A nurse is teaching a client about risk factors for heart disease.
Which of the following risk factors is modifiable? (Select All that Apply.)

Choice A rationale

Collecting the urine in the morning and dropping it off in the lab in the evening is incorrect because the specimen must be delivered promptly to the laboratory, typically within one hour, or refrigerated immediately to maintain sample integrity. Prolonged time or warm temperatures allow bacteria to multiply, leading to inaccurate culture results and potentially inappropriate diagnosis or treatment.

Choice B rationale

Thoroughly cleansing the urethral meatus is the critical initial step in obtaining a clean catch specimen, as this reduces the risk of contamination from normal flora and external debris. Using an antiseptic wipe to clean the area before urination ensures that the collected urine sample reflects the true microbial contents of the bladder and not contaminants from the skin surface.

Choice C rationale

Starting to collect the sample as soon as urination begins is incorrect because the initial urine flow should be voided into the toilet to flush out microorganisms residing in the distal urethra. The specimen should be collected from the midstream portion of the flow, ensuring that the collected sample is representative of the urine inside the bladder and minimizes external contamination.

Choice D rationale

Stating that a urine sample cannot be collected during menstruation is inaccurate, as a clean catch specimen can still be obtained, although careful cleansing is even more vital to prevent contamination with blood. While menstruation can complicate urinalysis interpretation, a clean catch midstream sample is often still feasible and necessary for culture or other analyses.

Choice A rationale

An increase of high-density lipoprotein (HDL) cholesterol is not the primary therapeutic effect of Lisinopril, which is an Angiotensin-Converting Enzyme (ACE) inhibitor and is not typically prescribed as a lipid-modifying agent. While improving overall cardiovascular health may indirectly benefit lipid profiles over time, the main pharmacological action is the inhibition of the renin-angiotensin-aldosterone system.

Choice B rationale

An increased heart rate is an undesirable and non-therapeutic effect of Lisinopril; in fact, ACE inhibitors are often used to manage conditions like heart failure where a decreased heart rate is sometimes a goal. Lisinopril works primarily on vascular smooth muscle to cause vasodilation, which ultimately lowers peripheral vascular resistance and does not directly increase cardiac chronotropy.

Choice C rationale

Decreased blood pressure is the primary and expected therapeutic outcome of Lisinopril, as it inhibits the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II. This inhibition leads to systemic vasodilation, reduced peripheral vascular resistance, and decreased aldosterone secretion, all contributing to a reduction in both systolic and diastolic blood pressure.

Choice D rationale

An increased blood pressure would indicate a lack of therapeutic effect or a potential failure of the medication to control the client's hypertension, necessitating a dose adjustment or change in antihypertensive regimen. Lisinopril is specifically prescribed to lower elevated blood pressure, making this outcome the opposite of the desired pharmacological action for hypertension management.