Chapter 46: Antihyperlipidemics and Peripheral Vasodilators Nursing School Test Banks

Chapter 46: Antihyperlipidemics and Peripheral Vasodilators
Test Bank

MULTIPLE CHOICE

1. A female patient has serum lipid levels performed, which reveal a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a high-density lipoprotein (HDL) of 40 mg/dL. The patients blood pressure is 138/72 mm Hg. The nurse may expect the provider to order which medication for this patient?
a. Amlodipine and atorvastatin (Caduet)
b. Colestipol HCl (Colestid)
c. Fenofibrate (TriCor)
d. Niacin and lovastatin (Advicor)
ANS: D
The combination drug of niacin and lovastatin is indicated for hypercholesterolemia and mixed dyslipidemia. Niacin raises HDL, so would be helpful in this patient who has low HDL. Combination drugs are used to enhance the antihyperlipidemic effect. Amlodipine and atorvastatin in combination are used for patients with hyperlipidemia and elevated blood pressure. Colestipol HCl is used to reduce cholesterol and LDL levels but has no effect on HDL or triglycerides. Fenofibrate is used to treat type IV and V hyperlipidemia, characterized by elevated very-low-density lipoprotein and triglycerides.

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: Page 666
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient has a serum cholesterol level of 270 mg/dL. The patient asks the nurse what this level means. Which response by the nurse is correct?
a. You have a high risk for coronary artery disease.
b. You have a moderate risk for coronary artery disease.
c. You have a low risk for coronary artery disease.
d. You have no risk for coronary artery disease.
ANS: A
A value of 270 mg/dL for serum cholesterol puts the patient at high risk.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 665
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

3. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient?
a. Increase fluid and slowly increase fiber intake.
b. Stop taking the medication immediately.
c. Take an over-the-counter laxative.
d. Take the medication on an empty stomach.
ANS: A
Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced with increased fluids and foods high in fiber. Stopping the medication is not indicated. Over-the-counter laxatives are not recommended until other methods have been tried. Giving the medication on an empty stomach will not relieve the discomfort.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 666
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient has been taking cholestyramine (Questran) to treat hyperlipidemia type II. The patient reports abdominal cramping and constipation. The patients serum low- density lipoprotein (LDL) has decreased from 170 mg/dL to 110 mg/dL, and triglycerides have not changed from 150 mg/dL since beginning the medication. The provider changes the medication to colesevelam HCl (Welchol).The patient asks the nurse why the medication was changed, and the nurse will explain that colesevelam HCl is ordered for which reason?
a. It has fewer side effects.
b. It has more convenient dosing.
c. It provides greater LDL reduction.
d. It provides greater triglyceride reduction.
ANS: A
Colesevelam is similar to cholestyramine but has fewer gastrointestinal side effects. This patient has demonstrated good results with the bile acid sequestrant, so the provider needs to offer a preparation with fewer adverse effects. Both drugs are given twice daily.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 666
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient is admitted to the hospital, and the provider orders gemfibrozil (Lopid) 600 mg twice daily, 30 minutes prior to meals. The nurse learns that the patient takes warfarin (Coumadin) once daily. The nurse will contact the provider to discuss
a. decreasing the dose of gemfibrozil.
b. giving the warfarin at noon.
c. increasing the dose of warfarin.
d. ordering frequent INR levels.
ANS: D
Gemfibrozil is highly protein-bound and competes for receptor sites with drugs such as warfarin. The anticoagulant dose should be decreased, and the INR should be closely monitored. Decreasing the dose of gemfibrozil is not recommended. Giving the warfarin at a different time of day does not change this drug interaction. The warfarin dose should be decreased not increased.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 666
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action?
a. Contact the provider to discuss decreasing the dose.
b. Counsel the patient to increase fluid intake.
c. Request an order for renal function tests.
d. Schedule the medication to be taken with meals.
ANS: A
Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 668
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient has been taking atorvastatin (Lipitor) for several months to treat hyperlipidemia. The patient reports muscle weakness and tenderness. The nurse will counsel the patient to
a. ask the provider about switching to simvastatin.
b. contact the provider to report these symptoms.
c. start taking ibuprofen to combat these effects.
d. stop taking the medication immediately.
ANS: B
Patients taking statins should report immediately any muscle aches or weakness, which can lead to rhabdomyolysis, a muscle disintegration that can become fatal. All statins carry this risk, so changing to another statin is not indicated. Ibuprofen may be useful, but notifying the provider is essential. Patients should not abruptly discontinue statins without discussing this with the provider.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 666
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse provides teaching to a patient who will begin taking simvastatin (Zocor) to treat hyperlipidemia. Which statement by the patient indicates understanding of the teaching?
a. I may have diarrhea as a result of taking this medication.
b. I may stop taking this medication when my lipid levels are normal.
c. I will need an annual eye examination while taking this medication.
d. I will increase my intake of vitamins A, D, and E while taking this medication.
ANS: C
The statins can affect visual acuity, so patients should be counseled to have annual eye examinations for assessment of cataract formation. The bile acid sequestrants, not statins, cause diarrhea. Statin drug therapy is lifelong or until behavioral changes prove equally effective (uncommon). Bile acid sequestrants, not statins, decrease the absorption of fat-soluble vitamins.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 670
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient, who has intermittent claudication, has been taking 400 mg of pentoxifylline (Trental) three times daily with meals for 2 weeks. The patient calls the clinic and reports mild flushing, occasional gastrointestinal upset, and continued pain in both legs. How will the nurse advise the patient?
a. Expect side effects to diminish as drug effects increase in several weeks.
b. Notify the provider of the continued pain and request increasing the dose.
c. Take a daily aspirin tablet to enhance the effects of pentoxifylline.
d. Take the medication 1 hour before or 2 hours after a meal.
ANS: A
Patients should be counseled that the desired therapeutic effects may take to 3 months. This patients side effects are mild and therefore do not warrant discontinuing the drug. This patient is receiving the maximum recommended dose. Aspirin is not indicated. Taking the medication with meals and not on an empty stomach minimizes gastrointestinal effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 671
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient will begin taking simvastatin (Zocor) to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action?
a. Return to the clinic annually for laboratory testing.
b. Take care when rising from a sitting to standing position.
c. Take the medication in the evening for best effect.
d. Use ibuprofen as needed for muscle aches and pain.
ANS: C
Simvastatin is given in the evening. Laboratory tests are performed every 3 to 6 months, not annually. Statins do not cause postural hypotension. Patients taking statins should report muscle aches and weakness immediately.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 670
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient will begin taking rosuvastatin calcium (Crestor) to treat hyperlipidemia. The patient asks the nurse how to take the medication for best effect. Which statement by the nurse is correct?
a. Increase your fluid intake while taking this medication.
b. Stop taking the medication if you develop muscle aches.
c. Take the medication with food to improve absorption.
d. You may increase dietary fat while taking this medication.
ANS: A
Patients taking antihyperlipidemics should be advised to increase fluid intake. It is not necessary to take with food. Patients should never stop taking a statin without consulting the provider. Patients should continue a low-fat diet while taking statins.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 668
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A patient with high cholesterol is ordered to take atorvastatin (Lipitor). What information will be included in the patient teaching? (Select all that apply.)
a. Dietary management is not a priority with this medication.
b. The medication should be taken on an empty stomach.
c. The medicine should be taken with a full glass of water.
d. The patient should watch for body aches or gastrointestinal upset as side effects.
e. The patient should have renal function tests frequently.
f. The patient should have liver function tests frequently.
ANS: C, D, F
This medication is most effective with careful monitoring of diet. Atorvastatin does not affect renal function.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 666-668
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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