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The nurse working at a community health fair is assessing risk factors for hypertension. Which client does the nurse recognize as having the greatest risk factor?

A.

A 73-year-old adult client with asthma and glaucoma

B.

An 80-year-old client with a family history of hypertension

C.

A 36-year-old client who was just diagnosed with obstructive sleep apnea

D.

A 45-year-old client with obesity and uncontrolled type 2 diabetes mellitus.

Answer and Explanation

The Correct Answer is D

A. A 73-year-old adult client with asthma and glaucoma: Age is a non-modifiable risk factor for hypertension, but asthma and glaucoma are not primary drivers of systemic high blood pressure. While chronic steroid use for asthma could impact pressure, this client lacks the metabolic profile that confers the highest risk. This profile is less concerning than metabolic syndrome.

B. An 80-year-old client with a family history of hypertension: Advanced age and genetics are significant risk factors for the development of essential hypertension. However, these factors are often managed over decades and may be less volatile than acute metabolic disease. This client has risk but lacks the compounded metabolic stressors found in other candidates.

C. A 36-year-old client who was just diagnosed with obstructive sleep apnea: Sleep apnea is a known secondary cause of hypertension due to repeated nocturnal sympathetic surges. While significant, the risk in a 36-year-old without other comorbidities is generally lower than in those with multiple chronic metabolic conditions. This represents a single, albeit important, risk factor.

D. A 45-year-old client with obesity and uncontrolled type 2 diabetes mellitus: The combination of obesity and uncontrolled diabetes significantly accelerates vascular damage and activates the renin-angiotensin-aldosterone system. These comorbidities contribute to metabolic syndrome, which is the strongest predictor of severe cardiovascular disease and hypertension. The inflammatory state of diabetes causes profound endothelial dysfunction.


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Related Questions

Correct Answer is B

Explanation

A. Macaroni and cheese: This food is high in carbohydrates and fats but does not contain significant amounts of Vitamin K. While not particularly heart-healthy, it does not directly interfere with the mechanism of warfarin. Patients on anticoagulants do not need to avoid this food specifically for PT/INR stability.

B. Kale chips: Kale is extremely high in Vitamin K, which is the direct physiological antagonist to warfarin. Consuming large or inconsistent amounts of leafy greens can lower the INR, making the blood more prone to clotting and reducing the medication's efficacy. Patients must maintain a consistent intake of Vitamin K to ensure stable anticoagulation levels.

C. Fast food burger and fries: High-fat meals can affect overall cardiovascular health and lipid levels but do not have a direct, acute impact on Vitamin K levels or warfarin metabolism. While the nurse should encourage better nutrition, this meal does not present the same immediate risk to PT/INR monitoring as high-Vitamin K foods.

D. Fruit salad: Most fruits are naturally low in Vitamin K and are safe for patients taking warfarin to consume. Fruit provides essential vitamins and fiber without interfering with the anticoagulant effects of the medication. This is a healthy dietary choice that does not require specific education regarding warfarin interactions.

Correct Answer is ["A","B","D"]

Explanation

A. Distended jugular veins: Right-sided failure increases pressure in the right atrium and vena cava, leading to visible engorgement of the internal jugular veins. This finding reflects the retrograde backup of blood into the systemic venous system. It is a primary clinical indicator of elevated central venous pressure.

B. Weight gain: Rapid increase in body mass in heart failure patients is almost exclusively due to the retention of sodium and water. As the kidneys perceive low perfusion, the renin-angiotensin-aldosterone system triggers fluid volume expansion. This leads to the systemic accumulation of fluid characteristic of right-sided dysfunction.

C. Orthopnea: This symptom involves difficulty breathing while lying flat and is a classic sign of left-sided heart failure and pulmonary congestion. It occurs when fluid from the lower extremities redistributes to the lungs in a recumbent position. Right-sided failure alone does not typically cause this pulmonary-specific symptom.

D. Peripheral edema: Increased systemic venous pressure causes fluid to leak from the capillaries into the interstitial spaces of the lower extremities. This presents as swelling in the feet, ankles, and pretibial areas, often worsening as the day progresses. It is a hallmark sign of right-heart pump failure.

E. Crackles the lungs: Adventitious lung sounds like crackles indicate fluid in the alveoli, which is a manifestation of pulmonary edema. Pulmonary edema is caused by the failure of the left ventricle to move blood into the systemic circulation. It is not a direct finding of isolated right-sided heart failure.

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