A nurse is caring for a client who is scheduled for surgical repair of a femur fracture and has a prescription for lorazepam preoperatively. Which of the following statements made by the client should indicate to the nurse that the medication has been effective?

A. Expert opinions: While expert opinions can provide valuable insights, they are considered lower in the hierarchy of evidence. They do not undergo the rigorous testing and peer review that higher levels of evidence, such as systematic reviews and randomized controlled trials, do.

B. Credible websites: Credible websites can be a good source of information, but they are not considered the highest level of evidence. The information on websites can vary greatly in quality and may not be peer-reviewed.

C. Qualitative studies: Qualitative studies can provide in-depth information about specific topics, but they are not considered the highest level of evidence. They often involve smaller sample sizes and do not provide the same level of quantitative data as systematic reviews or randomized controlled trials.

D. Systematic review: This is correct. Systematic reviews are considered the highest level of evidence in the hierarchy. They involve a comprehensive search of multiple databases to identify all relevant studies on a particular topic, followed by a rigorous assessment of the quality of each study. The results are then synthesized to provide a comprehensive overview of the current evidence.

(A) Decreased stimulation of the sympathetic nervous system (SNS): The sympathetic nervous system (SNS) plays a key role in regulating blood pressure. When the SNS is stimulated, it causes vasoconstriction, or narrowing of the blood vessels, which increases blood pressure. Therefore, decreased stimulation of the SNS would typically lead to vasodilation, or widening of the blood vessels, which would lower blood pressure, not increase it.

(B) Decreased elasticity of blood vessels: As people age, their blood vessels can lose elasticity, which can lead to hypertension. When blood vessels are elastic, they can easily expand and contract with each heartbeat, maintaining a healthy blood pressure. But when they become stiff or rigid, they can’t expand as easily, causing the pressure inside to increase.

(c) Increased peripheral vascular resistance (PVR): Peripheral vascular resistance is the resistance that blood must overcome to flow through the blood vessels. The more resistance, the harder the heart has to work to pump blood through the body, which can lead to increased blood pressure. Factors that can increase PVR include vasoconstriction, or narrowing of the blood vessels, and increased blood viscosity, or thickness.

(D) Decreased fluid volume: Decreased fluid volume, or hypovolemia, would typically lead to a decrease in blood pressure, not an increase. This is because blood pressure is directly related to the volume of blood in the blood vessels. When there’s less blood, the pressure inside the blood vessels is usually lower.

(E) Increased blood viscosity: Blood viscosity refers to the thickness of the blood. When blood is thicker, it’s harder for it to flow through the blood vessels, which increases the resistance to blood flow, leading to increased blood pressure.