High Cholesterol Meds
A nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse reaction to the medication?
A. Mental status changes
B. Tremor
C. Jaundice
D. Pneumonia
C
Gemfibrozil is liver toxic and so look for signs of liver injury (RUQ pain, N/V, jaundice). It can also cause gallstones and myopathy so monitor for muscle pain/tenderness, and signs of gallstones (RUQ pain, bloating, fat intolerance).
What are some adverse effects of nitroglycerin to teach your patients about? (select all)
A. Diaphoresis
B. Headache
C. Orthostatic hypotension
D. Constipation
E. Reflex tachycardia
B, C, E
Tell your patients to sit or lie down before taking nitro to avoid falls from hypotension, warn them that headaches are common, their pulse may elevate, and that they can start to form a tolerance to it over time.
What are some labs to monitor in a patient who had pernicious anemia and is now on vit B12 therapy to treat it? (Select all)
A. Folate levels
B. K+ levels
C. Sodium levels
D. H+H
E. Calcium levels
A, B, D
B12 can cause hypokalemia. The point of B12 therapy is also to raise H+H levels back to normal. B12 also causes folate to go from it's active form to inactive form. Other things to monitor are WBC and thrombocytes because B12 is essential in the production of these as well.
One of your patients was just prescribed furosemide to treat CHF. What class of medication is this and what is one lab value that must be monitored closely while someone is taking this?
Furosemide (Lasix) is a high ceiling loop diuretic. One lab value that must be monitored closely is potassium because diuretics classically waste potassium.
What two vital signs should you check before giving a patient metoprolol?
HR and BP
Metoprolol is a beta blocker and so lowers HR and heart contractility. A HR <60 and or a low systolic BP would warrant you to hold this medication.
A patient of yours came to the office for their yearly checkup. They were found to have high LDL and low HDL and were prescribed atorvastatin (Lipitor) to help treat it. What should you teach them about taking this medication? (Select all)
A. Take this medication with an evening meal or at bedtime
B. Rise slowly when getting up from a sitting/lying position
C. Avoid grapefruit or grapefruit juice while taking this
D. Alcohol in moderation is ok to consume while taking this
E. Report any muscle pain or tenderness while taking this
A, C, E
Statins are liver toxic (avoid alcohol, monitor for signs of liver injury), can cause myopathy (muscle pain/tenderness), are taken at night because most cholesterol is synthesized at night, and grapefruit juice should be avoided because it can raise blood levels of statins.
One of your patients has angina and is learning to deal with anginal attacks. They ask you: “What should I do if I’m having pain, take a tablet, wait 5 minutes but I still have pain after 5 minutes?” What should you tell them?
Call 911 and take a 2nd tablet
Take 2 more tablets
Wait 5 more minutes and take a 2nd tablet
Apply a nitroglycerin patch and wait 5 more minutes
A
Your patient should sit or lay down, take a tablet, and wait 5 minutes. If pain is still present after 5 minutes, call 911 and take a 2nd tablet. Wait 5 more minutes and if pain is still present, take a 3rd tablet and wait for EMS to arrive. (don’t take more than 3 tablets)
What anemia can Folic Acid masks the signs of?
B12 deficiency
A nurse is administering a dopamine infusion at a low dose to a patient who has severe heart failure. Which of the following findings is an expected effect of this medication?
A. Lowered heart rate
B. Increased myocardial contractility
C. Decreased conduction through the AV node
D. Vasoconstriction of renal blood vessels
B
The nurse should expect dopamine to cause increased myocardial contractility, which also increases cardiac output. This occurs with the stimulation of beta1 receptors and is a positive inotropic effect of dopamine when it is administered at a low dose.
What adverse effect would you look for in a patient who just received captopril?
A. Constipation
B. Blurry vision
C. Swelling of the tongue or face
D. Muscle weakness
C.
Captopril is an ACE inhibitor and one of the adverse effects of an ACE inhibitor is a angioedema as well as a dry, chronic cough
One of your patients was prescribed atorvastatin to treat their hyperlipidemia. What are S/S of adverse effects to this medication? (Select all)
A. N/V and RUQ pain
B. Muscle pain and tenderness
C. Flushing of the face
D. Tingling of the fingers and toes
A, B
Statins are liver toxic and can cause myopathy so look for signs of liver injury (RUQ pain, N/V, anorexia, jaundice) and myopathy (muscle pain/tenderness, increased CK levels)
You are about to start and IV drip of 1000 ml of 1/2 NS w/ 40 mEq of potassium chloride for one of your patients who has hypokalemia. What is the maximum rate at which this solution can be run?
A. 500 ml/hr
B. 200 ml/hr
C. 1000 ml/hr
D. 250 ml/hr
D.
The maximum rate at which potassium chloride can be run is 10 mEq/hr.
40 mEq/10 mEq/hr = 4 hr (fastest time this solution can be run)
1000ml/4hr = 250 ml/hr
What should you educate your patient on that is taking Ferrous Sulfate?
Dark green/Black stools, Abnormal bowel patterns, teeth staining, hypotension
dilute with water and rinse mouth after taking, drink with straw and take on empty stomach
One of your patients was just prescribed hydrochlorothiazide to treat primary HTN. What are some education points to go over with this patient about taking this medication? (select all)
A. Avoid potassium containing foods like bananas
B. Take this medication at night before bed
C. Report muscle weakness, muscle cramps, and or/palpitations
D. Rise slowly if feeling lightheaded
E. You can take this medication, even if you have chronic kidney disease
C, D
Hydrochlorothyazide is a thiazide diuretic and can cause hypokalemia, increased BG, and patients must have working kidneys for this medication to work. You also want to take this medication in the morning to avoid nocturia.
You just gave one of your patients spironolactone. What kind of dietary education would you provide for this patient?
A. Reduce intake of foods high in potassium like bananas.
B. Increase your intake of foods that are high in fiber.
C. Drink 3-4 L of fluid daily.
D. Avoid foods high in calcium like dairy products.
A.
Spironolactone is a potassium sparing diuretic and so can raise potassium levels.
Which of the following is a complication of Cholestyramine?
A. GI effects
B. Neuro Effects
A. GI Effects
Cholestyramine causes a decrease LDL by blocking the bile acid in your stomach from being absorbed in your blood.
One of your patients has angina pectoris and was prescribed a nitro patch to treat it long-term. What are some teachings to go over with them about patch use? (Select all)
A. apply the patch to a hairless part of the body
B. Leave the patch on all day, even at night
C. Wash the old patch spit with soap and water and then apply the new patch to a different spot on the body
D. Apply the patch to the chest, back, or abdomen, preferably
A, C, D
The patch should be taken off at night to reduce the risk of tolerance and it should be applied to a clean, hairless spot on either the chest, back, or abdomen for best use.
Education points for Warfarin are...
Electric razor, avoid leafy greens, soft toothbrush, bruising, tachycardia, jaundice
This medication is an aplha1, beta1, and beta2 agonist and increases HR, heart contractility, and causes bronchodilation. It is widely used to treat hypotension, cardiac arrest, and anaphalactic reactions.
Epinephrine
Make sure to monitor BP, HR, and patient condition while giving this because it can cause severely high BP and cause dangerous heart arrythmias.
You are about to give a patient of yours nifedipine. What is the action of this med and what should you check before giving it?
It's a calcium channel blocker and so blocks calcium channels in the smooth muscle of the arteries to cause widespread vasodilation. This reduces BP and BP should be checked before giving this.
What food should you avoid while on Atorvastatin?
A. Leafy Greens
B. Grapefruit Juice
C. Tyramine Foods
D. Shellfish
B. Grapefruit juice
Which thrombolytic is used to break down clots that have previously formed?
Alteplase (TPA)
One of your patients is on captopril to treat HTN. What are some adverse effects of this med? (select all)
A. Hyperkalemia
B. Neutropenia
C. Constipation
D. Cough
E. Orthostatic hypotension
A, B, D, E
Another adverse effect of ACE inhibitors is angioedema. Make sure to moniotr potassium labs, WBC, teach the patient about changing positions slowly, and if they form a chronic cough, switch them to an ARB.
One of your patients is on digoxin to treat their CHF. What S/S should be monitored for in digoxin toxicity? (select all)
A. Fatigue
B. Constipation
C. Anorexia
D. Rash
E. Vision changes
A, C, E
Other signs of digoxin toxicity include N/V, abdominal pain, weakness, bradycardia, and dysrhythmias.