NUR 2212-Chapter 41: Antihyperlipidemics and Peripheral Vasodilators McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

NUR 2212-Chapter 41: Antihyperlipidemics and Peripheral Vasodilators McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition 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 patient’s 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: p. 595 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: p. 592 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: p. 594 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 patient’s serum low-density lipoprotein (LDL) has decreased from 170 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: p. 593 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 international normalized ratio (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: p. 593