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Exhibits

The nurse is reviewing the client's medical record.

Select the 2 findings the nurse should identify as placing the client at risk for cardiovascular disease.

A.

Exercise

B.

Diet

C.

LDL level

D.

BMI

E.

HDL level

Answer and Explanation

Correct Answer : C,D

Rationale for Correct Answers:

  • LDL level: An LDL level of 145 mg/dL exceeds the recommended limit (<130 mg/dL), increasing the client’s risk for atherosclerosis and coronary artery disease. Elevated LDL contributes to plaque buildup in arterial walls, narrowing the vessels and raising the likelihood of myocardial infarction and stroke.
  • BMI: A BMI of 29.8 falls in the overweight range (25–29.9), nearing obesity. Excess body weight, particularly visceral fat, is associated with hypertension, insulin resistance, and dyslipidemia, all of which are significant risk factors for cardiovascular disease.

Rationale for Incorrect Answers:

  • Exercise: The client walks 30 minutes 5 days a week, meeting the American Heart Association’s guidelines for physical activity. Regular aerobic exercise reduces blood pressure, improves lipid profiles, and strengthens cardiac function.
  • Diet: The client reports following a Mediterranean diet, which is associated with lower cardiovascular risk due to its emphasis on fruits, vegetables, whole grains, lean protein, and healthy fats. Although wine consumption is noted, moderation aligns with Mediterranean patterns.
  • HDL level: The client’s HDL is 58 mg/dL, which is above the desired threshold (>55 mg/dL). Higher HDL levels offer cardioprotective effects by helping remove cholesterol from the bloodstream and reducing the risk of plaque buildup.


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Related Questions

Correct Answer is D

Explanation

A. NPH insulin: This is an intermediate-acting insulin with a delayed onset and is not appropriate for continuous infusion. It is not used in the acute management of diabetic ketoacidosis (DKA).
B. 0.45% saline: Hypotonic saline may be used later in DKA management, but initial fluid resuscitation requires isotonic fluids to restore intravascular volume and improve perfusion.
C. Glargine insulin: This is a long-acting insulin used for basal control and is not suitable for continuous infusion. It lacks the rapid onset and titratability needed in acute DKA treatment.
D. Normal saline: Isotonic 0.9% saline is the fluid of choice for initial resuscitation in DKA to treat dehydration, improve perfusion, and stabilize blood pressure before initiating insulin therapy.

Correct Answer is []

Explanation

Rationale for Correct Choices:

  • Administer oral corticosteroids: Corticosteroids are the cornerstone of treatment for nephrotic syndrome. They reduce glomerular permeability and inflammation, helping to decrease proteinuria and edema.
  • Encourage a low-sodium diet: A low-sodium diet helps minimize fluid retention and reduce edema associated with nephrotic syndrome. It is a supportive measure to enhance the effectiveness of corticosteroid therapy.
  • Nephrotic syndrome: The clinical signs of periorbital and abdominal edema, heavy proteinuria, hypoalbuminemia, and hyperlipidemia are hallmarks of nephrotic syndrome. The foamy urine and low albumin support this diagnosis.
  • Abdominal girth: Monitoring abdominal girth daily helps assess fluid retention (ascites) and the child’s response to treatment. Increasing girth may indicate worsening edema or inadequate diuresis.
  • Urine specific gravity: Specific gravity reflects urine concentration and can provide indirect evidence of hydration status and proteinuria. Persistently high values are common in nephrotic syndrome due to protein loss.

Rationale for Incorrect Options:

  • Initiate contact precautions: Contact precautions are not indicated unless the patient has a transmissible infection, which is not present here. Nephrotic syndrome is not contagious.
  • Administer IV antibiotics: IV antibiotics are not indicated without signs of infection. There is no fever, leukocytosis, or other infectious signs suggesting a bacterial process.
  • Initiate peritoneal dialysis: Dialysis is reserved for advanced renal failure, which is not present. Urine output is adequate, and labs do not indicate uremia or electrolyte crises.
  • Chronic kidney disease: CKD involves long-standing loss of renal function. This child’s presentation, especially the acute onset of edema and lab values, aligns more with nephrotic syndrome.
  • Hemolytic uremic syndrome: HUS typically follows diarrheal illness and presents with anemia, thrombocytopenia, and acute renal failure. This child has thrombocytosis and no signs of hemolysis.
  • Acute glomerulonephritis; AGN often presents with hematuria, hypertension, and mild to moderate proteinuria. Nephrotic syndrome is a better match due to severe proteinuria and hypoalbuminemia.
  • Bilirubin: Bilirubin levels evaluate liver function and are not relevant in nephrotic syndrome, which is a kidney disorder.
  • Head circumference: Monitoring head circumference is applicable for infants, not school-age children, and has no relevance to renal or fluid status.
  • HbA1c: HbA1c reflects long-term glucose control and is unnecessary in this case, as there is no history of diabetes or hyperglycemia.

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