NURSING 6005 CHAPTER 50: PROPHYLAXIS OF CORONARY HEART DISEASE: Drugs That Help Normalize Cholesterol and Triglyceride Levels Test Bank

NURSING 6005 CHAPTER 50: PROPHYLAXIS OF CORONARY HEART DISEASE: Drugs That Help Normalize Cholesterol and Triglyceride Levels Test Bank MULTIPLE CHOICE 1. A patient with a history of angina and hypertension is being started on nicotinic acid (Niacin). The nurse is providing patient education. What statement made by the patient demonstrates a need for further teaching? a. “I will take Tylenol with my medication to reduce the inflammatory effects.” b. “I will be cautious taking this medication, because I have mild liver damage.” c. “I will take an aspirin 30 minutes before my niacin to reduce flushing.” d. “This medication will lower my triglyceride levels.” ANS: A Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. Tylenol will not reduce the flushing or inflammatory effects of the medication; further patient teaching is required. The flushing reaction diminishes in several weeks and can be attenuated by taking 325 mg of aspirin 30 minutes before each dose. Nicotinic acid is hepatotoxic; therefore, the patient should be taught to have the liver enzymes checked and to self-monitor for signs and symptoms. Nicotinic acid reduces low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels. DIF: Cognitive Level: Analysis REF: Nicotinic Acid (Niacin) | Adverse Effects TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 2. A prescriber has ordered rosuvastatin (Crestor) for a patient with non–alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse before administration of this drug? a. Question the order, because rosuvastatin is contraindicated in patients with liver disease. b. No intervention is necessary; just administer the drug as ordered. c. Review the baseline liver function test results. d. Assess the patient for liver disease. ANS: C Before administering rosuvastatin, the nurse should review the results of the baseline liver function tests (LFTs). Statins can be used by patients with liver disease but not by those with alcoholic or viral hepatitis. Administering the drug before obtaining baseline LFT results would not allow for an accurate baseline. The patient clearly already has liver disease. DIF: Cognitive Level: Application REF: HMG-CoA Reductase Inhibitors (Statins) | Adverse Effects | Hepatotoxicity TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). 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. DIF: Cognitive Level: Analysis REF: HMG-CoA Reductase Inhibitors (Statins) | Adverse Effects | Myopathy | Rhabdomyolysis TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 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. “At least 6 months is required 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 too 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. DIF: Cognitive Level: Comprehension REF: HMG-CoA Reductase Inhibitors (Statins) | Beneficial Actions 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 lupuslike syndrome c. The patient’s LFT 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 can 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 lupuslike 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. DIF: Cognitive Level: Analysis REF: HMG-CoA Reductase Inhibitors (Statins) | Adverse Effects | Myopathy | Rhabdomyolysis TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual’s medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of: a. migraines. b. hypothyroidism. c. myopathy. d. heart failure. ANS: C When gemfibrozil and a statin are taken concurrently, the risk of myopathy is increased more than with either agent alone. Migraines, hypothyroidism, and heart failure are not drug-to-drug interactions. DIF: Cognitive Level: Analysis REF: HMG-CoA Reductase Inhibitors (Statins) | Adverse Effects | Myopathy | Rhabdomyolysis 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 stroke.” 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. 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. DIF: Cognitive Level: Analysis REF: HMG-CoA Reductase Inhibitors (Statins) | Adverse Effects | Hepatotoxicity 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