Test Bank Essential Cell Biology 5th Edition Alberts Hopkin Questions & Answers with rationales (Chapter 1-20)

Test Bank Essential Cell Biology 5th Edition Alberts Hopkin Questions & Answers with rationales (Chapter 1-20)

1. A female patient has a serum lipid panel performed, which reveals a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a highdensity lipoprotein (HDL) of 40 mg/dL. The patient’s blood pressure is 138/72 mm Hg. The patient is currently not receiving any prescription medications. Which of the following would be the most appropriate medication to be started at this time? a. Ezetimibe b. Colestipol c. Fenofibrate d. Atorvastatin ANS: D Statins have actions in decreasing serum cholesterol, LDL, VLDL, and triglycerides, and they slightly elevate HDL. Because the patient has elevated cholesterol levels, starting a statin at this time would be appropriate and considered an appropriate first-line antihyperlipidemic therapy. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Assessment | Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient has a serum cholesterol level of 270 mg/dL. The patient asks the nurse what this level means. Which response by the nurse is correct? a. “Your cholesterol places you at high risk for coronary artery disease.” b. “Your cholesterol places you at moderate risk for coronary artery disease.” c. “You have a low risk for coronary artery disease.” d. “You have no risk for coronary artery disease.” ANS: A A cholesterol value >270 mg/dL for serum cholesterol puts the patient at high risk for CAD. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 3. A patient begins taking cholestyramine to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient? a. Increase fluid intake and slowly increase fiber intake. b. Stop taking the medication immediately. c. Take an over-the-counter laxative. d. Take the medication on an empty stomach. ANS: A Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced with increased fluids and foods high in fiber. Stopping the medication is not indicated. Over-the-counter laxatives are not recommended until other methods have been tried. Giving the medication on an empty stomach will not relieve the discomfort. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation | Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient has been taking cholestyramine to treat hyperlipidemia. The patient reports abdominal cramping and constipation. The patient’s serum low-density lipoprotein (LDL) has decreased from 170 to 110 mg/dL, and triglycerides have not changed from 150 mg/dL since beginning the medication. The provider changes the medication to colesevelam. The patient asks the nurse why the medication was changed, and the nurse will explain that colesevelam is ordered for which reason? a. It has fewer side effects. b.It has more convenient dosing. c. It provides greater LDL reduction. d.It provides greater triglyceride reduction. ANS: A Colesevelam is similar to cholestyramine but has fewer gastrointestinal side effects. This patient has demonstrated good results with the bile acid sequestrant, so the provider has decided to offer a preparation with fewer adverse effects. Both drugs are given twice daily. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient is admitted to the hospital, and the provider orders gemfibrozil 600 mg twice daily, 30 minutes prior to meals. The nurse learns that the patient takes warfarin once daily. The nurse will contact the provider to discuss a. decreasing the dose of gemfibrozil. b. giving the warfarin at noon. c. increasing the dose of warfarin. d. ordering frequent INR levels. ANS: D Gemfibrozil is highly protein-bound and competes for receptor sites with drugs such as warfarin. The anticoagulant dose should be decreased, and the international normalized ratio (INR) should be closely monitored. Decreasing the dose of gemfibrozil is not recommended. Giving the warfarin at a different time of day does not change this drug interaction. The warfarin dose should be decreased, not increased. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient begins taking nicotinic acid and reports dizziness and flushing of the skin. The nurse will perform which action? a. Recommend that the patient take a baby aspirin with their niacin dose. b. Counsel the patient to increase fluid intake. c. Request an order for renal function tests. d. Schedule the medication to be taken with meals. ANS: A Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient has been taking atorvastatin for several months to treat hyperlipidemia. The patient reports severe muscle weakness and tenderness. The nurse will counsel the patient to do which of the following? a. Ask the provider about switching to simvastatin. b. Contact the provider to report these symptoms. c. Start taking ibuprofen to combat these effects. d. Stop taking the medication immediately. ANS: B Patients taking statins should report immediately any muscle aches or weakness, which can lead to rhabdomyolysis, a muscle disintegration that can become fatal. All statins carry this risk, so changing to another statin is not indicated. Ibuprofen may be useful, but notifying the provider is essential. Patients should not abruptly discontinue statins without discussing this with the provider. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse provides teaching to a patient who will begin taking simvastatin to treat hyperlipidemia. Which statement by the patient indicates understanding of the teaching? a. “I may have diarrhea as a result of taking this medication.” b. “I may stop taking this medication when my lipid levels are normal.” c. “I will need an annual eye examination while taking this medication.” d. “I will increase my intake of vitamins A, D, and E while taking this medication. ANS: C The statins can affect visual acuity, so patients should be counseled to have annual eye examinations for assessment of cataract formation. The bile acid sequestrants, not statins, cause diarrhea. Statin drug therapy is typically lifelong or until behavioral changes prove equally effective (uncommon). Bile acid sequestrants, not statins, decrease the absorption of fat-soluble vitamins. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient, who has intermittent claudication, has been taking 100 mg of cilostazol twice daily with meals for 2 weeks. The patient calls the clinic and reports continued pain in both legs during exercise. How will the nurse advise the patient? a. “It can take from 2-12 weeks for the medication to help with your claudication symptoms.” b. “Notify the provider of the continued pain and request increasing the dose.” c. “You should stop the medication immediately since it is not working.” d. “Take the medication right before you exercise for best effects.” ANS: A Patients should be counseled that the desired therapeutic effects may take up to 3 months. The patient is currently taking the maximum recommended daily dose of cilostazol, so an increase in dose would not be recommended. The medication should be taken 30 minutes before or 2 hours after the morning and evening meals. Taking it immediately before bouts of exercise will not increase effectiveness. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient will begin taking simvastatin to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action? a. Return to the clinic annually for laboratory testing. b. Take care when rising from a sitting to standing position. c. Take the medication in the evening for best effect. d. Use ibuprofen as needed for severe muscle aches and pain. ANS: C Simvastatin is given in the evening. Laboratory tests are performed every 3 to 6 months, not annually. Statins do not cause postural hypotension. Patients taking statins should report severe muscle aches and weakness immediately. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient will begin taking rosuvastatin to treat hyperlipidemia. The patient asks the nurse how to take the medication for best effect. Which statement by the nurse is correct? a. “Increase your fluid intake while taking this medication.” b. “Stop taking the medication immediately if you develop muscle aches.” c. “Take the medication with food to improve absorption.” d. “You may increase dietary fat while taking this medication.” ANS: A Patients taking antihyperlipidemics should be advised to increase fluid intake. It is not necessary to take with food. Patients should never stop taking a statin without consulting the provider. Patients should continue a low-fat diet while taking statins. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient has been prescribed cilostazol. Which statement by the client indicates the need for further teaching? a. “I can take the medication with food if it causes nausea.” b. “This medication is used to improve blood flow.” c. “I can continue to take ginkgo biloba to improve my memory.” d. “I should be cautious when standing.”