1
Q
- A lipid profile for a newly diagnosed hypertensive patient with a BMI (body mass index) of 27 shows a triglyceride level of 950 mg/dL, total cholesterol of
240 mg/dL, LDL (low density lipoprotein) of 145 mg/dL, and HDL (high-density lipoprotein) of 45 mg/dL. What is the best intervention for this patient?
A) Educate the patient about lifestyle changes that will help lower cholesterol levels
B) Initiate a prescription of metformin (Glucophage)
C) Recommend that the patient exercise at least 30 minutes daily
D) Initiate a prescription of fenofibrate (Tricor)
A
- D) Initiate a prescription of fenofibrate (Tricor) A triglyceride level above 800
mg/dL is considered to be “very high”; there is an increased risk of acute pancreatitis,
especially if the patient also drinks alcohol. Two fibrate drugs have been approved for
use in the United States: fenofibrate (Tricor) and gemfibrozil (Lopid). Another
option is nicotinic acid, but fibrates are more potent and better tolerated. In
addition, lifestyle changes are important; these include avoiding foods with
concentrated sugars, alcohol, weight loss if overweight or obese, and regular,
moderate to intense aerobic exercise.
2
Q
This case is followed by questions and multiple-choice answers specific to the case. The
nurse practitioner notices a gray ring on the edge of both irises of an 80-year-old woman.
The patient denies visual changes or pain. She reports that she has had the “ring” for many
years.
- What is the clinical significance of this finding in a 35-year-old patient?
A) The patient has a higher risk of blindness
B) The patient should be evaluated for hyperlipidemia
C) The patient should be evaluated by an ophthalmologist
D) The patient should be evaluated for acute glaucoma
A
- B) The patient should be evaluated for hyperlipidemia Arcus senilis is caused
by lipid deposits deep in the edge of the cornea and is quite commonly present in the
elderly. However, it can also appear earlier in life as a result of hypercholesterolemia.
3
Q
- A 25-year-old man with schizophrenia comes in for a routine annual physical. He
is a heavy smoker and has a body mass index (BMI) of 28. The patient has been on
olanzapine (Zyprexa) for 10 years. Regarding the patient’s prescription, which of the
following laboratory tests is recommended for monitoring the adverse effects of
atypical antipsychotics?
A) Fasting blood glucose, fasting lipid profile, and weight
B) Urinalysis, serum creatinine, 24-hour urine for protein and creatinine clearance
C) Liver function tests only
D) CBC with differential, liver function tests, and weight
A
- A) Fasting blood glucose, fasting lipid profile, and weight Patients on atypical
antipsychotics commonly gain weight and are at risk for obesity, hyperglycemia, and
type 2 diabetes. Zyprexa will increase lipids (cholesterol, low-density lipoprotein
[LDL], and triglycerides). Atypical antipsychotics also increase the risk of death
among frail elders and older adults living in nursing homes.
4
Q
- The 2013 American College of Cardiology/American Heart Association
(ACC/AHA) Arteriosclerotic Cardiovascular Disease (ASCVD) risk calculator
measures the risk of a cardiovascular event within 10 years after measurement. What
is the cutoff value when treatment for hyperlipidemia is recommended?
A) 6.5% or higher
B) 7.5% or higher
C) 8% or higher
D) 10 % or higher
A
- B) 7.5% or higher The estimated 10-year ASCVD risk score is 7.5% or higher.
The 2013 ACC/AHA guidelines recommend treatment with high-intensity statins
for patients aged 40 to 75 years with very high low-density lipoprotein (LDL) values
who have a score of 7.5% or higher.
5
Q
- A 55-year-old male patient with a body mass index (BMI) of 30 has a history of
angina and type 2 diabetes. His lipid profile results are total cholesterol of 280
mg/dL, low-density lipoprotein (LDL) of 195 mg/dL, and high-density lipoprotein
(HDL) of 25 mg/dL. The nurse practitioner diagnoses him with hyperlipidemia and
wants to start him on statin therapy. What intensity of treatment is recommended
for this patient?
A) Low-intensity statin
B) Moderate-intensity statin
C) High-intensity statin
D) Very high-intensity statin
A
- C) High-intensity statin This patient fulfills the criteria for high-intensity
statin dosing criteria from the 2013 American College of Cardiology/American
Heart Association (ACC/AHA) blood cholesterol guideline. He already has heart
disease (angina), type 2 diabetes, low-density lipoprotein (LDL) of 195 mg/dL, and
low high-density lipoprotein (HDL) of 25 mg/dL. This patient is at very high risk
for heart disease and warrants a high-intensity dose of statin. There are only two
choices at this level: atorvastatin (Lipitor) 40 to 80 mg or rosuvastatin (Crestor) 20
to 40 mg.
