Question 1

The nurse is explaining to a client that some risks for cardiovascular disease (CVD) can be minimized by nutritional change. What should the nurse recommend to reduce the client's risk of developing atherosclerosis?

Accepted Answer

Vitamin E, beta carotene, and selenium are marketed as beneficial to heart health but there have been no clinical studies that support these findings. In fact, there is some evidence that they may be a potential risk. Elevated cholesterol and low-density lipoprotein (LDL) levels have been linked to an increase in CVD in numerous studies.

Question 2

A client wants to know the difference between good and bad cholesterol. What should the nurse respond to this client?

Accepted Answer

Cholesterol is used by the body to synthesize steroid hormones, vitamin D, and bile acids as well as building cell walls. In moderation all cholesterol is considered "good"because it helps the body function properly. Cholesterol is considered to be "bad" when there is an overabundance that builds up in blood vessels and causes them to narrow. LDL is most often referred to as "bad cholesterol"by consumers because it has been linked with CVD. Fat stores are used for energy in the absence of sufficient glucose to supply the body's energy needs. Cholesterol is readily absorbed by the intestines.

Question 3

The nurse reviews the role of trans fats in elevating LDL levels. Which food should the nurse identify that contains this type of fat?

Accepted Answer

Olive oil is a source of Cis-monounsaturated fat which has been shown to produce a modest decrease in LDL and a modest increase in HDL. Margarine contains trans fats which lead to increased levels of LDL and reduction in HDL. Fatty fish and walnuts are sources of n-3 polyunsaturated fat, which is linked with reduction of LDL cholesterol and a possible modest increase in HDL.

Question 4

The nurse provides diet teaching to a client with an elevated cholesterol level. Which food should the nurse identify that contains linolenic acid and ?-linolenic acid?

Accepted Answer

Margarine and butter are sources for elaidic acid (a trans-monounsaturated fat) and myristic acid (a saturated fat). Baked goods and chocolate contain elaidic acid (a trans-monounsaturated fat) and stearic acid (a saturated fat). Soybean oil is a source of linoleic acid (n-6 polyunsaturated fat) and walnuts contain ?-linolenic acid (an n-3-polyunsaturated fat). Fatty fish are a source of eicosapentaenoic acid (an n-3 polyunsaturated acid) and pork contains stearic acid (a saturated fat).

Question 5

A client, concerned about fat intake, wants to know the difference between trans-monounsaturated fats and cis-monounsaturated fats. What should the nurse explain to this client?

Accepted Answer

The effect of monounsaturated fats depend if they are in the trans or cis configuration. Trans-monounsaturated fats increase LDL and decrease HDL levels, two negative effects. Cis-monounsaturated fatty acids may produce a mild decrease in LDL levels or have no effect, and produce a mild increase or have no effect on HDL levels.

Question 6

A client desires to lower LDL cholesterol level. Which percentage of calories should the nurse recommend that this client ingest each day of saturated fats?

Accepted Answer

The American College of Cardiology and the AHA recommend an intake of no more than 5-6% of calories from saturated fats and overall a reduced intake of trans fats. The other choices are not recommendations by the American College of Cardiology and the AHA.

Question 7

A client desires to lost 20 lbs. Which option should the nurse suggest to this client?

Accepted Answer

Saturated fats lead to increases of LDL. Polyunsaturated fats such as fatty fish have been linked with decreases in LDL and increases in HDL cholesterol. Dietary restrictions contribute to an imbalanced intake of nutrients and are not recommended. Based on TLC, weight loss can be achieved by decreasing the amount of fat in the diet, which also reduces the daily caloric intake, and limiting fat sources to food containing monounsaturated and polyunsaturated fats.

Question 8

A client wants to increase the amount of viscous fiber in the diet. Which foods should the nurse recommend to this client?

Accepted Answer

Sources of viscous fiber include broccoli, barley, legumes, oats, and various fruits and vegetables. Wheat and nuts are other sources of dietary fiber but are not considered viscous fiber. Benecol and Take Control spreads are sources of plant stanol/sterols which have also been shown to reduce LDL levels when included regularly in the diet. Flaxseed is a source of n-3 polyunsaturated fats.

Question 9

A client logs blood pressure and dietary intake as a method to help hypertension. Which food item should the nurse note is associated with an increase in blood pressure?

Accepted Answer

Foods high in sodium can result in fluid retention and an accompanying increase in blood pressure. Dietary protein does not affect blood pressure. A low-fat diet is recommended for clients with hypertension to reduce the risk of cardiac disease. High-fiber diets aid in lowering LDL and weight loss and would not have a negative effect on blood pressure management.

Question 10

The nurse provides teaching to a client with hypertension who is overweight. What should the nurse emphasize during this teaching?

Accepted Answer

The most important factors for the nurse to discuss with the client would be weight loss, exercise, and tobacco cessation. Alcohol abuse counseling is always appropriate for any client, but PSA testing is used to screen for prostate cancer and has no value in hypertension management. Blood sugar monitoring is helpful to screen for diabetes. Dietary fiber has been linked to reductions in LDL.

Question 11

A client is prescribed the Dietary Approaches to Stop Hypertension (DASH) diet to reduce risk factors for heart disease. What foods should the nurse recommend that this client ingest when following this diet?

Accepted Answer

Clients using the DASH diet should consume 5 servings of fruits, 3 servings of vegetables, and 2 servings of low-fat dairy products daily. Foods should include whole gains, poultry, fish, and nuts with limited amounts of red meat and foods containing simple carbohydrates and high fat snacks.

Question 12

A client wants to know what metabolic syndrome means. What should the nurse explain as the risk factors for this disease process?

Accepted Answer

Obesity and inactivity are the underlying risk factors for metabolic syndrome. Hypertension, lack of exercise, and buildup of abdominal fat are all risks of CVD. Poorly controlled diabetes is a risk factor for end organ damage including cardiovascular disease (CVD).

Question 13

A male client with a blood pressure of 124/82 mm Hg has a triglyceride level of 220 mg/dL, fasting glucose of 240 mg/dL, HDL level of 23 mg/dL, and waist circumference of 38 inches. For which health problem should the nurse prepare teaching for this client?

Accepted Answer

A BP of 124/82 mm Hg would be considered within normal range. A fasting glucose of 240 mg/dL requires close monitoring and possible testing to determine if the client has diabetes, since a diagnosis should not be made on a one-time variation in laboratory results. Obesity should be determined based on the client's height, weight, and BMI rather than weight alone. Since the client has a poorly controlled fasting blood sugar, an abdominal circumference of > 35 inches, and triglycerides > 150 mg/dl the client meets the diagnostic criteria for metabolic syndrome.

Question 14

The nurse assesses a male client with metabolic syndrome. Which findings should the nurse expect to assess? (Select all that apply.)

Accepted Answer

Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL.
Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL.
Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL.
Clients who have been diagnosed with metabolic syndrome must meet three or more of the following criteria: blood pressure above or equal to 135/85, triglycerides greater than or equal to 150 mg/dL, HDL cholesterol greater than or equal to 40 mg/dL (in men), waist circumference greater than or equal to 40 inches (men), and a fasting serum glucose level greater than or equal to 100 mg/dL.

Question 15

A client with heart failure experiences an increase in lower extremity edema and weigh gain. Which change in the client's behavior most likely contributed to the edema and weight gain?

Accepted Answer

The sudden onset of weight gain and development of edema points to an increased consumption of dietary sodium resulting in water retention and worsening heart failure. The likely cause of the increased sodium is processed foods which have high sodium levels. Worsening cardiac ejection fraction due to age is unlikely given the sudden onset of symptoms. Water retention is caused by sodium rather than an increase in dietary protein.

Question 16

The nurse reviews a low-sodium diet with a client with heart failure. Which non-sodium food seasoning should the nurse recommend to this client?

Accepted Answer

Salt substitutes, spices, and low-sodium marinades or sauces may be a good substitution for patients who use salt often at the table. Commercially prepared sauces and marinades may contain hidden sources of sodium and should be avoided. Sea salt is not an alternative for table salt in a sodium-restricted diet.

Quiz 21: Cardiovascular Diseases and Lipid Disorders