The nurse is evaluating a client for cardiovascular risk factors. Which laboratory result places the client at increased risk for cardiovascular disease?

HD cholesterol 60 mg/di

Total cholesterol 210 mg/at

LDL cholesterol 110 me di

Hgb A1C 5.3%

Answer and Explanation

The Correct Answer is C

A) "HDL cholesterol 60 mg/dL":
This is not a risk factor. High-density lipoprotein (HDL) is often referred to as "good cholesterol" because it helps remove excess cholesterol from the bloodstream, lowering the risk of atherosclerosis and cardiovascular disease. An HDL level of 60 mg/dL is considered protective against cardiovascular disease, as higher levels of HDL are associated with a lower risk of heart disease.

B) "Total cholesterol 210 mg/dL":
This is not a significant risk factor on its own. While total cholesterol above 200 mg/dL is a general indicator for cardiovascular risk, it is not as important as the breakdown of individual lipid components (HDL, LDL). A total cholesterol of 210 mg/dL is only slightly above the ideal less than 200 mg/dL, and on its own, it is not a strong indicator of increased cardiovascular risk without considering other factors like LDL and HDL levels.

C) "LDL cholesterol 110 mg/dL":
. Low-density lipoprotein (LDL) is known as "bad cholesterol" because it can lead to the buildup of plaque in the arteries, increasing the risk for atherosclerosis, heart disease, and stroke. An LDL level of 110 mg/dL is considered to be above optimal. For individuals at risk for cardiovascular disease, the target LDL cholesterol level is usually less than 100 mg/dL, and for those with high risk, it may be less than 70 mg/dL. Therefore, this level of LDL cholesterol places the client at increased risk for cardiovascular disease.

D) "Hgb A1C 5.3%":
This is not a risk factor. An Hgb A1C of 5.3% is within the normal range for glycemic control. The American Diabetes Association defines normal A1C as below 5.7%. A1C levels between 5.7% and 6.4% are considered pre-diabetes, and a level of 6.5% or higher indicates diabetes. A normal A1C level indicates no significant elevated blood glucose, which would be a risk factor for cardiovascular disease.

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Correct Answer is D

Explanation

A) "Increased viral load":
An increased viral load would indicate that the HIV virus is actively replicating in the body. This suggests that the antiretroviral therapy (ART) is not effective, as it has failed to suppress the viral replication. The goal of ART is to lower the viral load to undetectable levels, indicating that the virus is well controlled.

B) "Decreased neutrophil count":
. A decreased neutrophil count (neutropenia) is not directly related to the effectiveness of ART in managing HIV. Neutropenia can occur due to various causes, such as certain medications (including some ART medications), infections, or other underlying conditions. While neutropenia could be a side effect of ART, it does not directly reflect the effectiveness of HIV treatment. Monitoring CD4-T-cell counts and viral load is a better indicator of ART effectiveness.

C) "Decreased white blood cell count":
. A decreased white blood cell count (leukopenia) is also not an indicator of ART effectiveness. While some ART medications may lead to a decrease in white blood cell count, especially in the early stages of treatment, a decrease in the white blood cell count is not a measure of how well the therapy is controlling HIV. The effectiveness of ART is primarily assessed by the viral load and CD4-T-cell count.

D) "Increased CD4-T-cell count":
. CD4-T-cell count is a critical marker for monitoring the immune system's function in patients with HIV. CD4-T-cells are a type of T lymphocyte (white blood cell) that are targeted and destroyed by the HIV virus. A higher CD4-T-cell count indicates that the immune system is recovering and functioning better, which is a sign that the ART is effective in controlling the virus. Ideally, ART should result in a higher CD4-T-cell count and lower viral load, showing that the treatment is effectively suppressing the virus and preserving the immune system.

A. 2-6 hours before meals. B. Lispro lasts 24 hours and does not have to be timed with meals. C. 15-30 minutes before meals. D. 60 minutes before meals.

Correct Answer is B

Explanation

A. 2-6 hours before meals:
This timeframe is too long for rapid-acting insulin like Lispro. Rapid-acting insulins, such as Lispro, begin to work quickly after administration, typically within 15 minutes, and peak around 1 to 2 hours after injection. Administering it 2-6 hours before meals would not align with the timing of food intake and would likely lead to hypoglycemia before the meal. Timing of rapid-acting insulin should be closer to the meal to match the rise in blood glucose levels that occurs after eating.

B. Lispro lasts 24 hours and does not have to be timed with meals:
This statement is incorrect. Lispro is a rapid-acting insulin, and its duration of action is much shorter than 24 hours, typically lasting about 3-5 hours. It is crucial to time the administration of Lispro with meals to match its peak action with the rise in blood glucose levels after eating. A long-acting insulin would be the type that lasts for 24 hours, but that is not the case with Lispro.

C. 15-30 minutes before meals:
Lispro is a rapid-acting insulin, and its onset of action occurs within 15 minutes after injection. It is most effective when administered within 15-30 minutes before the start of a meal, as it peaks in about 1-2 hours and works to regulate blood glucose levels during and after the meal. This timing ensures that insulin works in concert with the rise in blood glucose following food intake, helping prevent hyperglycemia.

D. 60 minutes before meals:
Administering Lispro 60 minutes before a meal is too early. Rapid-acting insulins, such as Lispro, begin working quickly and reach peak action within 1-2 hours. If administered too far in advance, there is a risk that the insulin may have peaked before the meal, leading to a potential drop in blood glucose levels before the meal is consumed. This could result in hypoglycemia. Therefore, administering it closer to the meal, within 15-30 minutes, is the optimal timing.

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The nurse is evaluating a client for cardiovascular risk factors. Which laboratory result places the client at increased risk for cardiovascular disease?

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