Review Practice Exercise 3

Drugs Used to Treat Dyslipidemias > Pharmacology

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Practice Exercise 3

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Total Questions : 3

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Question 1:

A nurse is teaching a client who is taking digoxin (Lanoxin) and has a new prescription for colesevelam (Welchol). Which of the following should the nurse include in the teaching?

A. Take digoxin with your morning dose of colesevelam. B. Your sodium and potassium levels will be monitored periodically while taking colesevelam. C. Watch for bleeding or bruising while taking colesevelam. D. Take colesevelam with food and at least one glass of water.

Answer and Explanation

Choice A:

Take digoxin with your morning dose of colesevelam.This is incorrect because colesevelam can bind to digoxin in the gastrointestinal tract, reducing its absorption and effectiveness. Digoxin should be taken at least 4 hours before colesevelam to prevent drug interactions and maintain therapeutic cardiac effects.

Choice B:

Your sodium and potassium levels will be monitored periodically while taking colesevelam.This statement applies more to loop diuretics or other electrolyte-altering medications. Colesevelam does not directly affect electrolyte balance; its primary adverse effects are gastrointestinal, not disturbances in sodium or potassium levels.

Choice C:

Watch for bleeding or bruising while taking colesevelam.This teaching applies more to anticoagulants like warfarin. Colesevelam does not alter coagulation or platelet function, so monitoring for bleeding is not a necessary precaution. The main concern is drug interactions with fat-soluble vitamins and some other oral medications, not bleeding risk.

Choice D:

Take colesevelam with food and at least one glass of water.Colesevelam must be taken with meals and a full glass of water to maximize drug effectiveness and reduce the risk of constipation or bowel obstruction. Taking it with food enhances bile acid binding and improves tolerance. Adequate fluid intake helps minimize gastrointestinal adverse effects, which are the most common issues with this class of drug.Rationales for incorrect answers:

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Question 2:

The nurse is administering cholestyramine (Questran), a bile acid sequestrant. Which nursing intervention(s) is(are) appropriate? Select all that apply

A. Administering the drug on an empty stomach B. Administering the drug with meals C. Instructing the patient to follow a low-fiber diet while taking this drug D. Instructing the patient to take a fiber supplement while taking this drug E. Increasing fluid intake F. Not administering this drug at the same time as other drugs

Answer and Explanation

Choice A:

Administering the drug on an empty stomach:This reduces effectiveness because bile acid sequestrants need the presence of bile acids, which are released with meals.

Choice B:

Administering the drug with meals:Bile acid sequestrants should be taken with meals to enhance their action, as they bind bile acids that are secreted during digestion.

Choice C:

Instructing the patient to follow a low-fiber diet while taking this drug:This would worsen constipation and GI upset, making it inappropriate.

Choice D:

Instructing the patient to take a fiber supplement while taking this drug:Cholestyramine frequently causes constipation. A fiber supplement helps reduce this side effect and improve bowel function.

Choice E:

Increasing fluid intake:Adequate fluid intake is essential to prevent constipation and maintain bowel regularity while on cholestyramine.

Choice F:

Not administering this drug at the same time as other drugs:Cholestyramine can bind to other medications in the gut and decrease their absorption. Other drugs should be given at least 1 hour before or 4–6 hours after cholestyramine.Rationales for incorrect answers:

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Question 3:

A client is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for continued monitoring?

A. Abdominal pain B. Orange-red urine and saliva C. Decreased capillary refill time D. Sore throat and fever

Answer and Explanation

Choice A:

Abdominal pain: Cholestyramine can cause abdominal discomfort, bloating, and constipation because it interferes with normal bile acid recycling in the intestines. These effects are the most frequently reported adverse reactions and can be managed with increased fluids, dietary fiber, or stool softeners. Monitoring abdominal pain is an essential part of ongoing nursing care for such clients.Rationales for incorrect answers:

Choice B:

Orange-red urine and saliva: This effect is associated with rifampin, an antibiotic used in tuberculosis treatment, not with cholestyramine. Bile acid sequestrants do not alter body fluid color.

Choice C:

Decreased capillary refill time: This is generally a sign of improved circulation and not an adverse effect of cholestyramine. In fact, cholestyramine does not have a direct impact on peripheral circulation or capillary refill.

Choice D:

Sore throat and fever: These symptoms suggest infection or possible agranulocytosis, which may occur with other drugs but is not associated with cholestyramine therapy. Monitoring for infections is not a priority adverse effect for this medication.

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Practice Exercise 3

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