A nurse is caring for a client.
Exhibit 1
Medical History
0800:
Client has a history of hyperlipidemia, rheumatoid arthritis, and hypertension.
Client has a BMI of 32.
Client has a family history of colon cancer.
The nurse is reviewing the client's medical record. Which of the following findings places the client at risk for heart disease? (Select all that apply.)
Family history
Fasting glucose level
History of hyperlipidemia
History of rheumatoid
History of hypertension
Cholesterol level
Correct Answer : A,B,C,E,F
A. Family history: A family history of heart disease can increase an individual's risk of developing heart disease themselves, as genetic factors play a role in cardiovascular conditions.
B. Fasting glucose level: Elevated fasting glucose levels, indicative of diabetes or prediabetes, can contribute to heart disease risk. Diabetes is a significant risk factor for heart disease and can lead to complications such as atherosclerosis and coronary artery disease.
C. History of hyperlipidemia: Hyperlipidemia refers to elevated levels of lipids (cholesterol and triglycerides) in the blood. High levels of LDL cholesterol ("bad" cholesterol) and low levels of HDL cholesterol ("good" cholesterol) are associated with an increased risk of heart disease.
D. History of rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition that involves inflammation in the joints. Chronic inflammation associated with rheumatoid arthritis can affect blood vessels and increase the risk of heart disease and cardiovascular events.
E. History of hypertension: Hypertension, or high blood pressure, is a major risk factor for heart disease. It puts added strain on the heart and blood vessels, increasing the risk of atherosclerosis, heart attacks, and other heart-related complications.
F. Cholesterol level: Elevated levels of LDL cholesterol ("bad" cholesterol) and triglycerides, as well as low levels of HDL cholesterol ("good" cholesterol), are associated with an increased risk of heart disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Ensure that the width of the BP cuff is 50% of the client's upper arm circumference:
While using an appropriately sized cuff is crucial for accurate blood pressure measurement, the width of the cuff should be about 40% of the circumference of the upper arm, not 50%. However, adjusting the cuff size is not the most immediate action to take when faced with an elevated blood pressure reading.
B. Reposition the client supine and recheck her BP:
Repositioning the client supine is not necessary for routine blood pressure measurement in a sitting position. Moreover, repositioning the client may not significantly affect the blood pressure reading, especially if the initial reading was obtained correctly.
C. Recheck the client's BP in her other arm for comparison.
When obtaining a blood pressure reading, it's important to confirm the accuracy of the measurement, especially if the reading is elevated. Checking the blood pressure in the other arm allows for comparison and helps identify any significant differences between the arms, which could indicate arterial abnormalities or other issues. This step ensures accuracy and helps in making appropriate clinical decisions.
D. Request that another nurse check the client's BP in 30 min:
Waiting 30 minutes to recheck the blood pressure is not the most appropriate action when faced with an elevated reading. Prompt reevaluation and comparison of blood pressure readings are essential for accurate assessment and timely intervention, especially if the initial reading indicates hypertension.
Correct Answer is ["A","D","E"]
No explanation
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