A nurse is caring for a client in an outpatient clinic.
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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
Rationale for correct choices
• Compartment syndrome: The child has a nondisplaced fracture of the radius and ulna, which can lead to swelling and increased pressure within the forearm compartments. Compartment syndrome is a serious complication that can compromise circulation and nerve function if not identified and treated promptly. Early recognition is critical to prevent permanent muscle and nerve damage.
• Paresthesia: The child reports mild tingling in the fingers, indicating early sensory nerve involvement. Paresthesia is a key early sign of neurovascular compromise in compartment syndrome. Monitoring for worsening tingling, numbness, or pain is essential for timely intervention, such as fasciotomy if needed.
Rationale for incorrect choices
• Deep vein thrombosis: DVT is uncommon in pediatric patients, especially in the absence of immobility, central lines, or hypercoagulable conditions. While fractures increase risk in adults, it is not the highest-priority risk in this 9-year-old child with an acute upper extremity fracture.
• Malunion: Malunion refers to healing of a fracture in an abnormal position. While possible, this risk develops over time and is not the immediate concern in the acute phase. Neurovascular compromise and compartment syndrome are more urgent.
• Type of fracture: While the fracture type (nondisplaced radius and ulna) informs management, it does not by itself represent the complication risk. The clinical symptoms of tingling are more directly indicative of acute neurovascular compromise.
• Ecchymosis: Bruising reflects local tissue trauma but is not a definitive indicator of compartment syndrome. Ecchymosis should be monitored but does not provide the highest-priority evidence of risk.
• Location of fracture: The midshaft location guides treatment, such as splinting, but the presence of paresthesia is more directly associated with risk for compartment syndrome. Location alone does not indicate imminent neurovascular compromise.
Correct Answer is D
Explanation
Rationale:
A. Decreased inflammation: Furosemide is a loop diuretic that reduces fluid volume by promoting diuresis. While reducing edema may decrease swelling, “decreased inflammation” is not the primary measure of effectiveness for furosemide, as inflammation involves cellular processes rather than fluid removal.
B. Increased blood pressure: Furosemide typically lowers blood pressure by reducing circulating fluid volume. An increase in blood pressure would suggest the medication is not effective or another underlying issue is present, so this is not an expected finding.
C. Decreased pain: Pain reduction may occur indirectly if edema is relieved, but it is not a direct indicator of furosemide’s effectiveness. Pain levels are subjective and can be influenced by multiple factors, making this a less reliable measure.
D. Weight loss: A reduction in body weight reflects fluid loss, which is the primary therapeutic effect of furosemide. Monitoring daily weights is a standard and objective way to evaluate the effectiveness of diuretic therapy in clients with fluid volume excess.
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