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A nurse is caring for a client in an outpatient clinic.

Exhibits

Click to highlight the findings that are risk factors for the client developing a complication. To deselect a finding, click on the finding again.

Nurses' Notes

3 months ago:

61-year-old male client presents with reports of dizziness, palpitations, fatigue. and dyspnea with exertion. Reports that dizziness and palpitations started 2 months ago. Fatigue and dyspnea with exertion started 1 week ago. Has smoked 1 pack of cigarettes per day for 40 years.

Past medical history.

History of hyperlipidemia.

Walks at least a mile three times a week. Reports drinking two to three beers each evening

Client reports he follows the Dietary Approaches to Stop Hypertension (DASH) diet.

Family history.

Biological father has a history of hyperlipidemia and hypertension. Biological mother has history of renal failure requiring dialysis.

Physical examination:

Weight 88.6 kg (195.3 lb)

Height 170.2 cm (5 ft 7 in)

BMI 30.5

61-year-old male

Has smoked 1 pack of cigarettes per day for 40 years.

History of hyperlipidemia.

Walks at least a mile three times a week.

Reports drinking two to three beers each evening

Client reports he follows the Dietary Approaches to Stop Hypertension (DASH) diet.

Biological father has a history of hyperlipidemia and hypertension.

Biological mother has history of renal failure requiring dialysis.

BMI 30.5

Answer and Explanation

The Correct Answer is ["A","B","C","E","G","H","I"]

Rationale for correct choices

• 61-year-old male: Advanced age and male sex increase the risk of cardiovascular complications such as coronary artery disease, heart failure, and stroke. Aging contributes to arterial stiffness, reduced cardiac reserve, and higher likelihood of comorbidities, all of which elevate the risk profile for this client.

• Has smoked 1 pack of cigarettes per day for 40 years: Chronic smoking is a major modifiable risk factor for atherosclerosis, myocardial infarction, stroke, and peripheral arterial disease. Long-term tobacco use promotes endothelial damage, increases LDL cholesterol, and impairs oxygen delivery, significantly increasing cardiovascular risk.

• History of hyperlipidemia: Elevated cholesterol and triglycerides predispose the client to plaque formation in arteries, contributing to atherosclerosis and cardiovascular disease. Hyperlipidemia is a key risk factor for complications such as myocardial infarction and stroke, especially when combined with other comorbidities.

• Reports drinking two to three beers each evening: Excessive alcohol consumption contributes to hypertension, cardiomyopathy, and arrhythmias. Chronic alcohol intake can also exacerbate hyperlipidemia and increase the risk of liver disease, compounding cardiovascular and systemic complications.

• BMI 30.5: A BMI above 30 classifies the client as obese, which increases the risk for hypertension, type 2 diabetes, heart disease, and stroke. Obesity contributes to metabolic syndrome and further stresses the cardiovascular system, making the client more prone to complications.

• Family history: Biological father with hyperlipidemia and hypertension, Biological mother with renal failure: A strong family history of cardiovascular and renal disease increases the client’s genetic susceptibility to these conditions. Inherited risk factors, when combined with lifestyle factors, significantly elevate the likelihood of developing complications such as heart failure, chronic kidney disease, or stroke.

Rationale for incorrect choices

• Walks at least a mile three times a week: Regular physical activity is protective, not a risk factor, for cardiovascular and metabolic complications. Exercise helps improve lipid profile, blood pressure, and overall cardiovascular health, mitigating some of the client’s other risk factors.

• Client reports he follows the DASH diet: Adhering to the DASH diet is a positive lifestyle behavior that reduces blood pressure, supports heart health, and lowers the risk of stroke or heart disease. It is not a risk factor; rather, it is a mitigating factor against cardiovascular complications.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Rationale:

A. Instruct the client to discard the medication in the toilet: Disposing of medication in the toilet is not a recommended first action, as it does not address the client’s question about safely taking a half dose. Safe disposal is only necessary for expired or unwanted medications.

B. Manually break the tablets in half: Manually breaking tablets without knowing if they are designed to be split can lead to inaccurate dosing and affect drug efficacy. Some medications are not safe to split due to extended-release properties or uneven distribution of active ingredients.

C. Determine if the tablets are scored: Scored tablets are specifically designed to be split, ensuring accurate dosing. The nurse should verify whether the medication is scored before advising the client to cut it, ensuring safety and effectiveness of the prescribed dose.

D. Ask the pharmacy to create a liquid version of the medication: While a liquid formulation may be appropriate for accurate dosing if the tablet cannot be safely split, the first step is to confirm whether the current tablet can be divided. The pharmacy can then provide alternatives if splitting is unsafe.

A. "Plan to take this medication with food." B. "Limit foods that contain folic acid while taking this medication." C. "Limit foods that contain vitamin D while taking this medication." D. "Plan to take this medication with antacids."

Correct Answer is A

Explanation

Rationale:

A. "Plan to take this medication with food.": Taking phenytoin with food can help reduce gastrointestinal irritation, such as nausea and upset stomach, which is a common side effect. Consistent administration with meals improves tolerability while maintaining therapeutic drug levels.

B. "Limit foods that contain folic acid while taking this medication.": Phenytoin can actually decrease folic acid absorption, and limiting folic acid intake could worsen potential deficiencies. Instead, monitoring and possibly supplementing folic acid may be recommended. Advising restriction could be harmful.

C. "Limit foods that contain vitamin D while taking this medication.": Phenytoin can reduce vitamin D metabolism, which may increase the risk of bone loss and fractures. Limiting vitamin D intake is not advised; rather, ensuring adequate vitamin D and calcium intake is important for older adults to maintain bone health.

D. "Plan to take this medication with antacids.": Antacids can interfere with the absorption of phenytoin, reducing its effectiveness. Taking phenytoin with antacids is contraindicated, and spacing the timing between antacids and phenytoin is necessary to maintain therapeutic levels.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A home health nurse is verifying a client's prescribed medications and notes that one medication dose was decreased by half. The client asks the nurse if they can cut the tablets in half. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is providing teaching to an older adult client who has a seizure disorder and a new prescription for phenytoin. Which of the following instructions should the nurse include?

Correct Answer is A

Explanation

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