A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment.
On assessment the nurse might expect to see which finding?

Choice A rationale

Alcohol consumption, obesity, diabetes, stress, and high cholesterol are all significant risk factors for heart disease. However, smoking is not listed in this choice. Smoking is a major risk factor for heart disease as it damages the lining of the arteries, leads to the build-up of fatty deposits (atherosclerosis), and increases the risk of heart attacks and strokes.

Choice B rationale

Smoking, hypertension, obesity, diabetes, and high cholesterol are all major risk factors for heart disease. Smoking contributes to the development of atherosclerosis and increases the risk of heart attacks. Hypertension, or high blood pressure, strains the heart and blood vessels, increasing the risk of heart disease. Obesity is linked to multiple risk factors, including high cholesterol, diabetes, and hypertension. Diabetes can cause damage to blood vessels and increase the risk of cardiovascular complications. High cholesterol contributes to the formation of plaques in the arteries, leading to atherosclerosis.

Choice C rationale

Personality type is not a major risk factor for heart disease. Although certain personality traits, such as Type A behavior (characterized by competitiveness, urgency, and hostility), have been associated with increased stress and a higher risk of cardiovascular events, they are not considered primary risk factors. High cholesterol, diabetes, and smoking are significant risk factors, but this choice does not include hypertension or obesity, which are also crucial risk factors for heart disease.

Choice D rationale

Family history, hypertension, stress, and age are important risk factors for heart disease, but this choice does not include some key factors such as smoking, obesity, or diabetes. Family history of heart disease can indicate a genetic predisposition to cardiovascular conditions. Hypertension and stress contribute to cardiovascular risk, and age is a non-modifiable risk factor as the risk of heart disease increases with age. However, the absence of smoking, obesity, and diabetes makes this choice less comprehensive in assessing heart disease risk factors. .

Choice A rationale

Fibrocystic lesions in the breast are benign changes that involve the formation of cysts and fibrous tissue. These do not typically cause an orange-peel appearance of the skin.

Choice B rationale

A normal finding of the breast would not include an orange-peel or "peau d'orange" appearance, as this is considered an abnormal change often associated with underlying pathology.

Choice C rationale

Carcinoma of the breast can lead to an orange-peel appearance of the skin due to lymphatic obstruction. This dimpling effect is caused by the cancerous infiltration and thickening of the skin, making this the correct answer.

Choice D rationale

Fibroadenoma is a benign tumor of the breast and does not usually cause the skin changes described as orange-peel appearance. This condition is generally not associated with skin texture changes.