekly when taking cholestyramine. Cholestyramine should be taken at least 1 hour before other medications. When taken with other medications, cholestyramine can inhibit the absorption of the other drugs. Constipation is the principal complaint with cholestyramine. It can be minimized by increasing dietary fiber and fluids. Regular blood pressure checks are a good idea. The patient is taking cholestyramine because of high cholesterol, which contributes to hypertension. PTS: 1 DIF: Cognitive Level: Application REF: p. 572 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 16. Which is a possible benefit of taking fish-oil supplements? a. A decrease in low-density lipoprotein and triglyceride levels b. Decreased risk of thrombotic stroke c. Prevention of heart disease in high-risk patients d. Reduced risk of dysrhythmia in patients after myocardial infarction ANS: D Fish oil may be beneficial in prevention of heart dysrhythmias in patients who have had myocardial infarction or heart failure. It has not shown to be beneficial in decreasing cholesterol, reducing the risk of thrombotic stroke, or preventing heart disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 575-576 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 17. A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse include when teaching this patient? a. The need to discuss taking a bisphosphonate medication with her provider b. That statins are known to reduce the risk of osteoporosis c. That she should avoid foods high in calcium d. To discuss vitamin D supplements with her provider since statins deplete calcium ANS: A Studies demonstrating a protective effect of statins in reducing the risk of osteoporosis have been inconclusive. Women at risk should discuss taking a bisphosphonate medication with their providers. Statins are not known to reduce the risk of osteoporosis. She should consume foods containing calcium. Vitamin D supplements are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 568-569 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.) a. Facial flushing b. Constipation c. Hypoglycemia d. Gastric upset e. Itching ANS: A, D, E Adverse effects of nicotinic acid include intense flushing of the face, neck, and ears; itching; and GI upset (nausea, vomiting, and diarrhea). Constipation and hypoglycemia are not adverse effects of niacin therapy. PTS: 1 DIF: Cognitive Level: Application REF: p. 571 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies