Question 1

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?

Accepted Answer

Digoxin can be taken 1 hour before or 4 hours after taking a bile acid sequestrant. Colesevelam reduces the LDL cholesterol level, which is one of its therapeutic uses. Colesevelam augments statin therapy. Colesevelam does not significantly interact with or reduce the absorption of statins, digoxin, warfarin, or most other drugs.

Question 2

During discharge instruction, a nurse wants to assess a patient's understanding of treatment with cholestyramine (Questran). Which statement made by the patient best demonstrates a need for additional teaching?

Accepted Answer

Patients need not weigh themselves weekly when taking cholestyramine. Cholestyramine should be taken at least 1 hour before other medications. When taken with other medications, cholestyramine can inhibit the absorption of the other drugs. Constipation is the principal complaint with cholestyramine. It can be minimized by increasing dietary fiber and fluids. Regular blood pressure checks are a good idea. The patient is taking cholestyramine because of high cholesterol, which contributes to hypertension.

Question 3

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?

Accepted Answer

Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine.

Question 4

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?

Accepted Answer

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.

Question 5

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:

Accepted Answer

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.

Question 6

An Asian patient comes to the clinic. Upon assessment, the nurse notes a slight yellow tint to the skin and sclera, edema, and hepatomegaly. The drug history reveals that the patient has been taking rosuvastatin (Crestor) for 6 months. The nurse is concerned, because rosuvastatin (Crestor) has been shown to do what?

Accepted Answer

Rosuvastatin reaches abnormally high levels in people of Asian heritage. Consequently, hepatotoxicity may occur more often in Asian patients because of the high level of the drug in the blood. Rosuvastatin does not cause renal or pancreatic toxicity. Rosuvastatin does not cause renal failure. Rosuvastatin does not create myoglobin in the urine.

Question 7

A nurse is reviewing a patient's medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____.

Accepted Answer

Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may need to be reduced.

Question 8

Lovastatin (Mevacor) is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?

Accepted Answer

Patients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach.

Question 9

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?

Accepted Answer

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.

Question 10

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?

Accepted Answer

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.

Question 11

A patient is being started on nicotinic acid (Niaspan) to reduce triglyceride levels. The nurse is providing patient education and should include which adverse effects? (Select all that apply.)

Accepted Answer

Adverse effects of nicotinic acid include intense flushing of the face, neck, and ears; itching; and GI upset (nausea, vomiting, and diarrhea). Constipation and hypoglycemia are not adverse effects of niacin therapy.

Question 12

A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?

Accepted Answer

Regular exercise can reduce LDL cholesterol and elevate high-density lipoprotein (HDL) cholesterol, thereby reducing the risk of coronary heart disease (CHD). The patient should consider the cholesterol-lowering drug an adjunct to a proper diet and exercise. Drug therapy cannot replace other important interventions, such as diet and exercise. The patient should never be instructed to double the dose. Constipation is a side effect of most cholesterol-lowering agents. The patient should be encouraged to eat a high-fiber diet and increase fluids if not contraindicated.

Question 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?

Accepted Answer

Colesevelam can help control hyperglycemia in patients with diabetes; therefore, hypoglycemia is a possible risk. Hyperglycemia is not a risk for patients with diabetes who take colesevelam. Insulin and colesevelam do not interact; therefore, the insulin can be taken at the patient's preferred time or times. Either insulin or oral antidiabetic agents can be taken with colesevelam.

Question 14

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?

Accepted Answer

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.

Question 15

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:

Accepted Answer

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.

Question 16

A patient taking gemfibrozil (Lopid) and rosuvastatin (Crestor) concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?

Accepted Answer

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.

Quiz 50: Prophylaxis of Coronary Heart Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels

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?

During discharge instruction, a nurse wants to assess a patient's understanding of treatment with cholestyramine (Questran) . Which statement made by the patient best demonstrates a need for additional teaching?

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?