Chapter 50 - Hyperlipidemia

Question 1

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.”

Answer 1

D

Question 2

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

Answer 2

C

Question 3

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.

Answer 3

C

Question 4

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.”

Answer 4

B

Question 5

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

Answer 5

D

Question 6

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.”

Answer 6

B

Question 7

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.”

Answer 7

B

Question 8

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.”

Answer 8

D

Question 9

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.

Answer 9

C

Question 10

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.”

Answer 10

A

Question 11

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.”

Answer 11

C

Question 12

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 fat-soluble vitamins.”

Answer 12

D

Question 13

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.

Answer 13

A

Question 14

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

Answer 14

C

Question 15

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.”

Answer 15

C

Question 16

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

Answer 16

D

Question 17

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

Answer 17

A

Question 18

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

Answer 18

A. D. E.