A nurse is assessing a client who has circulatory overload. Which of the following findings should the nurse expect?

A) Improved sexual function:
While ACE inhibitors like lisinopril may have a beneficial impact on overall health, improved sexual function is not a direct therapeutic effect of this medication. In fact, ACE inhibitors can sometimes cause side effects like sexual dysfunction in some individuals. Therefore, improved sexual function is not considered a therapeutic outcome for lisinopril.

B) Decreased blood pressure:
Lisinopril is an ACE (angiotensin-converting enzyme) inhibitor that works by blocking the conversion of angiotensin I to angiotensin II, which results in vasodilation and lowered blood pressure. Therefore, a decreased blood pressure is the expected and desired outcome when a client is on lisinopril. This is the primary therapeutic effect of the medication.

C) Increase of HDL cholesterol:
Lisinopril does not have a direct effect on increasing HDL (high-density lipoprotein) cholesterol. While ACE inhibitors may have some indirect cardiovascular benefits, such as improving endothelial function or reducing risk factors for heart disease, raising HDL cholesterol is not one of their specific effects. This outcome would not indicate a therapeutic effect of lisinopril.

D) Prevention of bipolar manic episodes:
Lisinopril is not used for the treatment or prevention of bipolar disorder or its manic episodes. While certain medications, such as mood stabilizers or antipsychotics, may be used in the management of bipolar disorder, lisinopril is not effective for this purpose. Therefore, preventing bipolar manic episodes is not a therapeutic outcome of lisinopril.

A) Increase in the startle reflex:
As people age, many of their physiological responses become less efficient, but some reflexes, such as the startle reflex, may actually become more pronounced or exaggerated. This occurs due to changes in the nervous system and decreased inhibition of certain reflex pathways. The startle reflex, which is an automatic response to sudden stimuli, can become more sensitive in older adults as a result of slower processing in the central nervous system.

B) Increase in muscle mass:
With aging, there is typically a decrease in muscle mass, a condition called sarcopenia, which leads to reduced strength and physical endurance. This loss of muscle mass starts around the age of 30 and accelerates after age 60. Therefore, muscle mass generally decreases rather than increases in older adults.

C) Decrease in body fat:
In older adults, body fat generally increases, particularly in the abdominal area, as muscle mass decreases and metabolism slows. While there may be some loss of subcutaneous fat in the face and extremities, visceral fat often increases, contributing to a higher body fat percentage.

D) Decrease in systolic blood pressure:
As people age, systolic blood pressure tends to increase, not decrease. This is due to the stiffening of the arteries and reduced elasticity of the vascular walls, which makes it harder for blood vessels to expand and contract with each heartbeat. This leads to a rise in systolic blood pressure while diastolic blood pressure may remain stable or decrease slightly.