Resp/Cardio Assessment

A client who has angina pectoris comes to the ER reporting chest pain. When assessing the client, which of the following findings should the nurse expect? (Select all that apply) ​ A. Weakness in the arms ​B. Abdominal cramps ​C. Diaphoresis ​D. Severe apprehension ​E. Dizziness

A, C, D Weakness in the arms is correct. Common manifestations of angina include feelings of numbness or weakness in the hands, wrists, and arms. Abdominal cramps is incorrect. Nausea and vomiting are more common with angina than abdominal cramping. Diaphoresis is correct. Common manifestations of angina include diaphoresis, pallor, and shortness of breath. Severe apprehension is correct. Common manifestations of angina include severe apprehension and a feeling of impending doom. Dizziness is incorrect. Common manifestations of angina include dizziness and lightheadedness.

A nurse assessing a client determines that he is in the compensatory stage of shock. Which of the following findings support this condition? A. Confusion B. Lethargy C. unconciousness D. Petechiae

A. Confusion characterizes the compensatory stage of shock, as do decreased urinary output, cold and clammy skin, and respiratory alkalosis. Lethargy and petechiae are the progressive stage of shock Unconciousness is the irreversible stage of shock

A client is receiving positive pressure mechanical ventilation. Which of the following should the nurse implement to prevent complications? (Select all that apply) A. Palpate skin for a "popping" sensation. B. Verify prescribed ventilator settings daily. C. Administer midazolam hydrochloride (Versed) as needed. D. Give pantoprazole (Protonix) as prescribed. E. Reposition the endotracheal tube to the opposite side of the mouth.

A. D. E

A nurse is caring for a client who had a cardiac catheterization. Which f the following nursing interventions should the nurse include in the client's plan of care? (select all that apply) A. Check peripheral pulses in the affected extremity. B. Place the client in high-Fowler's position. C. Measure the client's vital signs every 4 hr. D. Keep the client's hip and leg extended. E. Have the client remain in bed up to 6 hr.

A. D. E

A nurse is admitting a client who has serum calcium level of 12.3 mg/dL and initiates cardiac monitoring. Which of the following findings should the nurse expect during the initial assessment? A. Lethargy B. Hyperactive deep tendon reflexes C. Prolonged ST segment D. Hyperactive bowel sounds

A. serum calcium level of 12.3 mg/dL is above the expected reference range. The nurse should monitor the client for lethargy, generalized weakness, and confusion.

A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. 48 hours after the incident, he becomes agitated, confused, and begins to hyperventilate. O2 sat drop to 80% on O2, therefore the pt is intubated and placed on mechanical ventilation. Which of the following conditions has he most likely developed? A. Pneumonia B. Acute Respiratory Distress Syndrome C. Bronchitis D. Atelectasis

B.

The morning weight for a client with emphysema indicates that the client has gained 5 pounds in less than a week, even though his oral intake has been modest. The client's weight gain may reflect which associated complication of COPD? A. Polycythemia B. Cor pulmonale C. Left-sided heart failure D. Respiratory acidosis

B.

What causes pulmonary vasoconstriction leading to the develpoment of cor pulmonale in the pt with COPD? A. polycythemia and hypocapnia B. alveolar hypoxia and hypercapnia C. long-term low-flow oxygen therapy D. excess mucus production and frequent pulmonary infections

B. ?

A nurse is caring for a client who is at risk for shock. Which of the following findings is the earliest indicator that this complication is developing? ​A. Hypotension ​B. Decreased urine output ​C. Narrowing pulse pressure D. ​Decreased level of consciousness

C. ​Narrowing pulse pressure is the earliest indicator of shock.

A client is requesting information regarding a serum troponin test. Which of the following is the nurse's best response? A. "It is a protein found in the serum of healthy clients." B. "Lab results are used alone to diagnose heart disease." C. "Troponin levels have a narrow time frame, so it is important to obtain this test now." D. "The slightest elevation in troponin levels will prompt treatment to prevent complications of cardiovascular disease."

D. Low levels of troponin are treated aggressively due to the increased risk of death from cardiovascular disease. The more damage there is to the heart, the greater the amount of troponin will be in the blood. The most common reason to perform this test is to confirm diagnosis of a myocardial infarction.

A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of pencillin. Which of the following medication should the nurse administer first? A. Dobutamine B. Methylprednisolone C. Furosemide D. Epinephrine

D. The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to administer epinephrine, a bronchodilator and vasopressor used for allergic reactions to reverse severe manifestations of anaphylactic shock.

A patient with a history of COPD and acute coronary syndrome affecting the anterior wall one year ago, is experiencing shortness of breath, a rapid irregular heartbeat, an O2 sat of 89%, and is expectorating pink0frothy sputum. The most like cause of these finding is? A. pulmonary edema B. cardiac tamponade C. pulmonary embolism D. inferior wall myocardial infarction

pulmonary edema

A client who has pulmonary edema develops tachypnea, dyspnea, crackles, and hypoxemia, and O2 ther does not help. The provider dx ARDS. The nurse should monitor this client for which of the following complications? ​ A. Respiratory acidosis ​B. Respiratory alkalosis C. ​Metabolic acidosis ​D. Metabolic alkalosis

​A. With ARDS, the alveoli collapse and the client has a decreased ability to exchange carbon dioxide for oxygen. Decreased ventilation (hypoxemia) causes carbon dioxide retention, resulting in respiratory acidosis.

A nurse is teaching a client who has emphasema about self management strategies. Which of the following client statements indicates that the client understands the instructions? ​A. "I will inhale slowly through pursed lips to help me breathe better." ​B. "I will drink a total of 2 quarts of fluid every day." ​C. "I will follow a daily diet high in calories and protein." ​D. "I will lie on my stomach to practice abdominal breathing every day."

​C. Clients who have emphysema have greater-than-usual nutritional requirements for calories and protein and often need nutritional supplements between meals. Weight loss and malnutrition are common in these clients.

A nurse is caring for a client who has hypovolemic shock. Which of the following is an expected finding? ​A. Hypertension B. ​Purpura C. Oliguria ​D. Bradypnea

​C. Oliguria is present in hypovolemic shock as a result of decreased blood flow to the kidneys.

A nurse is assessing a client who has chronic bronchitis. Which of the following percussion sounds should the nurse expect? ​A. Dullness ​B. Resonance ​C. Tympany ​D. Flatness

B. ​Resonance characterizes chronic bronchitis. It is a loud, low-pitched sound of long duration.

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is to? A. Promote oxygen intake B. Strengthen the diaphragm C. Strengthen intercostal muscles D. Promote carbon dioxide removal

D.

A client who has emphsema and has difficulty with mobility is receiving home health care. He spends most of his day in a reclining chair. Which physiological response to prolonged immobility should the nurse expect? ​A. Increased insulin production ​B. Decreased RBC production ​C. Decreased sodium excretion ​D. Increased calcium excretion

D. ​Prolonged immobility leads to the breakdown of bone tissue. This results in increased calcium excretion.

A nurse is caring for a client who has emphysema. Which of the follwoing findings should the nurse expect to assess in this client? (Select all that apply) A. Dyspnea B. Bradycardia C. Barrel chest D. Clubbing of the fingers E. Shallow respirations F. Hemoptysis

A, C, D, E, Dyspnea is correct. Emphysema is a lung disease involving damage to the alveoli in which they become weakened and collapse. Dyspnea is seen in clients with emphysema as the lungs try to increase the amount of oxygen available to the tissues. Bradycardia is incorrect. With emphysema, the heart rate will increase as the heart tries to compensate for less oxygen to the tissues. Barrel chest is correct. Clients with emphysema lose lung elasticity; the diaphragm becomes permanently flattened by overdistention of the lungs; the muscles of the rib cage become rigid; and the ribs flare outward. This produces the barrel chest typical of emphysema clients. Clubbing of the fingers is correct. Clubbing results from chronic low blood-oxygen levels. The tips of the fingers enlarge and the nails become extremely curved from front to back. Shallow respirations is correct. Clients with emphysema lose lung elasticity; consequently, respirations become increasingly shallow.

A nurse in an emergency department is preparing to administer alteplase accelerated therapy to a client who is having a MI. Which of the following actions should the nurse plan to take? ( Select all that apply) A. Administer the medication within 30 min of the client's arrival to the department. B. Reconstitute the medication with sterile water. C. Administer a 15 mg IV bolus. D. Tell the client that the purpose of the medication is to keep a new clot from forming. E. Assess the client for back pain.

A. B. C. E. Administer the medication within 30 min of the client's arrival to the department. The benefits of alteplase are greatly increased when administered as early as possible. Current recommendations are that the client is given alteplase within 30 min of arrival in the emergency department. Research shows a decrease in mortality and a reduction in the size of the infarction when alteplase is administered within 30 min. Reconstitute the medication with sterile water is correct. Alteplase is available as a powder. The nurse should use sterile water to reconstitute the medication. Administer the medication in a 15 mg IV bolus is correct. The nurse should administer an accelerated, or loading dose, to promote a rapid therapeutic effect of the medication. Tell the client that the purpose of the medication is to keep a new clot from forming is incorrect. The nurse should tell the client that the purpose of the medication is to dissolve the existing clot. The nurse will also administer anticoagulants to reduce the risk of new clot formation. Assess the client for back pain is correct. The nurse should assess the client for indications of bleeding, which include report of back pain, headache, changes in level of consciousness, and decreased levels of hematocrit and hemoglobin.

A client who has emphysema has dyspnea with minimal exertion. The nurse should monitor this client for which of the following complications? A. Resp. acidosis B. Resp. Alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. The client probably has hypoxemia and tries to increase his RR in an attempt to take in more O2. However, the client probably begins to exhale before he can fully exhale, causing in alveolar hypoventilation. CO2 builds up and the client develops chronic respiratory acidosis.

A nurse is caring for a client who had a cardiac catheterization 6 hr prior. The nurse makes the following observations: Vurine output for the first 4 hr of the evening shift was 3 times the intake in the same period. Vital signs are w/in normal limits and stable IV fluids are running at 50 ml/hr femoral insertion site dressing is intact Distal pulse are palpable and strong The nurse should recognized the discrepancy between the client's intake and output represents a physiological response to which of the following? A. Dye utilized for the study B. Improved cardiac function C. Intravenous fluids infusing at 50 mL/hr D. Sedative given during the procedure

A. The dye used during a cardiac catheterization acts as a diuretic and causes increased urination.

A nurse on a medical unit is caring for a client who has angina pectoris and reports chest pain w/severity of 6 on a 0 to 10 scale. The nurse administers sublingual nitroglycerin (NItrostat). After 5 mins, the client states that his chest pain is now a 2. Which of the following actions should the nurse take? ​ A. Administer another nitroglycerin tablet. ​B. Assess the client's blood pressure. ​C. Check the client's apical heart rate. ​Obtain an ECG.

A. ​Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first if the client is still reporting pain.

A patient is brought to the ER unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care? A. Hypercapnic respiratory failure related to decreased ventilatory effort B. Hypoxemic respiratory failure related to diffusion limitations C. Hypoxemic respiratory failure related to shunting blood D. Hypercapnic respiratory failure related to increased airway resistance

A: the patient with an opioid OD develops hypercapnic RF as a result of decrease in RR and depth. Diffusion limitation, blood shunting, and increased airway resistance are not the PRIMARY pathophysiology causing the RF.

A nurse is assessing a client who is being admitted to the step down unit 6 hr following a cardiac catheterization. The nurse notes that the affected leg is cool to the touch, has a decreased pulse, and a hard palpable area in the groin area. Which of the following is an appropriate action by the nurse? A. Instruct the client to notify the nurse if there is any bleeding from the site. B. Apply pressure to the femoral artery. C. Monitor the client for possible deep vein thrombosis. D. Observe the site again in 15 min for any changes.

B. Instruct the client to notify the nurse if there is any bleeding from the site is incorrect. This jeopardizes client safety by placing the client at risk for immediate harm, and is not an appropriate action by the nurse. Apply pressure to the femoral artery. is correct. The assessment findings are indicative of inadequate hemostasis of the affected femoral artery. The nurse should immediately apply pressure to the femoral artery to control bleeding and achieve hemostasis. Monitor the client for possible deep vein thrombosis. is incorrect. This jeopardizes client safety by placing the client at risk for immediate harm, and is not an appropriate action by the nurse. Observe the site again in 15 min for any changes is incorrect. This jeopardizes client safety by placing the client at risk for immediate harm, and is not an appropriate action by the nurse.

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which of the following dysrhythmias should the nurse expect to find on the ECG? A. First-degree AV block B. Atrial fibrillation C. Sinus bradycardia D. Sinus tachycardia

B. Atrial fibrillation causes a disorganized twitching of the atrial muscles. The rate is irregular with no visible P waves. The ventricular response is irregular which results in an irregular pulse and a pulse deficit

A 68 year old man has a long history of COPD and is admitted to the hospital with cor pulmonale. Which clinical manifestation noted by the nurse is consistent with the cor pulmonale dx? A. Audible crackles at both lung bases B. 3+ edema in the lower extremities C. Loud murmur at the mitral area D. High systemic BP

B. Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular vein distension, and right upper-quadrant abdominal tenderness would be expected.

A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury? A. atorvastatin B. Metformin C. Nitroglycerin D. Carvedilol

B. Metformin interacts with contrast dye and can cause acute kidney damage.

A nurse is caring for a client in the critical care unit follwoing a knife wound to the chest. The nurse suspects the client is developing cardiac tamponade. Which of the following findings supports this suspicion? A. widening pulse pressure B. Muffled heart sounds C. Elevating systolic bp D. decresing venous pressure

B. Muffled heart sounds are a key indicator of cardiac tamponade.

A nurse is caring for a client who has respiratory failure, is incubated, and is mechanically ventilated. The client pulls out the endotracheal tube. Which of the following is a priority nursing action? A. Prepare for reintubation. B. Ensure the airway is open. C. Provide nasotracheal suctioning. D. Deliver 100% oxygen via manual bag with face mask.

B. The client's urgent need for an open airway to receive oxygen takes priority.

A nurse is monitoring a client who has an anterior septal myocardial infarction. The client is on a dobutamine hydrochloride (Dobutrex) drip. The nurse understands the rationale for the client's dobutamine drip is to? ​A. dilate veins and arteries. ​B. improve cardiac output. ​C. reduce hypertension. ​D. reduce heart rate.

B. ​Dobutamine is a vasopressor to improve cardiac output.

A home health nurse visits a client who has COPD and receives O2 at 2L/ min via nasal cannula. The client tells the nurse she has been having difficulty breathing. Which of the following nursing actions is the priority at this time? ​A. Increase the oxygen flow to 3 L/min. ​B. Evaluate the client's respiratory status. ​C. Call emergency services for the client. ​D. Have the client cough and expectorate secretions.

B. ​The first action the nurse should take using the nursing process is to collect data from the client. The nurse should immediately evaluate the client's respiratory status before determining the appropriate interventions.

A client who has angina pectoris is experiencing chest pain and has taken 3 nitroglycerin tablets sublingually. The client reports relief from the chest pain but now reports a headache. The nurse should explain to the client that this symptom.. ​A. could mean an allergy to the medication. ​B. is an expected side effect of the medication. ​C. indicates tolerance to the medication. ​D. is probably a result of anxiety about the chest pain.

B. ​The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache.

A nurse in the ICU is caring for a client who has ARDS and is receiving mechanical ventilation via an endotracheal tube. The provider plans to extubate her within the next 24 hr. Which of the following is an important criterion for extubating this client? ​A. Ability to cough effectively ​B. Adequate tidal volume without positive pressure C. ​No indications of infection ​D. No need for supplemental oxygen

B. ​Typical weaning criteria include the ability to maintain adequate vital capacity, tidal volume, and minute ventilation without positive pressure or other or manually assisted breaths.

A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following should the nurse include as effective for preventing this disorder? A. Maintanance of ideal weight B. Annual influenza immunization C. Smoking cessation D. Regular moderate exercise

C

A client comes to the ER via ambulance to report severe radiation chest pain and sob. The client appears restless, frightened, and slightly cyanotic. The provider prescribes O2 by nasal cannula at 4 L/min stat, cardiac enzyme levels, IV fluids, and a 12-lead ECG. Which of the following actions should the nurse take first? ​A. Attach the leads for a 12-lead ECG. ​B. Obtain the blood sample. ​C. Initiate oxygen therapy. ​D. Insert the IV catheter.

C.

A nurse is providing home care instructions to a client who is being discharged following a cardiac catheterization. Which of the following should the nurse include in the instructions? A. It is acceptable to resume normal exercise routine. B. Change the dressing every 8 hr. C. A small hematoma at the site is expected. D. Pain medication will not be necessary.

C. It is acceptable to resume normal exercise routine is incorrect. Activity should be limited for several days. Change the dressing every 8 hr is incorrect. The dressing should be left in place for at least 1 day. A small hematoma at the site is expected is correct. Bruising and a small hematoma at the site is expected; therefore, the nurse should include this in the instructions. Pain medication will not be necessary is incorrect. Pain medication may be necessary for discomfort at the insertion site or back pain.

A client who has a history of MI is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following action of the medication? A. analgesic B. anti-inflammatory C. antiplatelet aggregate D. antipyretic

C. Aspirin is used to decrease the likelihood of blood clotting. It also is used to reduce the risk of a second heart attack or stroke by inhibiting platelet aggregation and reducing thrombus formation in an artery, a vein, or the heart.

A nurse is caring for a client who is postoperative. Which of the following should the nurse include in the postoperative teaching to prevent pulmonary complications? A. Performance of range-of-motion exercises B. Use of a suction device C. Use of an incentive spirometer D. Administration of an expectorant

C. Incentive spirometry promotes full lung re-expansion after surgery and can help prevent pulmonary complications.

A nurse is assessing a female client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assess for which earliest sign of ARDS? A. bilateral inspiratory and expiratory wheezing B. inspiratory crackles C. increased respiratory rate D. intercostal retractions

C. The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

A nurse is caring for a client who enters the emergency department of severe chest pain. Which of the following interventions should the nurse implement to determine if the client is experiencing a myocardial infarction? A. Check the client's blood pressure. B. Auscultate heart tones. C. Perform a 12-lead ECG D. Determine if pain radiates to the left arm.

C. ​The nurse should perform a 12-lead ECG when a client complains of chest pain to determine if the client is experiencing a myocardial infarction.

A nurses is assessing for the development of disseminated intravascular coagulation (DIC) in a client who has septic shock. Which of the following nursing statements indicates an understanding of the condition? ​A. "DIC is controllable with lifelong heparin usage." ​B. "DIC is characterized by an elevated platelet count." ​C. "DIC is caused by abnormal coagulation involving fibrinogen." ​D. "DIC is a genetic disorder involving vitamin K deficiency."

C. ​The nurse should understand DIC is caused by an abnormal coagulation involving fibrinogen formation and platelet counts.

A nurse is caring for a client who came to the ER reporting chest pain. The provider suspects a MI. While waiting for the laboratory to report the client's troponin levels, the client asks what this blood test will show. The nurse should explain that troponin is ​A. an enzyme that indicates damage to brain, heart, and skeletal muscle tissues. ​B. a protein whose levels reflect the risk for coronary artery disease. ​C. a heart muscle protein that appears in the bloodstream when there is damage to the heart. ​D. a protein that helps transport oxygen throughout the body.

C. ​Troponin is a myocardial muscle protein that releases into the bloodstream when there is injury to the myocardial muscle. Troponin levels are point-of-care testing for clients who are having or are at risk for having a myocardial infarction.

A 48 year old patient is in ICU following coronary artery bypass graft (CABG) surgery for treatment of a myocardial infarction. Thirty-six hours after the procedure, the pt O2 sat drop to 90% and he has developed crackles in the lungs. The nurse suspects cardiogenic shock. Which of the following symptoms would the nurse expect the pt to exhibit with cardiogenic shock? Select all that apply A. Hypertension B. Bradycardia C. Bounding pulse D. Confusion E. Tachycardia

D, E Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.

A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client has an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock? A. Decrease in the respiratory rate from 20 to 16 breaths per minute. B. Decrease in the urinary output from 50 mL to 30 mL per hour. C. Increase in the temperature from 37.5° C (99.5° F) to 38.6° C (101.5° F). D. Increase in the heart rate from 88 to 110 beats per minute.

D.

A nurse in a provider's office is assessing a client who reports occasional atypical chest pain, palpations, and exercise intolerance. On auscultation, the nurse notes a systolic click. Which of the following disorders should the nurse suspect? A. Aortic regurgitation B. Mitral stenosis C. Aortic stenosis D. Mitral valve prolapse

D. ​Although many clients with mitral valve prolapse are asymptomatic, others report atypical chest pain, palpitations, exercise intolerance, dizziness, and syncope. Findings include a midsystolic click and a late systolic murmur.

A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes.? A. Pigeon B. Funnel C. Kyphotic D. Barrel

D. Barrel shaped is due to the chronically use of the accessory muscles to assist with respiratory effort. The chest eventually develops in an anterior posterior diameter.

A nurse is caring for a client who has COPD. When developing this client's plan of care, the nurse should include which of the following interventions? A. Restrict the client's fluid intake to less than 2 L/day. B. Encourage the client to use the upper chest for respiration. C. ​Have the client use the early-morning hours for exercise and activity. D. Instruct the client to use pursed-lip breathing.

D. Pursed-lip breathing lengthens the expiratory phase of respiration and also increases the pressure in the airway during exhalation. This reduces airway resistance and decreases trapped air for clients who have COPD.

A nurse is caring for a client who has ARDS. Which of the following interventions should the nurse include in the client's care plan? ​A. Administer low-flow oxygen continuously via nasal cannula. B. Encourage oral intake of at least 3,000 mL of fluids per day. C. Offer high-protein and high-carbohydrate foods frequently. ​D. Position in semi- to high-Fowler's with support to the back.

D. ​ARDS causes severe dyspnea and life-threatening alterations in blood gases; therefore, maintaining an upright position will promote gas exchange and help relieve dyspnea.

A nurse is teaching a Group of postmenopausal women about activities to reduce the risk of developing CAD. Which of the following statements by a client requires clarification? A. ​"A weight loss program can increase the LDL cholesterol levels." B.​"Exercising regularly will lower HDL cholesterol levels." C. ​"Adding foods containing omega-3 fatty acids to my diet can lower my risk." D. ​"Increasing the intake of foods containing trans-fatty acids in my diet can lower my risk."

D. ​Increasing dietary intake of trans fatty acids increases the risk of developing coronary artery disease."

A client who has coronary artery disease tells the nurse he is afraid of dying from a heart attach. Which of the following is an appropriate nursing response? ​A. "Perhaps you should discuss this with your physician." ​B. "Of course you aren't going to die, at least not in the immediate future." ​C. "What makes you think you will die?" ​D. "Tell me more about these fears of dying from a heart attack."

D. ​With this response, the nurse uses the therapeutic communication technique of exploring to encourage further communication.

A nurse is reinforcing teaching with a client regarding reduction of risk factors for CAD. which of the following statements by the client indicate understanding of the teaching? (select all that apply) ​A. "I must stop smoking." ​B. "I should limit my exercise." ​C. "I will stop consuming alcohol." ​D. "I need to monitor my weight." ​E. "I am limiting my intake of fast foods."

​A. D. E "I must stop smoking" is correct. Nicotine in tobacco causes peripheral vasoconstriction, which increases blood pressure, cardiac afterload, and oxygen consumption. Alterations in blood vessels contribute to atherosclerosis and the formation of clots. Smoking cessation can decrease the risk of coronary artery disease by as much as 80%. Clients also should avoid secondhand smoke. "I should limit my exercise" is incorrect. A sedentary lifestyle or lack of exercise can lead to obesity, which is a significant contributing factor to the development of hypertension and heart disease. Less active individuals have a 30-50% increased incidence of developing hypertension. Regular physical activity helps to maintain body weight, decrease the risk of hypertension, and optimize lipid levels. Physical activity and dietary modification have been positively associated with decreasing lipid and cholesterol levels. "I will stop consuming alcohol" is incorrect. The client does not have to stop consuming alcohol. Consuming less than 3 oz per day can assist in decreasing the risk of coronary artery disease. However, consuming more than 3 oz per day has been associated with an increased risk of cardiac disease. "I need to monitor my weight" is correct. Obesity or an increase in weight is a significant factor in developing coronary artery disease. Weight management is vital to decreasing the risk of coronary artery disease. "I am limiting my intake of fast foods" is correct. Fast foods typically are prepared with high sodium and high fat, which increase the risk of atherosclerosis and coronary artery disease. An elevated cholesterol and serum lipid level predisposes a client to coronary artery disease. To promote cardiovascular health, clients should select healthier food options, such as fruits and vegetables, or foods prepared by baking or broiling.