Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
1. When planning patient care the nurse recognizes what patient is at greatest risk of
developing coronary artery disease?
a. A 32-year-old Asian American with total cholesterol of 120 mg/dL
b. A 62-year-old white American with total cholesterol of 260 mg/dL
c. A 48-year-old African American with total cholesterol of 198 mg/dL
d. A 26-year-old Native American with total cholesterol of 150 mg/dL
Ans: B
Feedback:
White Americans have the highest incidence of coronary artery disease (CAD). This
patient has total cholesterol of 260 mg/dL, which is considered high according to the
Third Report of the National Cholesterol Education Program Expert Panel. The other
three patients could be at risk due to cultural risk factors such as hypertension,
diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to
cholesterol ratio. However, their total cholesterol levels fall within normal or
desirable range.
2. The nurse is assessing a patient who reports taking cholestyramine (Questran)
mixed with diet cola twice per day. What is an appropriate nursing diagnosis for
this patient?
a. Acute pain related to central nervous system and GI effects
b. Constipation related to GI effects
c. Noncompliance related to how the drug is taken
d. Deficient knowledge regarding drug therapy
Ans: D
Feedback:
Cholestyramine should be mixed with water or other noncarbonated fluids so the
nurse now recognizes the need for medication teaching and chooses the nursing
diagnosis related to deficient knowledge. Nothing in this question indicates that the
patient is experiencing any adverse effects from the drug so that pain and constipation
would not be optimal nursing diagnoses. Until the nurse assesses the patient’s
understanding of how to take the drug, it would be incorrect to assume noncompliance
when it may actually be lack of understanding.
3. A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation.
What drug would the nurse suspect is most likely to contribute to this adverse
effect?
a. Bile acid sequestrants
, b. Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase
inhibitors
c. Cholesterol absorption inhibitor
d. Fibrates
Ans: A
Feedback:
Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress
to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid
sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated
with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or
fibrates.
4. The nurse is engaged in patient teaching about a newly prescribed bile acid
sequestrant that may be mixed with a carbonated beverage. What bile acid
sequestrant is the nurse describing?
a. Cholestyramine (Questran)
b. Colesevelam (Welchol)
c. Colestipol (Colestid)
d. Ezetimibe (Zetia)
Ans: C
Feedback:
Colestipol can be mixed with a carbonated beverage. The mixture should be stirred
and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption
inhibitor and comes in tablet form. The other two options are bile acid sequestrants,
but should not be taken with carbonated beverages. The carbonation interferes with
the absorption of the drug.
5. The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do.
What expected outcome will the nurse describe?
a. Decrease in serum cholesterol only
b. Decrease in serum cholesterol and low density lipoprotein (LDL) levels
c. Decrease in sitosterol and serum cholesterol
d. Decrease in campesterol and LDL levels
Ans: B
Feedback:
Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor
and should lower serum cholesterol and LDL levels as well as prevention of a first
myocardial infarction and slow the progression of coronary artery disease. A decrease
in serum cholesterol alone would result from the use of a bile acid sequestrant. A
cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels
as well as decrease levels of serum cholesterol and LDL.
1. When planning patient care the nurse recognizes what patient is at greatest risk of
developing coronary artery disease?
a. A 32-year-old Asian American with total cholesterol of 120 mg/dL
b. A 62-year-old white American with total cholesterol of 260 mg/dL
c. A 48-year-old African American with total cholesterol of 198 mg/dL
d. A 26-year-old Native American with total cholesterol of 150 mg/dL
Ans: B
Feedback:
White Americans have the highest incidence of coronary artery disease (CAD). This
patient has total cholesterol of 260 mg/dL, which is considered high according to the
Third Report of the National Cholesterol Education Program Expert Panel. The other
three patients could be at risk due to cultural risk factors such as hypertension,
diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to
cholesterol ratio. However, their total cholesterol levels fall within normal or
desirable range.
2. The nurse is assessing a patient who reports taking cholestyramine (Questran)
mixed with diet cola twice per day. What is an appropriate nursing diagnosis for
this patient?
a. Acute pain related to central nervous system and GI effects
b. Constipation related to GI effects
c. Noncompliance related to how the drug is taken
d. Deficient knowledge regarding drug therapy
Ans: D
Feedback:
Cholestyramine should be mixed with water or other noncarbonated fluids so the
nurse now recognizes the need for medication teaching and chooses the nursing
diagnosis related to deficient knowledge. Nothing in this question indicates that the
patient is experiencing any adverse effects from the drug so that pain and constipation
would not be optimal nursing diagnoses. Until the nurse assesses the patient’s
understanding of how to take the drug, it would be incorrect to assume noncompliance
when it may actually be lack of understanding.
3. A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation.
What drug would the nurse suspect is most likely to contribute to this adverse
effect?
a. Bile acid sequestrants
, b. Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase
inhibitors
c. Cholesterol absorption inhibitor
d. Fibrates
Ans: A
Feedback:
Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress
to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid
sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated
with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or
fibrates.
4. The nurse is engaged in patient teaching about a newly prescribed bile acid
sequestrant that may be mixed with a carbonated beverage. What bile acid
sequestrant is the nurse describing?
a. Cholestyramine (Questran)
b. Colesevelam (Welchol)
c. Colestipol (Colestid)
d. Ezetimibe (Zetia)
Ans: C
Feedback:
Colestipol can be mixed with a carbonated beverage. The mixture should be stirred
and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption
inhibitor and comes in tablet form. The other two options are bile acid sequestrants,
but should not be taken with carbonated beverages. The carbonation interferes with
the absorption of the drug.
5. The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do.
What expected outcome will the nurse describe?
a. Decrease in serum cholesterol only
b. Decrease in serum cholesterol and low density lipoprotein (LDL) levels
c. Decrease in sitosterol and serum cholesterol
d. Decrease in campesterol and LDL levels
Ans: B
Feedback:
Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor
and should lower serum cholesterol and LDL levels as well as prevention of a first
myocardial infarction and slow the progression of coronary artery disease. A decrease
in serum cholesterol alone would result from the use of a bile acid sequestrant. A
cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels
as well as decrease levels of serum cholesterol and LDL.
