1.

When planning patient care the nurse recognizes what patient is at greatest risk of
developing coronary artery disease?
A)
A 32-year-old Asian American with total cholesterol of 120 mg/dL
B)
A 62-year-old white American with total cholesterol of 260 mg/dL
C)
A 48-year-old African American with total cholesterol of 198 mg/dL
D)
A 26-year-old Native American with total cholesterol of 150 mg/dL
Ans:
B
Feedback:
White Americans have the highest incidence of coronary artery disease (CAD). This
patient has total cholesterol of 260 mg/dL, which is considered high according to the
Third Report of the National Cholesterol Education Program Expert Panel. The other
three patients could be at risk due to cultural risk factors such as hypertension, diabetes,
high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio.
However, their total cholesterol levels fall within normal or desirable range.
2.The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with
diet cola twice per day. What is an appropriate nursing diagnosis for this patient?
A)
Acute pain related to central nervous system and GI effects
B)
Constipation related to GI effects
C)
Noncompliance related to how the drug is taken
D)
Deficient knowledge regarding drug therapy
Ans:
D
Feedback:
Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse
now recognizes the need for medication teaching and chooses the nursing diagnosis
related to deficient knowledge. Nothing in this question indicates that the patient is
experiencing any adverse effects from the drug so that pain and constipation would not be
optimal nursing diagnoses. Until the nurse assesses the patient's understanding of how to
take the drug, it would be incorrect to assume noncompliance when it may actually be
lack of understanding.
3.A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug
would the nurse suspect is most likely to contribute to this adverse effect?
A)
Bile acid sequestrants
B)
Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors
C)
Cholesterol absorption inhibitor
D)
Fibrates
Ans:
A
Feedback:
Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to
fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid
sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated with
use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates.
4.The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant
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A)
B)
C)
D)
Ans:

that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse
describing?
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
Ezetimibe (Zetia)
C
Feedback:
Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and
all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and
comes in tablet form. The other two options are bile acid sequestrants, but should not be
taken with carbonated beverages. The carbonation interferes with the absorption of the
drug.

5.The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What
expected outcome will the nurse describe?
A)
Decrease in serum cholesterol only
B)
Decrease in serum cholesterol and low density lipoprotein (LDL) levels
C)
Decrease in sitosterol and serum cholesterol
D)
Decrease in campesterol and LDL levels
Ans:
B
Feedback:
Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and
should lower serum cholesterol and LDL levels as well as prevention of a first
myocardial infarction and slow the progression of coronary artery disease. A decrease in
serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol
absorption inhibitor would also decrease sitosterol and campesterol levels as well as
decrease levels of serum cholesterol and LDL.
6.The nurse is taking a health history on a 38-year-old man who is taking atorvastatin
(Lipitor) for high cholesterol. What will the nurse question specifically related to the safe
use of this drug?
A)
Alcohol
B)
Nicotine
C)
Caffeine
D)
Herbal therapy
Ans:
A
Feedback:
Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are
contraindicated with active liver disease or a history of alcohol-related liver disease so it
is important for the nurse to ask about the patient's use of alcohol. Nicotine, caffeine, and
herbal therapies are usually not identified as producing any drugdrug interactions with
atorvastatin.

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7.A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for
genetically linked hyperlipidemia. In preparation for patient teaching concerning this
drug, what initial action will the nurse take?
A)
Ask the parents to be present for the teaching session.
B)
Determine the appropriate time to discuss the drug with the patient.
C)
Question the doctor concerning the ordered dosage.
D)
Review the child's normal daily dietary intake of fatty foods.
Ans:
C
Feedback:
The nurse should question the order initially. The dosage is twice the dose for a 9-yearold is expected to receive. The other options are appropriate and would be done.
However, out of safety concerns, the nurse would clarify the dosage first.
8.The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for
what common adverse effects?
A)
Bloating and flank pain
B)
Neuropathy and flatulence
C)
Mild abdominal pain and diarrhea
D)
Constipation and flank pain
Ans:
C
Feedback:
The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea.
Bloating and flatulence are associated with bile acid sequestrants and the fibrates.
Constipation is usually associated with bile acid sequestrants. Neuropathy and flank pain
are usually not associated with lipid-lowering agents.
9.The nurse is preparing a patient for discharge who will receive a prescription for an betahydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the
patient demonstrates that they have a clear understanding of the teaching provided by the
nurse?
A)
I will not need to follow that low-fat diet anymore because this drug will take care
of my lipids.
B)
I should plan to take this drug before bedtime, because my body makes lipids
mostly at night.
C)
After I start taking this drug, I will not have to worry about the exercise routine
the doctor prescribed.
D)
I should take this drug first thing in the morning and make sure I drink a full glass
of water.
Ans:
B
Feedback:
HMG-CoA inhibitors should be taken at bedtime because the body produces lipids mostly
at night. Diet and exercise are still important when taking these drugs because the drug is
most effective in combination with other lipid-lowering actions.

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10.A patient taking atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle
pain not associated with exercise or injury. The nurse will ask questions to determine if
this patient has been taking what contraindicated substance?
A)
Over-the-counter (OTC) medications
B)
Ginseng
C)
Grapefruit juice
D)
Saw palmetto
Ans:
C
Feedback:
Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum
levels and toxic adverse effects, including rhabdomyolysis. Patients on this drug should
be cautioned to avoid drinking grapefruit juice. OTC drugs, ginseng, and saw palmetto
are not associated with increased toxicity.
11.What are the most common adverse effects of lovastatin (Mevacor)?
A)
Nausea, flatulence, and constipation
B)
Increased appetite and blood pressure
C)
Confusion and mental disorientation
D)
Hiccups, sinus congestion, and dizziness
Ans:
A
Feedback:
GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur
with lovastatin. Increased appetite is not associated with lovastatin but patients may think
that taking this drug means they can now eat anything they want and this would indicate
the need for further teaching. Confusion and mental disorientation are not associated with
this drug. Hiccups, sinus congestion, and dizziness would require exploration for cause
because they are not normally associated with lovastatin therapy.
12.The patient receives a prescription for niacin and the nurse is teaching his or her about the
medication. The nurse instructs the patient to call the provider if what common adverse
effect of niacin occurs?
A)
Hypotension
B)
Abdominal pain
C)
Vomiting
D)
Diarrhea
Ans:
B
Feedback:
Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making
its use somewhat limited. It also increases serum levels of uric acid and may predispose
patients to the development of gout. Hypotension, vomiting, and diarrhea are not
normally associated with the drug.

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13.The nurse is providing medication teaching to a patient who will begin taking niacin with
a bile acid sequestrant. How does the nurse instruct the patient to take these two
medications?
A)
Both medications should be taken 4 to 6 hours apart.
B)
Both medications should be taken in the morning.
C)
One medication should be taken in the morning but the other is taken at bedtime.
D)
Both medications can be taken at once just before going to bed.
Ans:
A
Feedback:
When niacin is prescribed with a bile acid sequestrant, the patient should be told to take
the two medications 4 to 6 hours apart in the evening, with the niacin normally taken
first.
14.The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator
named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurse's
best response?
A)
Micelles are absorbed into the intestinal wall and combined with proteins to
become chylomicrons.
B)
The drug makes the liver use cholesterol to produce more bile acids.
C)
The drug works in the brush border of the small intestine to prevent the absorption
of dietary cholesterol.
D)
The drug activates a specific hepatic receptor, resulting in increased breakdown of
lipids and reduction in triglyceride levels.
Ans:
D
Feedback:
Fenofibric acid is the first drug in this class. It activates a specific hepatic receptor that
results in increased breakdown of lipids, elimination of triglyceride-rich particles from
the plasma and reduction in the production to an enzyme that naturally inhibits lipid
breakdown. The result is seen as a decrease in triglyceride levels, changes in low density
lipoprotein production, which makes them more easily broken down in the body, and an
increase in high density lipoprotein levels.
15.The nurse conducts a review of research related to Beta-hydroxy-beta-methylglutaryl
coenzyme A inhibitors and finds the only one associated with data to show a reduction in
coronary artery disease and incidence of myocardial infarction is what drug?
A)
Pravastatin (Pravachol)
B)
Lovastatin (Mevacor)
C)
Atorvastatin (Lipitor)
D)
Fluvastatin (Lescol)
Ans:
A
Feedback:
Pravastatin is the only statin with outcome data to show effectiveness in decreasing
coronary artery disease and incidence of myocardial infarction (MI); it prevents a first MI

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even in patients who do not have a documented elevated cholesterol level. The other
medications do not have any evidence of effectiveness for this patient.
16.Which drug is most effective in reducing serum triglyceride levels?
A)
Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors
B)
Bile acid sequestrants
C)
Fibrates
D)
Niacin
Ans:
C
Feedback:
Fibrates decrease hepatic production of triglycerides. They are the most effective drugs
for reducing serum triglycerides. The other options are incorrect.
17.The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value
should be assessed regularly on this patient?
A)
Blood urea nitrogen (BUN)
B)
Complete blood count (CBC)
C)
Activated partial thromboplastin time
D)
Liver function studies
Ans:
D
Feedback:
Increased concentrations of liver enzymes commonly occur, and acute liver failure has
been reported with the use of atorvastatin and fluvastatin. Liver function studies should
be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course
of therapy. The other tests would not be pertinent to this specific drug.
18.The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMGCoA) reductase inhibitor as inhibiting what?
A)
An enzyme that controls the final step in production of cellular cholesterol
B)
An enzyme used immediately for energy
C)
An enzyme that combines with proteins to become chylomicrons
D)
An enzyme used to make bile acids
Ans:
A
Feedback:
HMG-CoA reductase is an enzyme that controls the final step in production of cellular
cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to
break down or metabolize fats into small molecules called micelles, which are absorbed
into the intestinal wall and combined with proteins to become chylomicrons, to allow
transport throughout the circulatory system. Cholesterol is a fat that is used make bile
acids.
19.A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse

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A)
B)
C)
D)
Ans:

categorize this serum concentration of cholesterol?

Optimal
Desirable
High
Very high
C
Feedback:
High is rated at or exceeding 240 mg/dL. Levels below 200 mg/dL are considered
desirable, although lower levels may be preferred if the patient has a history of coronary
artery disease. Low density lipoprotein (LDL) cholesterol below 100 mg/dL is considered
optimal, whereas LDL levels above 190 or triglycerides above 500 mg/dL is considered
very high.

20.The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids,
reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL)
concentrations. What is the correct answer?
A)
Fenofibrate (Tricor)
B)
Niacin (Niaspan)
C)
Atorvastatin (Lipitor)
D)
Gemfibrozil (Lopid)
Ans:
D
Feedback:
Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides
and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI)
and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL
concentrations.
21.A patient is being discharged on cholestyramine (Questran). Patient teaching should
include what about this medication?
A)
Should be administered with other medications
B)
Should be administered 1 hour before or 4 to 6 hours after other medications
C)
Should be administered 1 hour after other medications
D)
Should be administered on an empty stomach
Ans:
B
Feedback:
Cholestyramine should be administered 1 hour before or 4 to 6 hours after other
medications, because it may prevent the absorption of other drugs. Therefore, the other
options are incorrect.
22.The patient is admitted to the acute care facility with a diagnosis of acute renal failure.
While collecting the nursing history the patient reveals he was taking Pravastatin to
reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient
complains of muscle pain. What does the nurse suspect caused this patient's renal failure?

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A)
B)
C)
D)
Ans:

Gastric ulceration
Rhabdomyolysis
Congestive heart failure
Drug Toxicity
D
Feedback:
Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity
would cause liver damage, whereas the breakdown of muscle that occurs with
rhabdomyolysis results in kidney damage and acute renal failure. The patient identified
no symptoms related to gastric ulceration or congestive heart failure.

23.The patient receives a prescription for a lipid lowering medication from the health care
provider and, before discharge, asks the nurse what else he or she can do to improve his
or her lipid levels besides just taking medication. What recommendation will the nurse
make? (Select all that apply.)
A)
Quitting smoking
B)
Exercising
C)
Following a low sodium diet
D)
Reducing stress
E)
Avoiding alcohol
Ans:
A, B, D
Feedback:
Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress
reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is
not indicated as a means to lower serum lipid levels. Although a low sodium diet is a
healthy choice, it is not associated with elevating lipid levels.
24.A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that
plaque on the inner lumen of arteries begins as what?
A)
Fatty streaks
B)
White blood cells (WBCs)
C)
Foam cells
D)
Platelets and fibrin
Ans:
A
Feedback:
Coronary artery disease is characterized by the progressive growth of atheromatous
plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty
streaks in the endothelium, eventually injure the endothelial lining of the artery, causing
an inflammatory reaction. This inflammatory process triggers the development of
characteristic foam cells, containing fats and WBCs that further injure the endothelial
lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel
lining and cause the atheroma to grow, further narrowing the interior of the blood vessel
and limiting blood flow.

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25.The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and
explains that exercise has what effect?
A)
Increases high density lipoproteins (HDLs) and decreases low density lipoproteins
(LDL)
B)
Increases LDL and decreases triglycerides
C)
Decreases HDL and increases LDL
D)
Decreases both HDL and LDL
Ans:
A
Feedback:
Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise
also decreases triglyceride levels.
26.The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk
factors can be controlled or modified. What modifiable factors would the nurse include?
A)
Gender, obesity, family history, and smoking
B)
Inactivity, stress, gender, and smoking
C)
Obesity, inactivity, diet, and smoking
D)
Stress, family history, and obesity
Ans:
C
Feedback:
The risk factors for CAD that can be controlled or modified include obesity, inactivity,
diet, stress, and smoking. Gender and family history are risk factors that cannot be
controlled.
27.The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In
teaching the patient about therapeutic lifestyle changes such as diet and exercise, the
nurse explains that the desired goal for cholesterol levels is what?
A)
High high density lipoprotein (HDL) values and high triglyceride values
B)
Low soluble fiber
C)
Elevated blood lipids, fasting glucose less than 100
D)
Low low density lipoprotein (LDL) values and high HDL values
Ans:
D
Feedback:
The desired goal for cholesterol readings is for a patient to have low LDL and high HDL
values. HDL serves as a protective mechanism to reduce cholesterol so higher levels are
desirable. High LDL levels increase plaque formation. Fiber does not contribute to risk
for coronary artery disease (CAD) although a diet high in fiber is preferable. Elevated
blood lipids are never desirable but control of blood sugar levels reduces CAD risk.
28.The nurse cares for a patient who is in her second trimester of pregnancy with extremely
high serum cholesterol levels. What lipid lowering medication would be appropriate for
the nurse to administer to this patient?

Page 9

A)
B)
C)
D)
Ans:

Colesevelam (Welchol)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Atorvastatin (Lipitor)
A
Feedback:
Bile acid sequestrants are the drug of choice for pregnant women if a lipid-lowering agent
is needed. Women of child-bearing age should not take beta-hydroxy-beta-methylglutaryl
coenzyme A (HMG-CoA) reductase inhibitors because they are in Pregnancy Category X.
Pravastatin, simvastatin, and atorvastatin are all HMG-CoA reductase inhibitors.

29.The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD).
What condition does the nurse encourage the patient to control in order to reduce CAD
risk? (Select all that apply.)
A)
Obesity
B)
Hypertension
C)
Bradycardia
D)
Depression
E)
High stress levels
Ans:
A, B, E
Feedback:
Successful treatment in reducing risk for CAD involves reducing risk factors including
decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to
have the most impact on serum lipid levels); losing weight, which helps to decrease
insulin resistance and the development of type 2 diabetes; eliminating smoking;
increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and
gout. Depression and bradycardia have not been linked to CAD.
30.The nurse cares for a 10-year-old child brought to the clinic for an annual checkup who is
diagnosed with hypercholesterolemia. What is the most common cause of
hypercholesterolemia in children?
A)
Gender
B)
Diet
C)
Familial connection
D)
Exercise
Ans:
C
Feedback:
Familial hypercholesterolemia may be seen in children. Because of the importance of
lipids in the developing nervous system, treatment is usually restricted to tight dietary
restrictions to limit fats and calories. Gender, diet, or exercise-resistant
hypercholesterolemia is possible in children, but they are not the most common causes.
31.The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his

Page 10

A)
B)
C)
D)
Ans:

diet to lose weight and control serum lipid levels without success. He is currently taking a
combination of medications but his total cholesterol remains above 200. What future
therapy might help this patient?
Endocannabinoid blocker
Bile acid sequestrant with niacin
Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and
gemfibrozil
Peroxisome proliferator receptor alpha activator
A
Feedback:
Blocking the endocannabinoid system results in feelings of satiety and decreased
appetite, leading to weight loss; decreased release of growth hormone, increased oxygen
and glucose use in the muscle, decreased fat synthesis in the liver, decreased levels of
triglycerides and low density lipoproteins, and increased levels of high density
lipoproteins, improving the lipid profile; increased sensitivity of insulin receptor sites,
leading to decreased blood glucose levels; decreased fat production and storage;
increased levels of adiponectin; and decreased activity of tumor necrosis factor, a
proinflammatory agent, and decreased activity of C-reactive protein, which is associated
with proinflammatory and prothrombotic states. Combining bile acid sequestrant with
niacin or HMG-CoA with gemfibrozil is contraindicated. Peroxisome proliferator
receptor alpha activators help to control lipid levels but do not contribute to dietary
changes and appetite suppression.

32.The nurse provides patient teaching related to medication and lifestyle changes the
patient can make to reduce serum lipid levels. One month later, the nurse evaluates the
patient teaching as having been effective based on what data? (Select all that apply.)
A)
Total cholesterol 184
B)
High density lipoprotein (HDL) cholesterol 84
C)
Low density lipoprotein (LDL) cholesterol 164
D)
Triglycerides 184
E)
Weight loss of 8 pounds
Ans:
A, B, E
Feedback:
Serum lab levels within the desirable level would indicate the teaching was effective;
they include a total cholesterol level of less than 200, an HDL cholesterol level of higher
than 40, an LDL cholesterol level of less than 129, and a triglyceride level of less than 50.
Weight loss is also a positive outcome.
33.The nurse is caring for a 35-year-old woman taking a beta-hydroxy-beta-methylglutaryl
coenzyme A (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching
this patient about her medications what priority teaching point will the nurse include in
the teaching plan?
A)
Need for frequent ophthalmic examinations
B)
Information about a cholesterol-lowering diet

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C)
D)
Ans:

Use of barrier contraceptives

Calling her doctor with any respiratory symptoms
C
Feedback:
It is important to teach a woman of childbearing age taking HMG-CoA reductase
inhibitors to use barrier contraceptives because there is a risk of severe fetal
abnormalities associated with these drugs if taken during pregnancy. She should have
routine ophthalmic examinations but does not need more frequent examinations.
Cholesterol lowering diet should have been initiated before beginning medications to
lower lipid levels. There are no associated respiratory risks with these medications so she
would call the doctor with respiratory symptoms as she normally would.

34.When providing patient teaching to a patient beginning therapy with a beta-hydroxy-betamethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the
need for regular monitoring of what laboratory studies? (Select all that apply.)
A)
Renal function tests
B)
Liver function tests
C)
Lipid panel
D)
Hemoccult of stool
E)
Albumin level
Ans:
A, B, C
Feedback:
It is important to monitor renal and liver function to identify early signs of toxicity or
rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of
drug therapy. Hemoccult of stool would be more important with bile acid sequestrants
that are associated with GI irritation. Altered albumin levels are not associated with
HMG-CoA reductase inhibitors.
35.The nurse is preparing to teach the patient about diet therapy when beginning bile
sequestrant medication to lower lipid levels. What important teaching point will the nurse
include in the teaching plan?
A)
Increasing carbohydrate intake
B)
Reducing protein intake
C)
Increasing fiber intake
D)
Reducing fluid intake
Ans:
C
Feedback:
The nurse would want to teach this patient to increase fiber intake to avoid constipation
that often occurs with this medication. Protein intake does not need to be reduced, but the
patient should be taught to avoid fatty protein and instead meet protein needs with
vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if
weight loss is needed, otherwise no change is needed. Fluid intake should be maintained
or increased if there are no diagnoses that would contraindicate fluid intake to help avoid
constipation.

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