Antihyperlipidemics
A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide?
A. Follow each tablet with an antacid tablet.
B. Swallow the tablet with a glass of grapefruit juice.
C. Take the medication before bed.
D. Have a meal or a snack when taking the medication.
C
Statins are most effective if taken at bedtime or with the evening meal because this is when the peak production of cholesterol takes place.
The nurse is providing education to a client who has been prescribed captopril. What common adverse effect would the nurse mention in the teaching?
a. Rhinitis
b. Dry Cough
c. Photosensitivity
d. TinnitusB
A persistent cough develops in a significant number of clients taking captopril, and this problem may lead to discontinuation of the drug. Photosensitivity, rhinitis, and rash are not common adverse effects of ACE inhibitors.
A client diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The client has received the first two doses of the medication and reports dizziness. What is the nurse’s best action?
a. Reassure the client that this is an expected adverse effect.
b. Report this finding to the client’s primary health care provider.
c. Assess the client’s blood pressure.
d. Withhold the next scheduled dose and implement falls precautions.
C
If a client reports dizziness after beginning treatment with a calcium channel blocker, hypotension is a likely cause. The nurse should obtain objective data by assessing the client’s blood pressure before taking further action. The nurse should not independently withhold the drug. The nurse should assess the client before providing reassurance. There may be no need to report this to the provider if it is transient.
A nurse is caring for a client who has a new prescription for warfarin. The nurse should use the results of which of the following diagnostic tests to monitor the effect of this therapy?
A. International normalised ratio (INR)
B. Platelet count
C. White blood cell count (WBC)
D. Activated partial thromboplastin time (aPTT)
A. International normalised ratio (INR)
The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?
a. Sodium
b. CBCc. Calcium
d. Potassium
D.
Furosemide is associated with a loss of potassium, so the client will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.
A nurse is reinforcing teaching with a client who is to start taking atorvastatin. The nurse should instruct the client that she will need which of the following baseline examinations prior to starting therapy?
A. Liver function tests
B. Vision testing
C. Complete blood count
D. Dental examination
A
Statins such as atorvastatin can cause liver damage and liver disease is a contraindication for taking the medication. The client should have baseline liver function testing before beginning therapy, then every 1 to 2 months, at 6 and 12 weeks, and then periodically throughout therapy
A nurse is reinforcing teaching with a client who has a prescription for lisinopril. Which of the following statements indicates an understanding of the teaching?
A. "I can expect my voice to be hoarse while taking this medication."
B. "I should use salt substitutes while taking this medication."
C. "I should check my pulse before each dose of this medication."
D. "I will contact my provider if I become pregnant while taking this medication."
D. "I will contact my provider if I become pregnant while taking this medication."
Answer Rationale: The nurse should instruct the client to notify the provider if pregnancy occurs while taking lisinopril. This medication can cause fetal injury including fetal death if taken in the second or third trimester. If a client becomes pregnant, the ACE inhibitor should be withdrawn.
A client receiving amlodipine for angina is now reporting dizziness. Which intervention should the nurse prioritize to help alleviate the condition?
a. Apply a cold cloth over the forehead.
b. Instruct the client to lie down.
c. Instruct the client to drink more water.
d. Reduce the dosage of amlodipine.
d. Dizziness is a common central nervous system adverse effect seen with calcium channel blocker use. The nurse should instruct the client to lie down until the dizziness passes. Applying a cold cloth over the forehead will not relieve the dizziness. The dosage should not be reduced or altered unless instructed by the health care provider. Increasing the fluid consumption will also not help in alleviating dizziness.
A nurse is collecting data from a client who is taking warfarin and has an elevated PT/INR. Which of the following medications should the nurse anticipate administering?
A. Vitamin K
B. Protamine
C. Praxbind
D. Andexxa
D. Vitamin K
The effects of warfarin can be reversed with the administration of phytonadione, or Vitamin K.
A 91-year-old client is being discharged on the diuretic spironolactone. What assessment finding would the nurse attribute to adverse effects of this medication?
a. polyuria and polyphagia
b. confusion and irregular heart rate
c. diarrhea and positive stool for occult blood (FOB) test
d. blood pressure of 160/109 mm Hg
B
The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Diarrhea, gastrointestinal bleeding, and hypertension are not recognized as adverse effects of spironolactone. Polyuria is expected, but polyphagia is atypical.
In addition to liver function testing, what diagnostic is priority to complete for a female patient prior to beginning a new prescription of a statin?
A. Pregnancy test
B. PT/INR
C. Potassium
D. Creatinine/BUN
A. Pregnancy test
Statins are a Category X medication and can cause during pregnancy and lactation.
A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering?
a. Valsartan
b. Furosemide
c. Verapamil
d. Isosorbide dinitrate
A
If the patient cannot continue taking an angiotensin-converting enzyme (ACE) inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia, an angiotensin receptor blocker (ARB) or a combination of hydralazine and isosorbide dinitrate is prescribed (see Table 29-3).
The client is taking a calcium-channel blocker. What adverse effects might the client experience?
a. Hypertension and tachycardia
b. Headache and dizziness
c. Palpitations and tingling of extremities
d. Fever and bronchospasm
B
Adverse effects of calcium channel blockers include hypotension, headache, dizziness, lightheadedness, weakness, edema, nausea, and constipation.
A nurse is caring for a client who is taking warfarin. When providing education, the nurse should include information about minimizing intake of foods high in vitamin K. What food will the nurse include in the teaching?
a. Eggs
b. Milkc. Grapefruit
d. Spinach
D.
What sign is most indicative of hydration in a patient taking diuretics?
a. Bradycardia
b. Dry cough
c. Body weight
d. Skin turgor
C
Obtain an accurate body weight, to provide a baseline to monitor fluid balance. The other options would not indicate dehydration.
A nurse is reviewing the medical record of a client who has been taking simvastatin for 9 months. The client has an alanine aminotransferase (ALT) 120 units/L and aspartate aminotransferase (AST) 100 units/L. Which of the following data from the client’s dietary history should the nurse report to the provider?
A. The client drinks milk when taking the medication.
B. The client drinks grapefruit juice every evening.
C. The client eats spinach salad daily.
D. The client consumes a diet high in gluten
B. The client drinks grapefruit juice every evening.
Grapefruit inhibits the drug-metabolizing enzyme CYP3A4. Clients taking statin medications and consuming grapefruit juice can experience medication toxicity, leading to headache, gastrointestinal disturbances, and damage to the muscles and liver. The nurse should report this finding to the provider to prevent further harm to the client.
A client is receiving captopril for heart failure. Which finding indicates that the medication isn't producing the desired treatment outcome and requires the nurse to notify the health care provider?
A. Skin rash
b. Peripheral edema
c. Dry cough
D. Orthostatic hypotension
B
Peripheral edema is a sign of fluid volume overload and worsening heart failure. A skin rash, dry cough, and orthostatic hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.
A nurse is collecting data from a client prior to administering nifedipine. For which of the following findings should the nurse contact the provider?
A. Peripheral edema of the ankles
B. BP of 148/94 mm Hg
C. Heart rate of 66/min
D. Increased alkaline phosphatase level
A.
Peripheral edema can occur due to the vasodilation principles of nifedipine. The nurse should monitor for edema of the feet and ankles and notify the provider if this occurs.
A nurse is collecting data from a client who is receiving clopidogrel following the placement of a cardiac stent. Which finding should the nurse identify as an adverse effect of this medication?
A. Constipation
B. Hypotension
C. Black stools
D. Hypothermia
C Black Stools
Clopidogrel helps prevent stent closure, but can cause gastrointestinal bleeding, with manifestations such as black, tarry stools, coffee-ground emesis, and easy bruising. The nurse should notify the provider immediately of any of these findings.
A client has been prescribed furosemide. The nurse should recommend what food in order to prevent adverse effects?
a. Potatoes
b. Brown Rice
c. Chicken Breastd. Cheese
Potassium-Rich Foods
Avocados
Dried fruits
Navy beans
Prunes
Sunflower seeds
Bananas
Grape -fruit
Oranges
Rhubarb
Tomatoes
Broccoli
Lima beans
Peaches
Decaffeinated Coffee
Watermelon
Cantaloupe
Nuts
Potatoes
Spinach
A nurse is reinforcing teaching with a client who has hyperlipidemia and is taking atorvastatin daily. Which of the following statements by the client indicates understanding?
A. "I will notify my provider if my arms feel weak."
B. "I must take this medication without food."
C. "It is best if I take this medication in the morning."
D. "It is not necessary to have any routine lab tests done."
A. "I will notify my provider if my arms feel weak."
Atorvastatin is an HMG-CoA reductase inhibitor. It is in a class of medications more commonly known as statins, which are the most effective medications in lowering LDL and total cholesterol. Two serious adverse effects of statins are hepatotoxicity and myopathy. The nurse should instruct the client to report any onset of muscle weakness or aches to the provider due to the possibility of myopathy.
A nurse is caring for an older adult client who has a prescription for captopril. For which of the following possible adverse effects should the nurse instruct the client to notify the provider immediately?
A. Metallic taste
B. Headache
C. Sore ThroatC
A sore throat, fever, easy bruising, and bleeding are manifestations of neutropenia, which is a serious adverse effect of captopril and other angiotensin-converting enzyme inhibitors (ACE inhibitors). The nurse should inform the client to notify the provider immediately if any of these manifestations occur.
The client has been prescribed amlodipine for hypertension. The client’s blood pressure upon a revisit remains elevated. The nurse inquiries about the use of which alternative therapy?
a. St. John's Wort
b. Lavender
c. Prune Juice
d. Hawthorne
A
When taken with a calcium channel blocker, the herb St. John's wort can cause a decrease in serum levels of the calcium channel blocker. Neither hawthorn, lavender, nor prune juice is known to affect serum levels of calcium channel blockers.
A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 0800 dose. The results show that the aPTT is at 3.5 times the control value. What is the nurse’s priority action?
a. Give a dose larger than is prescribed to the client.
b. Give the dose as prescribed and chart the results.
c. Check the client's vital signs prior to administering the dose.
d. Hold the dose and call the primary health care provider.
Answer D
The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The client’s value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the primary health care provider.
A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides?
a. Thiazide diuretics
b. Loop diuretics
c. Potassium-sparing diuretics
d. Osmotic diuretics
A
A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides.