Deck 19: Drug Therapy for High Blood Lipids

Question 1

Which statement by a patient who has been prescribed an antilipidemic drug indicates the need for additional teaching?

A) "Once my lipid profile levels are normal,I will no longer need to take the drug."
B) "Taking this drug will decrease my risk for having a heart attack."
C) "My goal is to increase my HDL cholesterol and decrease my LDL cholesterol."
D) "I will continue walking and watching the fat in my diet while I'm taking this drug."

Answer 1

"Once my lipid profile levels are normal,I will no longer need to take the drug."

Question 2

What problem is usually caused by high blood lipid levels?

A) Atherosclerosis
B) Blindness from glaucoma
C) Chronic hypotension
D) Deadly dysrhythmias

Answer 2

Atherosclerosis

Question 3

What is one of the main intended responses of fibrates?

A) Increased triglycerides
B) Increased blood clotting
C) Increased LDL cholesterol
D) Increased HDL cholesterol

Answer 3

Increased HDL cholesterol

Question 4

For which patient should statin drugs be avoided?

A) Children over age 8 years
B) Women who are pregnant
C) Men who are over age 65 years
D) Women who are over age 65 years

Question 5

A patient prescribed atorvastatin (Lipitor)reports all of the following problems or changes since starting this drug.Which problem or change do you report to the prescriber?

A) Abdominal cramps and bloating
B) Muscle aches and weakness
C) Urinating more at night
D) Loss of taste for sweets

Question 6

A patient prescribed atorvastatin (Lipitor)reports experiencing some muscle pain and weakness.What is your best action?

A) Administer ordered acetaminophen (Tylenol)as needed.
B) Document the finding as the only action.
C) Reassure the patient that this is an expected side effect.
D) Hold the drug and notify the prescriber.

Question 7

How do antihyperlipidemic drugs from the statin class lower "bad" cholesterol levels?

A) They act as a filter in the blood to trap bad cholesterol and allow white blood cells to destroy it.
B) They block the absorption of dietary fats through the walls of the intestinal tract.
C) They bind to cholesterol in the intestinal tract and promote its excretion in stool.
D) They inhibit HMG CoA reductase and decrease normal liver production of cholesterol.

Question 8

A patient who is prescribed simvastatin (Zocor)asks why liver function tests must be drawn every 6 months.What is your best response?

A) "The tests are important because early liver problems do not cause symptoms."
B) "The tests help your prescriber decide what your dose of simvastatin should be."
C) "The tests tell your prescriber how well your body is responding to the therapy."
D) "The tests indicate how much cholesterol is being produced by your liver."

Question 9

A patient with high blood lipids asks why the lipid profile did not improve after 3 months following a low-fat diet.What is your best response?

A) "You may need to follow a no-fat diet to improve your lipid profile."
B) "You must follow a low-fat diet for at least 6 months to see improvement."
C) "You will definitely need to be prescribed a drug to see improvement."
D) "You may have a genetic factor that is causing your high blood lipid levels."

Question 10

What is the most common side effect of nicotinic acid agents?

A) Itching
B) Blurred vision
C) Muscle weakness
D) High blood pressure

Question 11

A patient has been prescribed an antihyperlipidemic drug.Which laboratory value should you report to the prescriber?

A) Total cholesterol 198 mg/dL
B) Triglycerides 135 mg/dL
C) Low-density lipoprotein (LDL)195 mg/dL
D) High-density lipoprotein (HDL)60 mg/dL

Question 12

Which laboratory finding should be reported to the prescriber before giving any antihyperlipidemic drug?

A) Aspartate aminotransferase 41 IU/L
B) Alanine aminotransferase 24 IU/L
C) Alkaline phosphatase 130 IU/L
D) Gamma-glutamyltransferase 50 IU/L

Question 13

What enzyme is inhibited by the "statin" type of lipid-lowering drugs?

A) Integrase
B) Alteplase
C) Reverse transcriptase
D) HMG CoA reductase

Question 14

How do bile acid sequestrants work to lower blood lipids?

A) Increasing the intestinal excretion of dietary fat
B) Preventing the liver from making excess lipids
C) Decreasing the movement of blood lipids into blood vessel cells
D) Moving extra lipids out of atheromas and into the intestinal tract

Question 15

Which lipid-lowering drug type can cause gout?

A) Statins
B) Fibrates
C) Nicotinic acid agents
D) Bile acid sequestrants

Question 16

Which lipid-lowering drug type can cause gallstones?

A) Statins
B) Fibrates
C) Nicotinic acid agents
D) Bile acid sequestrants

Question 17

A patient who has been prescribed lovastatin (Mevacor)asks why all urine must be saved for intake and output measurements.What is your best response?

A) "All patients on this unit have orders for strict intake and output measurements."
B) "Intake and output measurements are important indicators of how well your kidneys are functioning."
C) "A side effect of this drug can be blockage of urine flow through the kidneys and decreased urine output."
D) "Sometimes this drug can cause the kidneys to make extra urine resulting in increased urine output and dehydration."

Question 18

What does the term "rhabdomyolysis" mean?

A) High blood lipid levels
B) Skeletal muscle breakdown
C) Coronary artery disease from atherosclerosis
D) Skin yellowing (jaundice)from liver complications

Question 19

Which statement about cholesterol is true?

A) The only source of cholesterol is from the foods a person eats.
B) Cholesterol always has harmful effects on a person's body.
C) Too much cholesterol leads to a deficit of bile acids that digest fat.
D) It is a fatty,waxy material present in cell membranes of the body.

Question 20

What is the most common side effect of bile acid sequestrants?

A) Intestinal gas
B) Facial flushing
C) Blurred vision
D) Muscle weakness

Question 21

What should you teach a woman of childbearing age who is prescribed a statin drug?

A) "These drugs should not be taken during pregnancy,but are safe to use when breastfeeding."
B) "Statins drugs can interfere with fetal brain development and should not be taken during pregnancy or breastfeeding."
C) "Because these drugs control fats produced by the liver,they will help control weight gain during pregnancy."
D) "You can take these drugs during pregnancy as long as you do not have a history of muscle or liver problems."

Question 22

A patient is prescribed Cozaar (losartan)25 mg orally for hyperlipidemia.What is your best action?

A) Administer the drug as ordered.
B) Check that the dosage is correct.
C) Always give the drug early in the morning.
D) Hold the drug and contact the prescriber.

Question 23

A patient is prescribed niacin (Niaspan)500 mg orally.The pharmacy sends niacin (Niacor)500 mg.What is your best action?

A) Hold the drug and contact the prescriber.
B) Administer the Niacor in place of the Niaspan.
C) Ask the pharmacy to send the patient's ordered Niaspan.
D) Check the patient's chart to find out if he or she takes Niacor at home.

Question 24

What action must you take for a diabetic patient who is prescribed niacin (Niacor)?

A) Give insulin only in the presence of food.
B) Check the blood glucose level more often.
C) Decrease the morning insulin dosage.
D) Encourage increased caloric intake.

Question 25

For which patient is drug therapy with nicotinic acid contraindicated?

A) 28-year-old who has familial hyperlipidemia
B) 38-year-old who had hyperthyroidism and lactose intolerance
C) 58-year-old who has an actively bleeding duodenal ulcer
D) 78-year-old who takes an oral drug for type 2 diabetes

Question 26

A patient who is prescribed cholestyramine (Questran)tablets reports experiencing bloating,nausea,and gas.What is your best action?

A) Hold the drug and notify the prescriber.
B) Document the finding as the only action.
C) Administer the drug before meals to avoid nausea.
D) Teach the patient to drink 12 to 16 ounces of water with the drug.

Question 27

Which health problems should you teach a patient can be caused by chronic hyperlipidemia? (select all that apply)

A) Hypertension
B) Pancreatitis
C) Peptic ulcer disease
D) Xanthoma
E) Diabetes mellitus

Question 28

A patient is prescribed cholestyramine (Questran)is also taking warfarin (Coumadin).For which specific action should you be prepared?

A) To administer IV vitamin K
B) To ask the patient about diarrhea
C) To keep accurate intake and output records
D) To teach the patient about the need for a fat-free diet

Question 29

A patient who is prescribed niacin (Niacor)reports experiencing flushing and hot flashes.What is your best action?

A) Hold the drug and notify the prescriber.
B) Give the niacin at least 1 hour before meals.
C) Reassure the patient that this is an expected side effect.
D) Administer the ordered NSAID 30 minutes before the niacin.

Question 30

Why should the use of cholestyramine (Questran)and colestipol (Colestid)be avoided in children?

A) These drugs can cause muscle breakdown in children.
B) These drugs can cause intestinal obstruction in children.
C) These drugs can cause mental deficits in children.
D) These drugs can cause bleeding and easy bruising in children.

Question 31

A patient prescribed ezetimibe (Zetia)has developed swelling around the eyes,nose,and lips.What is your priority action at this time?

A) Elevate the head of the bed.
B) Notify the prescriber.
C) Assess the patient's airway.
D) Check the patient's blood pressure.

Question 32

Which statement made by a patient who has been prescribed simvastatin (Zocor)indicates the need for more teaching?

A) "I have been taking this drug every night at bedtime as directed by my pharmacist."
B) "I have stopped using butter when I cook and have been using olive oil instead."
C) "My LDL cholesterol level today is 101 mg/dL so the drug has cured my cholesterol problem."
D) "I hope that by reducing my fatty food intake,I might not have to take medications to manage my cholesterol problem."

Question 33

Which laboratory blood value is most important for you to monitor when a patient is prescribed both colestipol (Colestid)and warfarin (Coumadin)?

A) Hematocrit
B) Hemoglobin
C) Red blood cell (RBC)count
D) International normalized ratio (INR)

Question 34

A hospitalized patient who is prescribed lovastatin (Mevacor)80 mg orally looks at the four tablets you provides and says,"At home,I only take two pills for 80 mg.I think this is too many pills." What is your best action?

A) Hold the dose and contact the prescriber or pharmacist to confirm that the order is correct.
B) Remind the patient that the prescriber knows what is best for his or her particular health problem.
C) Explain that each tablet contains 20 mg of the drug instead of 40 mg,and that four 20 mg tablets are the same dosage as two 40 mg tablets.
D) Explain to the patient that while at home a lower dosage of the drug may have been prescribed than what is required while being hospitalized.

Question 35

A patient is prescribed colesevelam (WelChol)1875 mg twice a day.Available tablets are 625 mg each.How many tablets should you administer to the patient for each dose?

A) 2
B) 3
C) 4
D) 5

Question 36

Why should you ask a patient prescribed a "statin" drug for hyperlipidemia about his or her daily alcohol consumption?

A) Alcohol increases the action of most statin drugs and can lead to side effects.
B) Statin drugs increase the action of alcoholic beverages causing a person to feel drunk only after two drinks.
C) Taking a statin and consuming more than two alcoholic drinks per day is stressful on the liver.
D) Alcohol interferes with the action of statin drugs so the prescriber must order a much higher dose.

Question 37

A patient who has been taking niacin (Niacor)daily for 1 week reports intense itching.What is your best response?

A) "This is a common side effect and many people can control it by taking aspirin."
B) "Stop taking the drug and talk with your prescriber as soon as possible."
C) "Unless your skin forms blisters or peels,continue to take the drug."
D) "Do you have any other drug,food,pet,or pollen allergies?"

Question 38

Which food,drink,or herbal supplement should you warn a patient prescribed gemfibrozil (Lopid)to avoid?

A) Caffeinated beverages
B) Grapefruit juice
C) St.John's wort
D) Dairy products

Question 39

Why do the most common side effects of any bile acid sequestrant include bloating,abdominal discomfort,and constipation?

A) Many patients are lactose intolerant and these drugs contain lactose.
B) Bile acid sequestrants exert their effects directly in the intestinal tract.
C) The action of bile acid sequestrants on the liver releases bile into the intestinal tract.
D) The drugs inhibit the absorption of dietary fiber,increasing its concentration and effects in the intestinal tract.

Question 40

A patient prescribed niacin extended action (Niaspan)reports all of the following new onset problems.For which problem should you notify the prescriber?

A) Moderate itchiness,especially at night
B) Six to seven loose stools daily
C) Increased nighttime urination
D) Swollen,painful great toe

Question 41

A patient is prescribed to receive simvastatin (Zocor)60 mg orally.The drug on hand is simvastatin 40 mg/scored tablet.How many tablets should you give for the correct dose?

Question 42

What are the expected and intended responses for nicotinic acid agents? (select all that apply)

A) Total cholesterol is decreased.
B) Total triglyceride level is increased.
C) LDL cholesterol level is decreased.
D) VLDL cholesterol is increased.
E) HDL cholesterol level is increased.

Question 43

What are the symptoms of late liver disease? (select all that apply)

A) Yellowing of the skin
B) Light-colored diluted urine
C) Pale gray-colored stools
D) Pain on the right side just below the ribs
E) Reddened mucous membranes in the mouth

Question 44

Which teaching points should you include for a patient prescribed any antihyperlipidemic drug? (select all that apply)

A) Continue to follow a low-fat diet.
B) Be sure to exercise regularly.
C) Always take these drugs with food.
D) Fast for at least 8 hours before your lipid levels are drawn.
E) You will need follow-up laboratory tests once a year.