Nokea
A client is currently taking propranolol (Inderal) for hypertension, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client, which of the following would likely result?
- A. The client would experience hypoglycemia from increased absorption of glipizide
- B. The client would experience decreased analgesia from decreased absorption of acetaminophen
- C. The client would experience an increase in blood pressure due to decreased absorption of propranolol
- D. The client would experience hypotension from increased absorption of propranolol
- E. The client would experience hyperglycemia from decreased absorption of glipizide
Correct Answer: C,E
Rationale: The use of bile acid resins, like cholestyramine, decreases the absorption of some medications including glipizide and propranolol. This decreased absorption could result in hyperglycemia and an increase in blood pressure for this particular client.
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A nurse is caring for a client taking a cholestyramine drug. What instructions should the nurse give to this client to prevent constipation?
- A. Eat foods high in dietary fiber
- B. Follow a complete liquid diet
- C. Be sure to stay on complete bed rest
- D. Take the water-soluble form of vitamin A
Correct Answer: A
Rationale: The nurse should instruct the client taking a cholestyramine drug to eat foods high in dietary fiber to prevent constipation. The nurse need not instruct the client to have a complete liquid diet or complete bed rest, instead, the nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.
A client with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. The nurse understands that this drug would be contraindicated if the client has which condition?
- A. Endocrine disorder
- B. Primary biliary cirrhosis
- C. Arterial bleeding
- D. Respiratory depression
Correct Answer: B
Rationale: The fibric acid derivative clofibrate is contraindicated in clients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in clients with an endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in clients with respiratory depression.
A nurse is caring for a client receiving gemfibrozil. Which of the following would the nurse include in the teaching plan for this client?
- A. Take the drug along with meals
- B. Observe caution while driving
- C. Take a single dose once daily in the evening
- D. Be alert for mild to severe facial flushing
Correct Answer: B
Rationale: When preparing a teaching plan for the client receiving the fibric acid derivative gemfibrozil, the nurse should instruct the client to observe caution while driving. Rosuvastatin calcium is taken as a single dose once daily in the evening. The nurse instructs a client prescribed nicotinic acid to take it along with meals; it may also cause mild to severe facial flushing.
A client is receiving pravastatin to reduce the risk of coronary heart disease due to hyperlipidemia. The client is also receiving amiodarone for an arrhythmia. The nurse understands that the client is at risk for which of the following based on these two drugs?
- A. Increased anticoagulant effect
- B. Increased hypoglycemic effect
- C. Increased risk of myopathy
- D. Decreased effects of pravastatin
Correct Answer: C
Rationale: When the HMG-CoA reductase inhibitor pravastatin is administered with amiodarone, the nurse should monitor the client for increased risk of myopathy as an effect of the interaction between the two drugs. Increased anticoagulant effect is observed in clients receiving warfarin along with pravastatin. Increased hypoglycemic effects are observed in clients receiving sulfonylureas with fibric acid derivatives. The interaction of pravastatin with amiodarone does not decrease the effect of pravastatin.
A client is receiving atorvastatin. The nurse would be alert to client complaints of which of the following?
- A. Headache
- B. Sedation
- C. Insomnia
- D. Diarrhea
- E. Constipation
Correct Answer: A,C,E
Rationale: Atorvastatin is an HMG-CoA reductase inhibitor (statin). Adverse reactions of statins include headache, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, and nausea.