A nurse has been scheduled to work 3 days in a row and has been told he will get the same patients to ensure continuity of care. Upon arrival on his second day, he notices one of his patients has been admitted to hospice. The nurse recognizes that hospice care is for clients who have:

Choice A rationale:

Hypertension increases vascular resistance and damages arterial walls, promoting atherosclerosis and elevating risk for coronary artery disease and other cardiovascular complications.

Choice B rationale:

Smoking accelerates endothelial injury, promotes plaque formation, and increases oxidative stress, significantly raising risk for heart disease and vascular complications.

Choice C rationale:

Daily exercise improves cardiovascular health, lowers blood pressure, and reduces lipid levels, serving as a protective factor rather than a risk for heart disease.

Choice D rationale:

Rheumatoid arthritis involves chronic systemic inflammation, which accelerates atherosclerosis and increases cardiovascular risk independent of traditional factors.

Choice E rationale:

Cholesterol level of 275 mg/dL is markedly elevated, promoting plaque deposition in arteries and increasing risk for coronary artery disease.

Choice F rationale:

Fasting glucose of 90 mg/dL is within normal range, showing no evidence of diabetes or metabolic syndrome, so it does not increase heart disease risk.

Choice A rationale

Hyperthyroidism is a metabolic condition characterized by an overactive thyroid gland, leading to symptoms like weight loss, tachycardia, and anxiety. While it can cause tremors or muscle weakness in severe cases, it is not traditionally classified as a primary or high-risk factor for falls compared to sensory deficits. Medical management usually stabilizes these symptoms. Fall risk assessments prioritize factors that directly impair the patient's ability to perceive their environment or maintain physical balance.

Choice B rationale

Hearing impairment can affect a person's awareness of their surroundings and their ability to hear warnings or verbal cues. While it is a sensory deficit, it does not impact physical stability or depth perception as significantly as visual impairment does. Most fall risk assessment tools, like the Morse Fall Scale, focus more heavily on gait, history of falling, and visual cues. Hearing loss is a concern for communication but is not the primary physiological driver of falls.

Choice C rationale

Hyperlipidemia involves elevated levels of lipids in the blood, which increases the long-term risk for cardiovascular disease and stroke. It is a chronic metabolic condition that does not acutely affect a patient’s balance, strength, or coordination. Unless the condition leads to a secondary event like a stroke, it does not contribute to the immediate risk of falling. Therefore, it is rarely included in the criteria used by nurses to determine a patient's fall risk.

Choice D rationale

Visual impairment is a significant risk factor for falls because it directly affects a client’s ability to navigate their environment safely. Reduced acuity, loss of peripheral vision, or poor depth perception makes it difficult to see obstacles, changes in floor levels, or hazards like spills. The inability to process visual information accurately leads to missteps and loss of balance. Ensuring adequate lighting and the use of corrective lenses is a standard intervention for these high-risk clients.