The nurse has reviewed the Nurses' Notes, Vital Signs, and Laboratory Results from 3 months ago.

Exhibits

The nurse is reviewing the client's plan of care. Which of the following findings indicate the client's condition has improved? Select all that apply.

Rationale:

A. Hyperkalemia: Furosemide is a loop diuretic that promotes potassium excretion, which can lead to hypokalemia, not hyperkalemia. Monitoring for low potassium is important, but hyperkalemia is not a primary concern with these medications.

B. Hypoglycemia: Neither furosemide nor gentamicin directly affects blood glucose levels. Hypoglycemia is not a typical complication of these medications.

C. Ototoxicity: Gentamicin, an aminoglycoside antibiotic, and furosemide, a loop diuretic, can both cause ototoxicity, which may result in tinnitus, hearing loss, or balance disturbances. Monitoring for auditory changes is essential when these medications are used concurrently.

D. Liver toxicity: These medications are not primarily hepatotoxic. Liver function monitoring is not a routine requirement for furosemide or gentamicin unless there are other predisposing conditions.

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.