ATI Care of Patients with Vascular Problems, Questions and Answers with Explanations

ATI Care of Patients with Vascular Problems, Questions and Answers with Explanations, 100% Correct, Download to Score A

Test Bank

MULTIPLE CHOICE

1. A client with atherosclerosis asks a nurse which factors are responsible for this condition. What is the nurse’s best response?

a.	“Injury to the arteries causes them to spasm, reducing blood flow to the extremities.”
b.	“Excess fats in your diet are stored in the lining of your arteries, causing them to constrict.”
c.	“A combination of platelets and fats accumulates, narrowing the artery and reducing blood flow.”
d.	“Excess sodium causes injury to the arteries, reducing blood flow and eventually causing obstruction.”

ANS: C

Most researchers believe that a combination of platelet and lipid accumulation following intimal injury is responsible for the process of atherosclerosis.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 773

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Teaching/Learning

2. The nurse is working with clients at a health fair. Which teaching takes priority to reduce the risk of atherosclerosis?

a.	Instructing a diabetic client not to smoke or use any tobacco
b.	Teaching diet changes to a client with elevated cholesterol levels
c.	Suggesting limiting alcohol to an older client with hypolipidemia
d.	Encouraging exercise to an obese client who lives a sedentary lifestyle

ANS: A

Atherosclerosis can be caused by mechanical and/or chemical injury. People with diabetes often have premature, severe atherosclerosis from elevated low-density lipoprotein (LDL) levels and intimal injury from hyperglycemia. Cigarette smoking or other tobacco use releases toxins into the bloodstream and causes vasoconstriction, further contributing to intimal injury. This would be the priority teaching intervention, although all teaching would be appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

3. A client with hyperlipidemia who is being treated with dietary fat restrictions and an exercise program asks the nurse why his serum lipid levels are still elevated. What activity by the nurse is most appropriate?

a.	Developing a very low-fat diet that the client will adhere to
b.	Explaining familial tendencies in hyperlipidemia
c.	Referring the client to a registered dietitian for weight loss
d.	Educating the client on antihyperlipidemic medications

ANS: B

The liver of clients with familial hyperlipidemia makes excessive cholesterol and other fats. If the client is compliant with the treatment regimen and problems persist, a familial problem may exist. The client is already on a low-fat diet and exercise program, so further refining the diet and counseling for weight loss is redundant. The nurse might want to explore medications with the client, but education is premature until familial hyperlipidemia has been explored.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Teaching/Learning

4. A client with atherosclerosis is attempting to stop cigarette smoking with the use of a nicotine patch. Which statement by the client indicates a good understanding of smoking cessation education?

a.	“Abruptly discontinuing this patch can cause high blood pressure.”
b.	“Abruptly discontinuing this patch can cause nausea and vomiting.”
c.	“Smoking while using this patch increases the risk of respiratory infection.”
d.	“Smoking while using this patch increases the risk of a heart attack.”

ANS: D

Nicotine constricts blood vessels, increases mean arterial pressure, and increases afterload. Smoking while using a nicotine patch increases afterload to such an extent that the myocardium must work harder, with coronary arteries constricted. This may cause a myocardial infarction.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Implementation)

5. A client with hypercholesterolemia and atherosclerosis is prescribed nicotinic acid (Niaspan). Which instruction does the nurse provide the client?

a.	“This medication may make you flush.”
b.	“Take this medication on an empty stomach.”
c.	“You will not need to change your diet with this medication.”
d.	“Take this medication when you experience chest pain.”

ANS: A

Nicotinic acid causes increased release of prostaglandins, resulting in vasodilation. Clients may experience flushing and a very warm feeling all over. Taking the drug with meals minimizes this side effect. The medication will not take the place of adjusting the diet and exercising. Nicotinic acid is not used to treat acute chest pain.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 775

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Implementation)

6. The nurse incorporates dietary teaching into the plan for a client with a low-density lipoprotein (LDL) level of 158 mg/dL. What dietary instruction by the nurse is most appropriate?

a.	“You should keep your saturated fat intake below 10% of your total calories.”
b.	“This result is normal, so continue your current dietary practices.”
c.	“Your total cholesterol intake should be less than 300 mg/day.”
d.	“You should restrict protein sources to fish and chicken only.”

ANS: A

An LDL level of 158 mg/dL is borderline high. American Heart Association (AHA) dietary guidelines advise clients to have a total saturated fat intake of less than 10% of the total caloric intake. A decrease in saturated fat intake is considered more important than decreasing the total cholesterol number because saturated fat is a main determinant of cholesterol synthesis in the body. Teaching the client the best sources of low-fat protein is a good idea, but this is too vague by itself to be the best answer. The client needs more specific information on managing the diet to keep the LDL from becoming even higher.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

7. The nurse is assisting the hospitalized client with his food selections for breakfast. The client is on a low-cholesterol diet. What recommendations are most appropriate for this client?

a.	Cheese omelet, skim milk, whole wheat toast, coffee
b.	Skim milk, oatmeal, banana, orange juice, coffee
c.	Whole wheat French toast, a side of bacon, coffee
d.	Blueberry muffin, orange juice, decaffeinated coffee

ANS: B

Cholesterol is found in animal-based products such as milk, eggs, and cheese. It is also found in baked goods such as muffins. The cheese omelet, bacon, and muffin are too high in cholesterol.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort—Nutrition and Oral Hydration) MSC: Integrated Process: Nursing Process (Implementation)

8. The nurse is reviewing the menu selections of a client who has ordered a low-cholesterol diet. What meal items does the nurse question?

a.	Vegetarian wrap
b.	Cheesesteak sandwich
c.	Fruit salad with yogurt
d.	Grilled fish sandwich

ANS: B

In collaboration with the dietitian, educate the client about the types of fat content in food. Meats and eggs contain mostly saturated fats, and their intake should be limited. Cholesterol is also found in animal sources, such as meats and eggs.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort—Nutrition and Oral Hydration) MSC: Integrated Process: Nursing Process (Implementation

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