A client is seen in the emergency department following an episode of chest pressure and breathlessness while mowing the lawn. Which information obtained by the nurse indicates an increased risk for ischemic heart disease? Select all that apply.

Works for a large outdoor lawn care franchise.

Does not receive the flu vaccine annually.

Recent history of chest muscle injury.

Family history of diabetes mellitus.

Unable to afford prescribed "statin" medication.

Answer and Explanation

Correct Answer : D,E

Rationale:
A. Works for a large outdoor lawn care franchise: Occupation alone does not inherently increase risk for ischemic heart disease unless associated with high physical or environmental stressors. Routine outdoor work is not a direct cardiovascular risk factor.

B. Does not receive the flu vaccine annually: Lack of vaccination may increase susceptibility to influenza, but it is not a primary risk factor for ischemic heart disease. Flu infection can exacerbate cardiac conditions, but the absence of vaccination alone does not indicate elevated baseline risk.

C. Recent history of chest muscle injury: Musculoskeletal chest pain does not reflect coronary artery disease risk. Muscle injury may mimic angina but does not contribute to ischemic heart disease development.

D. Family history of diabetes mellitus: Diabetes is a well-established risk factor for atherosclerosis and ischemic heart disease. A family history of diabetes increases the client’s likelihood of developing metabolic and cardiovascular complications.

E. Unable to afford prescribed "statin" medication: Nonadherence to lipid-lowering therapy due to cost increases cardiovascular risk by allowing elevated cholesterol levels to persist, contributing to plaque formation and ischemic heart disease.

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Free Nursing Study Resources

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Rationale:

• Assist with ambulation with 1 person assist: The client has balance disturbances and slurred speech due to alcohol-related neurological impairment and possible hepatic encephalopathy. Ambulation assistance helps prevent falls and injury while promoting mobility. One-person assist is sufficient for safety while encouraging independence.

• Assess level of consciousness: Ongoing neurological monitoring is critical in patients with chronic liver disease and potential hepatic encephalopathy. Changes in orientation, alertness, or responsiveness can indicate worsening liver dysfunction, elevated ammonia levels, or acute complications, necessitating timely intervention.

• Encourage a high calorie regular diet: Chronic alcohol use often leads to malnutrition and protein-calorie deficiency. Providing a high-calorie diet supports nutritional needs, energy balance, and liver recovery while preventing further weight loss and muscle wasting. Dietary modifications are essential for long-term management.

• Monitor for bleeding: The client has coagulopathy indicated by prolonged PT (18 seconds) and elevated INR (2.4). Liver dysfunction reduces clotting factor synthesis, increasing the risk of spontaneous bleeding. Close monitoring for bruising, hematuria, or gastrointestinal bleeding is essential to prevent complications.

• Prepare to insert an esophageal balloon tamponade tube: This procedure is typically reserved for acute variceal bleeding, which the client is not currently experiencing. Inserting a balloon tamponade unnecessarily could cause trauma, esophageal rupture, or worsen coagulopathy. Monitoring for bleeding is indicated instead of prophylactic invasive procedures.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}

Explanation

Rationale:

• Being familiar with stroke symptoms: Recognizing early stroke symptoms such as facial droop, arm weakness, and speech difficulty allows for rapid activation of emergency services. Early recognition is critical because timely treatment with thrombolytic therapy significantly improves outcomes. Education on symptom recognition empowers both the client and spouse to act quickly if symptoms recur.

• Help prevent reoccurrence: Prompt recognition and rapid response to stroke symptoms reduce delays in treatment during future events. Early intervention can limit brain injury and decrease long-term disability. Knowing when to seek immediate care helps prevent complications associated with prolonged ischemia.

• Anticoagulant medication: While anticoagulants may be prescribed due to atrial fibrillation, understanding medication use alone does not fully demonstrate stroke education comprehension. Anticoagulation reduces embolic risk but does not replace the need for symptom recognition.

• Accepting help: Accepting help relates more to coping and rehabilitation rather than prevention of recurrent stroke. Although support is important for recovery, it does not directly reduce the likelihood of another ischemic event. This option does not address early detection or risk mitigation.

• Using assistive devices: Assistive devices support mobility and safety during recovery but do not prevent stroke recurrence. Their use is more relevant to functional adaptation after neurological deficits. This reflects rehabilitation planning rather than stroke prevention knowledge. It does not demonstrate understanding of warning signs or risk reduction.

• Lower serum cholesterol: Lowering cholesterol is part of long-term cardiovascular risk management but is not directly linked to the education focus in this statement. Cholesterol control is typically achieved through medication and lifestyle changes, not symptom recognition. This narrows prevention to a single risk factor rather than comprehensive stroke awareness. It does not capture the urgency of recognizing acute symptoms.

• Prevent all falls: Falls prevention is important after stroke due to weakness and balance issues, but it is unrelated to preventing stroke recurrence. Education on falls focuses on safety rather than vascular risk reduction.

• Decrease independence: Stroke education aims to preserve function and independence, not reduce it. While some assistance may be necessary during recovery, the goal is maximizing autonomy. This option contradicts rehabilitation and recovery principles.

• Increase risk factors: Education is designed to reduce, not increase, stroke risk factors. Awareness and lifestyle modification are intended to mitigate future events. It does not demonstrate correct understanding by the client or spouse.

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A client is seen in the emergency department following an episode of chest pressure and breathlessness while mowing the lawn. Which information obtained by the nurse indicates an increased risk for ischemic heart disease? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse determines the client and spouse understand the stroke education when they verbalize that dropdown will dropdown.

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}

Explanation

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