A 62-year-old woman has prehypertension (BP 142/90 mm Hg) and smokes a pack of cigarettes per day. She has no symptoms of CAD but a recent LDL level was 154 mg/dL (3.98 mmol/L). Based on these findings, the nurse would expect that which treatment plan would be used first for this patient?

Correct Answer: C

Rationale: In this case, the most appropriate initial treatment plan for the 62-year-old woman with prehypertension, high LDL levels, and who smokes a pack of cigarettes per day would be option C) Diet therapy and smoking cessation. The rationale behind selecting option C is based on addressing the modifiable risk factors that are directly contributing to the patient's cardiovascular health. Diet therapy aims to lower LDL cholesterol levels through dietary modifications such as reducing saturated fat intake. Smoking cessation is crucial as smoking is a major risk factor for cardiovascular disease and quitting smoking can significantly reduce the risk of heart disease. Option A, which suggests diet and drug therapy, may be considered if lifestyle modifications alone are not effective in reaching treatment goals. However, in this scenario, focusing on lifestyle changes first is paramount. Option B, exercise instruction only, while beneficial for overall health, may not be as critical as addressing the high LDL levels and smoking in this patient with prehypertension. Option D, drug therapy and smoking cessation, could be considered if the patient's condition worsens or if lifestyle modifications alone are insufficient to manage her risk factors. Educationally, this question highlights the importance of addressing modifiable risk factors in cardiovascular disease management. It emphasizes the role of lifestyle modifications, such as diet therapy and smoking cessation, as foundational components of treatment before considering pharmacological interventions. This case underscores the significance of a holistic approach to patient care, focusing on prevention and lifestyle changes to improve cardiovascular health outcomes.

Correct Answer: A

Rationale: Rationale: A) The statement that a common cause of diastolic failure is left ventricular hypertrophy is accurate. Diastolic heart failure occurs when the heart muscle becomes stiff and cannot relax properly during diastole, often due to conditions like hypertension or hypertrophy. B) While coronary artery disease (CAD) is a significant risk factor for heart failure, it is not a primary risk factor. Other common causes include hypertension, valvular heart disease, and cardiomyopathy. C) Systolic heart failure is characterized by a reduced left ventricular ejection fraction, typically below 40-50%. This means that the heart is not effectively pumping out enough blood with each contraction. D) Systolic failure is not characterized by abnormal resistance to ventricular filling. Instead, it is related to the heart's inability to contract effectively and pump blood out to the body. Educational Context: Understanding the different types and causes of heart failure is crucial for healthcare professionals working in areas like medical-surgical nursing. Recognizing the distinctions between systolic and diastolic heart failure helps in providing appropriate care and interventions for patients with heart failure. Knowledge of risk factors, diagnostic criteria, and treatment options is essential for managing heart failure effectively.

Correct Answer: C

Rationale: Buerger's disease, also known as thromboangiitis obliterans, is a rare disease characterized by inflammation and clotting of small and medium-sized arteries and veins in the limbs. The correct answer is C) Both A and B - vascular inflammation and limb ischemia. The vascular inflammation in Buerger's disease leads to the formation of blood clots, which can result in limb ischemia due to reduced blood flow to the extremities. This can cause symptoms such as pain, skin ulcers, and tissue damage in the affected limbs. Option A) Vascular inflammation alone is not sufficient to describe Buerger's disease as limb ischemia is a key feature of the condition. Option B) Limb ischemia alone does not encompass the full spectrum of the disease, as the underlying vascular inflammation is what triggers the ischemic events in Buerger's disease. Option D) None of the above is incorrect as Buerger's disease is indeed characterized by both vascular inflammation and limb ischemia. In an educational context, understanding the characteristics of Buerger's disease is important for healthcare professionals, especially those working in cardiovascular or vascular specialties. Recognizing the signs and symptoms of this disease is crucial for early diagnosis and appropriate management to prevent complications such as tissue loss and amputation. By knowing that Buerger's disease involves both vascular inflammation and limb ischemia, healthcare providers can provide better care and support to patients with this condition.

Correct Answer: B

Rationale: The correct answer is B) blood in the urine. When a patient on heparin infusion develops blood in the urine, it is indicative of a possible complication known as heparin-induced thrombocytopenia (HIT). HIT is a serious immune-mediated reaction to heparin, leading to a decrease in platelet count and an increased risk of thrombosis. This can manifest as blood in the urine due to the formation of blood clots in the urinary tract. Option A) vomiting is unlikely to be the earliest evidence of a heparin infusion complication like HIT. Option C) a drop in prothrombin time would not be an early sign of a heparin-related complication since heparin does not directly affect prothrombin time. Option D) pain in the calf of the leg suggests a possible deep vein thrombosis (DVT) which can be a complication of heparin therapy but is not the earliest sign compared to blood in the urine. In an educational context, understanding the early signs of complications related to heparin therapy is crucial for nurses and healthcare providers to promptly recognize and manage adverse events. Monitoring for subtle changes in the patient's condition can help prevent serious consequences associated with heparin-induced complications.

Correct Answer: D

Rationale: In the context of improving compliance with the medical regimen in hypertensive clients, establishing a relationship with each client (Option D) is the most crucial action for the nurse to take. Building a strong nurse-client relationship fosters trust, open communication, and mutual respect. When clients feel understood, supported, and valued, they are more likely to adhere to their treatment plan, including taking medications as prescribed, following lifestyle recommendations, and attending follow-up appointments. Insisting that clients keep their appointments on time (Option A) is important but may not address the underlying reasons for non-compliance. Explaining the pathophysiology of hypertension (Option B) is informative but may not directly impact compliance if the client does not feel connected to the nurse. Warning clients about side effects of medications (Option C) is necessary but may not address the holistic needs of the client in terms of compliance. Educationally, it is essential for nurses to recognize the significance of forming therapeutic relationships with clients to promote positive health outcomes. By prioritizing the establishment of trust and rapport, nurses can create a supportive environment where clients feel empowered to actively participate in their care, leading to improved adherence to medical regimens and better management of chronic conditions like hypertension.