A nurse is reinforcing the education for a patient on the risks of coronary artery disease (CAD) the
LPN knows that the following are modifiable risk factors: (Select all that apply.)
Family History and Genetics
Poorly Controlled Hypertension
Poorly Controlled Diabetes Mellitus
Poorly Controlled Hyperlipidemia
Morbid obesity
Smoking and Use of Tobacco Products
Age
Age
Correct Answer : B,C,D,E,F
A. Family History and Genetics: Genetic predisposition and familial patterns of cardiovascular disease are fixed biological traits. These factors cannot be altered by lifestyle changes or medical interventions. While they inform risk assessment, they are classified as non-modifiable risk factors in clinical practice.
B. Poorly Controlled Hypertension: High blood pressure is a modifiable risk factor that can be managed through diet, exercise, and pharmacological therapy. Reducing systemic vascular resistance decreases the mechanical stress on the coronary arterial walls. Effective control significantly lowers the long-term risk of plaque formation and myocardial infarction.
C. Poorly Controlled Diabetes Mellitus: Chronic hyperglycemia leads to endothelial damage and accelerates the progression of coronary atherosclerosis. Through glycemic control, dietary modifications, and medication adherence, a patient can mitigate the metabolic impact on their vasculature. It is a key target for secondary prevention of coronary artery disease.
D. Poorly Controlled Hyperlipidemia: Elevated levels of low-density lipoproteins contribute directly to the formation of atherosclerotic plaques in the coronary arteries. Lipid levels are modifiable through statin therapy and a low-fat, high-fiber diet. Managing cholesterol is essential for reducing the risk of acute coronary syndromes.
E. Morbid obesity: Excessive adipose tissue is associated with chronic inflammation, insulin resistance, and increased cardiac workload. Weight reduction through caloric restriction and increased physical activity is a direct way to modify this risk factor. It improves the overall metabolic profile and reduces strain on the cardiovascular system.
F. Smoking and Use of Tobacco Products: Tobacco use causes immediate vasoconstriction and long-term damage to the vascular endothelium. Smoking cessation is one of the most impactful modifiable changes a patient can make to prevent coronary artery disease. It results in a rapid decrease in cardiovascular risk after the habit is discontinued.
G. Age: The natural aging process involves the progressive stiffening of arteries and cumulative exposure to various stressors. Age is a non-modifiable risk factor that cannot be influenced by nursing interventions or patient behavior. Risk assessments use age to stratify patients but focus on other variables for active management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Laying in Trendelenburg position: This position involves placing the head lower than the feet, which significantly increases venous return to the heart. In a patient with valvular disease, this extra volume would exacerbate pulmonary congestion and severely worsen respiratory distress. This position is strictly contraindicated for anyone experiencing orthopnea or congestive heart failure.
B. Laying flat on their back: A supine position allows fluid to redistribute from the lower extremities into the pulmonary circulation. This increase in preload overwhelms the failing heart's ability to pump, leading to acute shortness of breath. Patients with orthopnea cannot tolerate lying flat and will instinctively seek an upright position to breathe.
C. Laying in bed in semi-Fowler's position with multiple pillows under their head: Elevating the upper body uses gravity to keep fluid in the lower extremities and reduce the volume of blood returning to the heart. This decreases pulmonary capillary pressure and allows for better lung expansion and gas exchange. Using multiple pillows is a classic compensatory behavior for patients with valvular-induced heart failure.
D. Laying prone in the bed flat: The prone position restricts chest wall expansion and does not address the issue of fluid redistribution to the lungs. Lying flat in any orientation will trigger the sensation of breathlessness associated with orthopnea. Proper nursing care for these patients requires maintaining a high-Fowler's or semi-Fowler's position to optimize respiratory effort.
Correct Answer is C
Explanation
A. "I will notify my doctor if my urine output increases after a few doses.": Diuresis is the intended pharmacological outcome for a patient with heart failure receiving loop diuretics. Increased urinary frequency and volume indicate that the medication is effectively reducing fluid overload. Reporting this expected finding would be an unnecessary use of clinical resources.
B. "I will not eat my usual banana with my breakfast cereal in the morning.": Furosemide promotes the excretion of potassium in the distal tubule and the loop of Henle. Bananas are a high-potassium food that helps prevent the development of hypokalemia during diuretic therapy. Restricting dietary potassium while taking a non-potassium-sparing diuretic increases the risk of cardiac arrhythmias.
C. "I will need to change positions slowly when going from laying down to sitting and then sitting to standing.": Rapid fluid volume reduction and vasodilation can lead to a significant drop in blood pressure upon standing. This orthostatic hypotension increases the risk of falls and syncope in older adult patients. Gradual transitions allow the body's baroreceptors to adjust and maintain adequate cerebral perfusion.
D. "I will take my furosemide with a full glass of water just before bed time.": Administering loop diuretics in the evening results in nocturia, which disrupts the patient's sleep cycle and increases fall risks at night. Medication should be taken in the morning to allow for peak diuresis during waking hours. Timing the dose correctly is essential for maintaining patient safety and quality of life.
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