Which lipoprotein carries triglycerides from digested food out of the intestine to muscle and fat tissue?
Chylomicrons
✓
Very low-density lipoprotein
Low-density lipoprotein
High-density lipoprotein
Correct Answer
Chylomicrons
Chylomicrons are assembled by the absorptive cells of the small intestine and carry dietary triglycerides through the lymph and blood to tissues. Very low-density lipoprotein is made by the liver and carries triglycerides the liver has packaged, not fat absorbed from a meal. Low-density lipoprotein is cholesterol rich and delivers cholesterol to tissues. High-density lipoprotein carries cholesterol away from tissues back toward the liver.
Category: Lipoproteins and Lipids
Question 2
Which enzyme on the capillary walls of muscle and adipose tissue frees fatty acids from the triglycerides carried in circulating lipoproteins?
HMG-CoA reductase
Lipoprotein lipase
✓
Pancreatic amylase
Cholesterol esterase
Correct Answer
Lipoprotein lipase
Lipoprotein lipase splits triglycerides in chylomicrons and VLDL so the released fatty acids can be burned for energy or stored; fibrates and niacin lower triglycerides partly by increasing its activity. HMG-CoA reductase is the liver enzyme that controls cholesterol synthesis and is the target of statins. Pancreatic amylase digests starch in the intestine. Cholesterol esterase acts in the gut on dietary cholesterol esters, not on circulating triglycerides.
Category: Lipoproteins and Lipids
Question 3
After VLDL gives up much of its triglyceride, which remnant particle remains that can be cleared by the liver or converted to LDL?
HDL
Chylomicron remnant
IDL
✓
Lipoprotein(a)
Correct Answer
IDL
Intermediate-density lipoprotein (IDL) is the leftover particle from VLDL; the liver takes up some of it, and lipases convert the rest into cholesterol-rich LDL. HDL is a separate particle that collects excess cholesterol from tissues. A chylomicron remnant is what is left of a chylomicron, and it is taken up by the liver rather than becoming LDL. Lipoprotein(a) is an LDL-like particle with an added protein, not a product of VLDL breakdown.
Category: Lipoproteins and Lipids
Question 4
Long-term statin therapy has been linked to which metabolic adverse effect, especially in patients with obesity or metabolic syndrome?
Hypothyroidism
Hypokalemia
Metabolic alkalosis
New-onset diabetes
✓
Correct Answer
New-onset diabetes
Statins can raise blood glucose and hemoglobin A1c, and they are associated with new-onset diabetes, most often in patients who already have risk factors such as obesity or metabolic syndrome; the cardiovascular benefit usually outweighs this risk. Hypothyroidism is not caused by statins, although it can raise cholesterol. Hypokalemia is linked to drugs such as loop and thiazide diuretics. Metabolic alkalosis is not a statin effect.
Category: Statins
Question 5
How are liver enzymes monitored for a patient who is starting a statin?
At baseline, then when clinically indicated
✓
Monthly for as long as the statin is taken
Every week during the first few months
Never, because statins do not affect the liver
Correct Answer
At baseline, then when clinically indicated
Serious statin-related liver failure is rare and routine periodic testing did not prevent it, so current labeling advises checking liver enzymes before therapy starts and afterward only if symptoms or another clinical reason arise. Monthly for as long as the statin is taken describes an outdated practice that is no longer required. Every week during the first few months is not a recommended schedule. Never, because statins do not affect the liver is wrong because statins can raise transaminases.
Category: Statins
Question 6
Which of these conditions is a contraindication to atorvastatin?
Controlled hypertension
Decompensated cirrhosis
✓
Type 2 diabetes
Osteoarthritis
Correct Answer
Decompensated cirrhosis
Acute liver failure and decompensated cirrhosis are contraindications to atorvastatin, because statins are processed by the liver and can raise transaminases. Controlled hypertension is common in patients who take statins and is not a reason to avoid one. Type 2 diabetes raises cardiovascular risk and is often an indication for a statin. Osteoarthritis has no bearing on statin use.
Category: Statins
Question 7
Which of these statins is not metabolized to a significant degree by cytochrome P450 enzymes, giving it fewer drug interactions?
Simvastatin
Lovastatin
Pravastatin
✓
Atorvastatin
Correct Answer
Pravastatin
Pravastatin is cleared mostly without the hepatic CYP enzymes, so drugs that inhibit those enzymes raise its level far less than they raise the levels of most other statins. Simvastatin is heavily metabolized by CYP3A4, so inhibitors of that enzyme can raise its level sharply. Lovastatin shares that CYP3A4 dependence. Atorvastatin is also metabolized by CYP3A4, so strong inhibitors such as clarithromycin raise its level and the risk of muscle injury.
Category: Statins
Question 8
When triglyceride levels are very high, drug treatment is used to reduce the risk of which acute complication?
Acute kidney injury
Rhabdomyolysis
Peptic ulcer bleeding
Acute pancreatitis
✓
Correct Answer
Acute pancreatitis
Very high triglyceride levels can trigger acute pancreatitis, so they are treated promptly, often with a fibrate, along with diet changes and limiting alcohol. Acute kidney injury is not a direct complication of high triglycerides. Rhabdomyolysis is a rare adverse effect of statins and fibrates, not a result of high triglycerides. Peptic ulcer bleeding is not caused by high triglycerides, although active peptic ulcer disease is a contraindication to niacin.
Category: Lipoproteins and Lipids
Question 9
Evolocumab lowers LDL cholesterol through which mechanism?
Blocking PCSK9 so fewer LDL receptors are destroyed
✓
Inhibiting HMG-CoA reductase in the liver
Blocking cholesterol uptake in the small intestine
Binding bile acids in the intestine
Correct Answer
Blocking PCSK9 so fewer LDL receptors are destroyed
PCSK9 normally tags liver LDL receptors for destruction; evolocumab, a monoclonal antibody, binds PCSK9 so more receptors survive and recycle to the cell surface to pull LDL out of the blood. Inhibiting HMG-CoA reductase in the liver is how statins work. Blocking cholesterol uptake in the small intestine is how ezetimibe works. Binding bile acids in the intestine is how bile acid sequestrants work.
Category: PCSK9-Targeting Drugs
Question 10
Inclisiran also targets PCSK9. How does its action differ from that of alirocumab?
It binds circulating PCSK9 as an antibody
It reduces the liver's production of PCSK9
✓
It activates PPAR-alpha in liver cells
It blocks the NPC1L1 transporter in the gut
Correct Answer
It reduces the liver's production of PCSK9
Inclisiran is a small interfering RNA that silences the message the liver uses to make PCSK9, so less PCSK9 is produced and LDL receptor numbers rise. It binds circulating PCSK9 as an antibody describes alirocumab and evolocumab, not inclisiran. It activates PPAR-alpha in liver cells describes fibrates. It blocks the NPC1L1 transporter in the gut describes ezetimibe.
Category: PCSK9-Targeting Drugs
Question 11
A patient is learning to self-inject alirocumab from a prefilled pen. Which instruction is correct?
Store the pens in the freezer between doses
Shake the pen hard to mix the solution
Let a refrigerated dose reach room temperature first
✓
Inject into the same spot every time
Correct Answer
Let a refrigerated dose reach room temperature first
Alirocumab is kept refrigerated, and a dose is allowed to warm to room temperature before injection, which makes the injection more comfortable. Store the pens in the freezer between doses is wrong because freezing damages the antibody. Shake the pen hard to mix the solution is wrong because shaking can damage the protein; a cloudy or discolored solution should not be used. Inject into the same spot every time is wrong because sites in the thigh, abdomen or upper arm should be rotated.
Category: PCSK9-Targeting Drugs
Question 12
Why does binding bile acids in the intestine lower the blood level of LDL cholesterol?
Cholesterol is excreted unchanged by the kidneys
The drug is absorbed and blocks liver cholesterol synthesis
The liver makes fewer LDL receptors
The liver uses more cholesterol to make new bile acids
✓
Correct Answer
The liver uses more cholesterol to make new bile acids
Bound bile acids are lost in the stool instead of being reabsorbed, so the liver converts more of its cholesterol into new bile acids and increases its LDL receptors to pull more LDL from the blood. Cholesterol is excreted unchanged by the kidneys is wrong because cholesterol is not eliminated through urine. The drug is absorbed and blocks liver cholesterol synthesis is wrong because sequestrants stay in the gut. The liver makes fewer LDL receptors is the opposite of what happens.
Category: Bile Acid Sequestrants
Question 13
Colesevelam is contraindicated in a patient with a history of which condition?
Bowel obstruction
✓
Gout
Osteoporosis
Hypertension
Correct Answer
Bowel obstruction
Colesevelam is a bulky, nonabsorbed resin that can worsen constipation and is contraindicated in patients with a history of bowel obstruction; it is also avoided with very high triglycerides or a history of pancreatitis from hypertriglyceridemia. Gout is a caution with niacin, not with sequestrants. Osteoporosis is not a contraindication. Hypertension does not affect sequestrant use.
Category: Bile Acid Sequestrants
Question 14
Besides lowering LDL, cholestyramine is approved to relieve which symptom in patients with partial biliary obstruction?
Jaundice
Pruritus
✓
Steatorrhea
Ascites
Correct Answer
Pruritus
When bile flow is partly blocked, bile acids build up in the skin and cause intense itching (pruritus); cholestyramine binds bile acids in the gut and lowers their levels. Jaundice comes from bilirubin buildup, which cholestyramine does not correct. Steatorrhea, fatty stool from poor fat absorption, can actually be worsened by sequestrants. Ascites is fluid in the abdomen from liver disease or other causes and is not treated with cholestyramine.
Category: Bile Acid Sequestrants
Question 15
Fenofibrate lowers triglycerides mainly through which mechanism?
Inhibiting HMG-CoA reductase in the liver
Binding PCSK9 in the bloodstream
Activating PPAR-alpha to boost lipoprotein lipase activity
✓
Binding bile acids in the intestine
Correct Answer
Activating PPAR-alpha to boost lipoprotein lipase activity
Fibrates activate peroxisome proliferator-activated receptor alpha, which increases lipoprotein lipase activity so triglyceride-rich particles are broken down faster; they also raise HDL. Inhibiting HMG-CoA reductase in the liver is how statins act. Binding PCSK9 in the bloodstream is how PCSK9 monoclonal antibodies act. Binding bile acids in the intestine is how sequestrants act, and sequestrants can actually raise triglycerides.
Category: Fibrates
Question 16
When a fibrate must be added to a statin, why is fenofibrate generally chosen over gemfibrozil?
Fenofibrate lowers LDL more than any statin
Gemfibrozil cannot be taken by mouth
Fenofibrate has no effect on triglycerides
Gemfibrozil sharply raises the myopathy risk of statins
✓
Correct Answer
Gemfibrozil sharply raises the myopathy risk of statins
Gemfibrozil interferes with statin metabolism and raises statin levels, so it is contraindicated with simvastatin and avoided with rosuvastatin because of myopathy and rhabdomyolysis; fenofibrate carries less of this risk, although muscle symptoms are still monitored. Fenofibrate lowers LDL more than any statin is false because statins are far stronger LDL-lowering drugs. Gemfibrozil cannot be taken by mouth is false because it is an oral tablet. Fenofibrate has no effect on triglycerides is false because lowering triglycerides is its main use.
Category: Fibrates
Question 17
A patient taking fenofibrate develops swelling, warmth and redness in one calf. Which fibrate adverse effect should the nurse suspect?
Deep vein thrombosis
✓
Peripheral neuropathy
Acute gout flare
Hypokalemia
Correct Answer
Deep vein thrombosis
Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, has been reported with fibrates, and one swollen, warm, red calf is a classic sign that needs prompt evaluation. Peripheral neuropathy causes numbness or tingling, not a swollen, warm calf. Acute gout flare usually affects a joint such as the big toe, and gout is a concern with niacin rather than fibrates. Hypokalemia causes weakness and cramps without local swelling and is not a fibrate effect.
Category: Fibrates
Question 18
A provider is considering niacin for a patient with dyslipidemia. Which coexisting problem would rule the drug out?
Hypothyroidism
Active peptic ulcer disease
✓
Asthma
Osteoarthritis
Correct Answer
Active peptic ulcer disease
Niacin can irritate the stomach and is contraindicated in active peptic ulcer disease, as well as in active liver disease, unexplained persistent transaminase elevation and arterial bleeding. Hypothyroidism is not a contraindication, although it can raise cholesterol on its own. Asthma does not limit niacin use. Osteoarthritis has no bearing on niacin therapy.
Category: Niacin
Question 19
A patient plans to manage high cholesterol with an over-the-counter flush-free niacin. What should the nurse explain?
It works exactly like prescription niacin
It must be combined with a statin to be absorbed
It releases little free nicotinic acid and has no proven lipid benefit
✓
It is stronger than extended-release niacin
Correct Answer
It releases little free nicotinic acid and has no proven lipid benefit
Flush-free products contain compounds such as inositol hexanicotinate that release little or no free nicotinic acid, so they do not cause flushing but have not been shown to improve lipid levels, and they should not be used to treat dyslipidemia. It works exactly like prescription niacin is wrong because the active form is largely missing. It must be combined with a statin to be absorbed is not true of any niacin product. It is stronger than extended-release niacin is wrong because it has no proven lipid effect.
Category: Niacin
Question 20
A patient starting ezetimibe asks which reaction would need emergency care. Which finding should the nurse name?
Mild diarrhea
A stuffy, runny nose
Mild aching in the joints
Swelling of the lips and tongue
✓
Correct Answer
Swelling of the lips and tongue
Angioedema, swelling of the lips, tongue or throat, is a rare hypersensitivity reaction to ezetimibe that can block the airway, so the patient seeks emergency care at once. Mild diarrhea is a common, usually minor effect. A stuffy, runny nose reflects the upper respiratory symptoms that are among its common effects. Mild aching in the joints is also a common effect; it is reported to the provider but is not an emergency.
Category: Ezetimibe