Nokea
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.
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A client is prescribed a bile acid resin and has been taking this therapy long term. The primary health care provider has prescribed vitamins A and D in waterHIV/AIDS water-soluble form. Which nursing diagnosis would be most likely?
- A. Risk for Impaired Skin Integrity
- B. Constipation
- C. Risk for Injury
- D. Risk for Imbalanced Nutrition: Less Than Body Requirements
Correct Answer: D
Rationale: Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for injury may be appropriate for clients taking fibrates or statins.
Which of the following should be included by the nurse during client teaching to improve client outcomes for a client receiving antihyperlipidemic drugs?
- A. Measures to minimize gastrointestinal upset
- B. Consultation with a dietitian for assistance with diet teaching
- C. Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels
- D. Focus on the importance of taking drug exactly as prescribed
- E. Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider
Correct Answer: A,B,D,E
Rationale: Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels.
The nurse is reviewing a client's medical record for predisposing factors for myopathy requiring that the client be started on low doses of statins and titrated as tolerated or until cholesterol goals are met. Which of the following would the nurse identify as one of these factors?
- A. Asian descent
- B. Severe renal insufficiency
- C. Use of antihistamines
- D. Use of cyclosporine
- E. Cigarette smoking
Correct Answer: A,B,D
Rationale: Predisposing factors for myopathy with statin therapy include Asian descent, severe renal insufficiency, and use of cyclosporine.
A nurse is reviewing a client's laboratory test results after being on statin therapy for several months. Which of the following would the nurse interpret as indicating effectiveness of the drug?
- A. Total cholesterol 220 mg/dL
- B. LDL cholesterol 80 mg/dL
- C. HDL cholesterol 30 mg/dL
- D. LDL cholesterol 165 mg/dL
- E. HDL cholesterol 60 mg/dL
Correct Answer: B,E
Rationale: Effectiveness of therapy would be indicated by values that are low or optimal. This would include a total cholesterol below 200 mg/dL, LDL less than 100 mg/dL, and HDL greater than 40 mg/dL.
A client is receiving warfarin therapy as part of the treatment plan for atrial fibrillation. The client is also to begin therapy with cholestyramine. When assessing the client, the nurse would be alert for which of the following?
- A. Bruising
- B. Blood in the stool
- C. Subtherapeutic INR
- D. Supratherapeutic INR
- E. Calf pain and warmth
Correct Answer: C,E
Rationale: Coadministration of warfarin and cholestyramine can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).