While completing a nursing admission history, you obtain this information about the patient's cardiovascular risk factors: patient's mother and two siblings have had myocardial infarctions. Patient smokes and has a 20 pack/year history of cigarette use. Her work as a mail carrier involves a lot of walking. She takes metoprolol (Lopressor) for hypertension and her blood pressure has been in the range of 130/60 to 140/85. Which interventions will be most important to include in the discharge plan? (Choose all that apply.)

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Refer to community programs that assist in smoking cessation. Smoking is a significant modifiable risk factor for cardiovascular disease. By referring the patient to smoking cessation programs, the nurse can address a crucial risk factor and support the patient in making lifestyle changes to improve cardiovascular health. Option B, teaching about the impact of family history on cardiovascular risk, is important for raising awareness. However, addressing smoking cessation, a modifiable risk factor, takes precedence in the discharge plan. Option C, educating about the need for a change in antihypertensive therapy, is not the most immediate intervention needed. The patient's blood pressure is within an acceptable range, and smoking cessation would have a more significant impact on cardiovascular risk reduction. Option D, assisting in reducing stress associated with cardiovascular risk, is important for overall well-being. However, addressing smoking cessation directly impacts a major risk factor and should be the priority in the discharge plan. Educationally, this case highlights the importance of prioritizing interventions based on modifiable risk factors to improve patient outcomes. It emphasizes the role of nurses in promoting lifestyle changes and providing support to patients in managing their cardiovascular health effectively.

Correct Answer: B

Rationale: The correct answer is B) Inferior vena cava. The inferior vena cava is the largest vein in the human body and carries deoxygenated blood from the lower extremities and abdominal organs back to the heart. This vein enters the right atrium of the heart proximally. Option A) Pulmonary artery is incorrect because it carries deoxygenated blood from the heart to the lungs. Option C) Pulmonary vein is incorrect because it carries oxygenated blood from the lungs to the heart. Option D) Superior vena cava is incorrect because it carries deoxygenated blood from the upper body parts to the heart. Understanding the anatomy and function of major blood vessels is crucial in comprehending the circulation of blood throughout the body. The knowledge of the inferior vena cava being the largest vein and its specific role in returning deoxygenated blood from the lower extremities is fundamental in understanding cardiovascular physiology. This information is essential for healthcare professionals, especially those in fields like cardiology, nursing, and emergency medicine.

Correct Answer: D

Rationale: In the context of a client with mitral valve prolapse, it is essential for a nurse to discourage alcohol consumption due to its potential to cause cardiac stimulation. Mitral valve prolapse is a condition where the valve between the left atrium and left ventricle of the heart doesn't close properly, leading to backflow of blood. Alcohol consumption can exacerbate this by increasing heart rate and potentially causing arrhythmias, putting additional strain on the already compromised valve. Option A, tachycardia, is not the primary reason for discouraging alcohol consumption in mitral valve prolapse. While alcohol can indeed lead to tachycardia, the specific concern in this scenario is the direct cardiac stimulation that can worsen the condition. Option B, cinchonism, is unrelated to alcohol consumption and mitral valve prolapse. Cinchonism is a condition caused by excessive quinine consumption. Option C, hypertension, is not directly linked to alcohol consumption in the context of mitral valve prolapse. Alcohol can contribute to hypertension in general, but the focus here is on the cardiac effects specific to the valve condition. Educationally, understanding the impact of alcohol on cardiovascular conditions like mitral valve prolapse is crucial for nurses to provide holistic care. By grasping the physiological effects of alcohol on the heart, nurses can effectively educate patients on lifestyle modifications to manage their condition and prevent complications.

Correct Answer: D

Rationale: In the scenario presented, the correct nursing intervention to maintain adequate cardiac output in a client with dysrhythmia and decreased cardiac output is to provide supplemental oxygen (Option D). Supplemental oxygen helps to increase the oxygen supply to the heart muscle, which is crucial in enhancing cardiac output and improving tissue perfusion. Option A, encouraging mild exercises, would not be appropriate in this situation as it may further strain the heart and exacerbate the dysrhythmia, leading to a decrease in cardiac output. Placing the client in a supine position (Option B) may not necessarily address the underlying issue of decreased cardiac output and could even worsen certain dysrhythmias. Ensuring IV access (Option C) is important for administering medications or fluids, but it does not directly address the need to improve cardiac output in this case. Educationally, understanding the rationale behind providing supplemental oxygen in this context is crucial for nursing students and healthcare professionals. It reinforces the concept of oxygen therapy as a supportive measure in managing cardiac conditions to optimize cardiac function and tissue oxygenation. It also highlights the importance of critical thinking and prioritizing interventions based on the client's condition and needs.

Correct Answer: C

Rationale: The correct answer is A) Acute pulmonary edema occurs when there is a sudden increase in left ventricular end-diastolic pressure, leading to leakage of fluid into the alveoli and interstitial spaces in the lungs. This pathophysiology explanation is correct because acute pulmonary edema is primarily caused by an increase in hydrostatic pressure in the pulmonary capillaries, often due to left-sided heart failure. When the left ventricular end-diastolic pressure rises, it causes fluid to be pushed into the lung tissues, leading to symptoms such as dyspnea, orthopnea, and pink frothy sputum. Option B, C, and D are incorrect as they do not accurately describe the pathophysiology of acute pulmonary edema. It's important for students to understand the mechanism behind this condition to recognize the signs and symptoms, understand the treatment options, and grasp the importance of managing left-sided heart failure to prevent complications like acute pulmonary edema. Educational context: Understanding the pathophysiology of acute pulmonary edema is crucial for healthcare professionals, especially those working in cardiology, critical care, or emergency settings. By grasping the underlying mechanism of this condition, clinicians can provide timely and effective interventions to improve patient outcomes. This knowledge also underlines the importance of managing heart failure effectively to prevent complications like acute pulmonary edema.