The laboratory tests for four patients show the following results. Which patient should the nurse teach first about preventing CAD because the patient is at the greatest risk for CAD even without other risk factors?

Correct Answer: D

Rationale: In this scenario, patient D should be taught first about preventing coronary artery disease (CAD) because they are at the greatest risk based on their lipid profile results. Patient D has a total cholesterol of 250 mg/dL, triglycerides of 164 mg/dL, LDL of 172 mg/dL, and HDL of 32 mg/dL, which indicate elevated levels of LDL (bad cholesterol) and triglycerides, and low levels of HDL (good cholesterol), all of which are significant risk factors for CAD. Patients A, B, and C have more favorable lipid profiles compared to patient D. While patient C has higher total cholesterol and LDL levels, their HDL level is higher compared to patient D. Patients A and B have even better lipid profiles with lower total cholesterol, LDL, and triglycerides, and higher HDL levels compared to patient D. In an educational context, it is crucial for nurses to understand how to interpret lipid profile results and identify patients at higher risk for CAD. Teaching patients about lifestyle modifications, such as healthy diet, regular exercise, smoking cessation, and medication adherence, is essential in preventing CAD. Patient D requires immediate education and intervention to address their elevated risk factors and reduce the likelihood of developing CAD.

Correct Answer: C

Rationale: In advising a male patient who has had a myocardial infarction (MI) about sexual activity, the nurse should recommend option C) Prophylactic nitroglycerin may be used if angina occurs. This is the correct answer because nitroglycerin is a vasodilator that helps to relax and widen blood vessels, increasing blood flow to the heart muscle. If the patient experiences angina, which can be triggered by physical exertion like sexual activity, nitroglycerin can help relieve chest pain by improving blood supply to the heart. Option A) The patient should use the superior position is incorrect because there is no evidence to support the superiority of this position in reducing the risk of complications during sexual activity after an MI. Option B) Foreplay may cause too great an increase in heart rate is incorrect as moderate physical activity, including foreplay, is generally considered safe for most patients with stable cardiovascular conditions. Option D) Performance can be enhanced with the use of sildenafil (Viagra) is also incorrect. While sildenafil is a medication commonly used to treat erectile dysfunction, it is not recommended for patients with recent myocardial infarction or those who are taking nitrates like nitroglycerin due to the risk of a dangerous drop in blood pressure. Educational context: It is crucial for healthcare providers to address sexual activity concerns with patients who have had a myocardial infarction. Providing accurate information and guidance can help alleviate anxiety and ensure the patient's safety. Educating patients about using nitroglycerin prophylactically if angina occurs during sexual activity empowers them to manage their condition effectively and engage in a healthy and satisfying sex life while prioritizing their cardiovascular health.

Correct Answer: C

Rationale: The correct answer is C) Both A and B: Data collection and interpretation are both crucial aspects of the nurse's role in hemodynamic monitoring. Data collection involves gathering vital signs, cardiac output measurements, blood pressure readings, and other relevant information to assess the patient's cardiovascular status. Nurses must accurately collect this data to provide a comprehensive picture of the patient's hemodynamic stability. Interpretation involves analyzing the collected data to identify trends, abnormalities, and potential complications. Nurses need to have a deep understanding of normal hemodynamic parameters and be able to recognize deviations that may indicate deteriorating cardiac function or other issues requiring intervention. Option A) Data collection alone is not sufficient as without the ability to interpret the data, the information gathered may not be used effectively to guide patient care. Option B) Interpretation alone is also inadequate because without accurate data collection, nurses cannot make informed decisions based on incomplete or inaccurate information. Option D) None of the above is incorrect because both data collection and interpretation are essential components of the nurse's role in hemodynamic monitoring. In an educational context, understanding the nurse's role in hemodynamic monitoring is vital for providing safe and effective patient care, especially in critical care settings where hemodynamic instability can have serious consequences. Nurses must be competent in both data collection and interpretation to assess and intervene promptly in response to changes in a patient's cardiovascular status.

Correct Answer: D

Rationale: Rationale: The correct answer is D) improvement of symptoms. When evaluating a patient's response to anticoagulant therapy for arterial occlusion, the primary goal is to assess whether the treatment is effectively improving the patient's symptoms. Improvement of symptoms indicates that the therapy is successfully restoring blood flow to the affected area, reducing the risk of further complications such as tissue damage or ischemia. Option A) increased claudication is incorrect because it suggests a worsening of symptoms, which would indicate that the anticoagulant therapy is not effective. Claudication refers to pain and discomfort in the legs due to reduced blood flow, so an increase in claudication would be a negative outcome. Option B) decreased blood pressure is also incorrect as it is not directly related to evaluating the response to anticoagulant therapy for arterial occlusion. Blood pressure management is important in cardiovascular health, but in this context, improvement in symptoms is a more specific indicator of treatment effectiveness. Option C) compliance to skin care is irrelevant to the evaluation of anticoagulant therapy for arterial occlusion. Skin care may be important for wound healing or prevention of skin breakdown in patients with circulation issues, but it is not a primary consideration when assessing the response to anticoagulant therapy for arterial occlusion. Educational context: Understanding how to evaluate the response to anticoagulant therapy in patients with arterial occlusion is crucial for healthcare professionals managing cardiovascular conditions. By focusing on the improvement of symptoms, clinicians can determine the efficacy of treatment and make informed decisions to optimize patient care and outcomes. This rationale highlights the importance of clinical assessment and outcome monitoring in cardiovascular healthcare.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) should be instructed in preventing hypotensive reactions. When a patient with essential hypertension complains of dizziness upon changing position, it could indicate orthostatic hypotension, a common side effect of antihypertensive medications. Providing education on preventing hypotensive reactions, such as rising slowly from sitting or lying down, increasing fluid intake, and monitoring blood pressure regularly, can help manage this issue. Option A) is probably not taking his medications properly is incorrect because assuming non-adherence without evidence can lead to incorrect conclusions and potentially harm the patient's trust in healthcare providers. Option C) is responding as expected to the prescribed medications is incorrect because dizziness upon changing position is not an expected response to antihypertensive medications and warrants further evaluation. Option D) should be totally reevaluated is too drastic a response at this stage without first addressing potential medication-related side effects. In an educational context, understanding the relationship between essential hypertension, antihypertensive medications, and potential side effects like orthostatic hypotension is crucial for healthcare professionals. Recognizing and managing these side effects through patient education is essential in providing safe and effective care for individuals with hypertension.