A) Family history: Family history is a significant non-modifiable risk factor for atherosclerosis. While individuals cannot change their genetic predisposition, awareness of family history can inform lifestyle choices and risk assessments. Those with a family history should be particularly vigilant about managing other risk factors.

B) High blood pressure: High blood pressure is a modifiable risk factor that can be controlled through lifestyle changes such as diet, exercise, and medication if necessary. Effective management of hypertension can significantly reduce the risk of atherosclerosis and related cardiovascular diseases.

C) Obesity: Obesity is another modifiable risk factor. Individuals can manage their weight through healthy eating, physical activity, and lifestyle modifications. Reducing obesity can improve overall cardiovascular health and decrease the risk of developing atherosclerosis.

D) Age: Age is a non-modifiable risk factor. As people age, the risk for atherosclerosis naturally increases due to various biological changes. While aging itself cannot be altered, awareness of age-related risks can prompt individuals to adopt healthier lifestyles.

E) Lack of physical activity: This is a modifiable risk factor. Increasing physical activity can improve cardiovascular health and reduce the likelihood of developing atherosclerosis. Regular exercise can help maintain a healthy weight and improve blood pressure and cholesterol levels, contributing to overall heart health.

F) Gender: Gender is also a non-modifiable risk factor. While certain genders may have different risks at various life stages (e.g., men often have a higher risk at a younger age), this characteristic cannot be changed. Understanding gender-related risks can aid in tailoring preventive strategies but does not offer a means of modification.

G) Smoking: Smoking is a critical modifiable risk factor for atherosclerosis. Quitting smoking can significantly lower the risk of cardiovascular diseases and improve overall health. Smoking cessation should be a priority for individuals looking to prevent or manage atherosclerosis effectively.

A. Within the expected reference range: While a blood pressure of 130/82 mm Hg is close to normal, it is not considered fully within the expected reference range. The normal range is typically defined as less than 120/80 mm Hg.

B. Elevated: The reading of 130/82 mm Hg falls into the "elevated" category, which is defined as systolic blood pressure between 120-129 mm Hg and diastolic pressure less than 80 mm Hg. This indicates that while the client is not hypertensive, they are at increased risk for developing hypertension in the future.

C. Stage 2 hypertension: This category is defined by a systolic reading of 140 mm Hg or higher, or a diastolic reading of 90 mm Hg or higher. The client’s reading does not meet these criteria, so this option is not applicable.

D. Stage 1 hypertension: Stage 1 hypertension is characterized by systolic readings between 130-139 mm Hg and diastolic readings between 80-89 mm Hg. Although the systolic reading is in the Stage 1 range, the diastolic reading of 82 mm Hg places the overall reading in the "elevated" category, rather than Stage 1 hypertension.

A) Intermittent claudication: This symptom is indicative of arterial insufficiency, not chronic venous insufficiency. Intermittent claudication is characterized by pain in the legs during activity due to insufficient blood flow, which is not typical in venous conditions.

B) Decreased pedal pulses: In chronic venous insufficiency, pedal pulses are usually normal. Decreased pedal pulses suggest arterial disease, where blood flow is compromised. Thus, this finding would not be expected in a client with venous insufficiency.

C) Bronze/brown discoloration of the skin: This is a hallmark finding in chronic venous insufficiency. The discoloration occurs due to the deposition of hemosiderin from the breakdown of red blood cells, which is a result of prolonged venous stasis and chronic edema, particularly around the lower extremities.

D) Cool skin temperature: Skin temperature in chronic venous insufficiency is typically warm due to increased blood flow and stasis in the veins. Cool skin temperature is more characteristic of arterial insufficiency, where blood supply is reduced and can lead to cooler extremities.

E) Full screen mode is in effect during your proctored testing: This statement is irrelevant to the clinical assessment of chronic venous insufficiency and serves no purpose in understanding the client’s condition. It does not contribute to the assessment findings.

A) Intermittent claudication: This term describes the leg pain and cramping that occurs during physical activity, such as walking, and is relieved by rest. It is a classic symptom of peripheral arterial disease (PAD) and results from insufficient blood flow to the muscles due to narrowed or blocked arteries. The client's description aligns perfectly with this definition.

B) Neuropathy: While neuropathy can cause leg pain, it typically presents differently, often with sensations like tingling, numbness, or burning rather than cramping during activity. Neuropathy does not specifically correlate with the pattern of pain relief upon resting, which is characteristic of intermittent claudication.

C) Deep vein thrombosis (DVT): DVT generally presents with symptoms like swelling, warmth, and tenderness in the affected leg, rather than cramping pain that is related to activity. The pain associated with DVT is not typically relieved by rest, making this option inconsistent with the client’s symptoms.

D) Venous insufficiency: This condition is characterized by symptoms such as swelling, varicosities, and skin changes, primarily in the lower extremities. Pain related to venous insufficiency tends to occur after prolonged standing or sitting and is not typically relieved by rest in the same way as intermittent claudication. Therefore, this option does not accurately describe the client’s experience.

A. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on 2 or more separate occasions.": This statement accurately reflects the criteria for diagnosing hypertension. According to guidelines, a diagnosis is typically confirmed when blood pressure readings consistently exceed normal levels (usually defined as 130/80 mm Hg) on two or more separate visits.

B. "For confirmed diagnosis of hypertension, BP readings should be lower than normal on only one occasion.": This statement is incorrect. A single low reading does not confirm a diagnosis of hypertension. In fact, it contradicts the concept of hypertension, which involves consistently high readings.

C. "For confirmed diagnosis of hypertension, BP readings should be higher than normal on more than three separate occasions.": This statement is misleading. While multiple readings are often taken, the threshold for diagnosis is two or more elevated readings, not three.

D. "For confirmed diagnosis of hypertension, the BP readings should be higher than normal on only one occasion.": This statement is inaccurate, as a single elevated reading is not sufficient for diagnosis. Consistent elevations over multiple occasions are necessary for a confirmed diagnosis.

A) Shiny, hairless lower extremities: In advanced peripheral arterial disease (PAD), the skin on the lower extremities often appears shiny and hairless due to reduced blood flow. The lack of hair growth and the shiny appearance are indicative of ischemia and poor circulation, making this a common finding in clients with advanced PAD.

B) Warm lower extremities: This finding is not typical in advanced PAD. Due to compromised blood flow, the lower extremities are more likely to feel cool or cold to the touch rather than warm. Warm skin can indicate good blood flow, which is usually absent in cases of significant arterial disease.

C) Thin toenails: In advanced PAD, toenails may become thin and brittle due to insufficient blood supply, which can lead to impaired nail growth. This change is consistent with the overall effects of reduced circulation and is an expected finding in clients with advanced PAD.

D) Lower extremity bilateral pulse 3+: A 3+ pulse indicates a strong and bounding pulse, which is not typically present in advanced PAD. In fact, patients with PAD often exhibit diminished or absent pulses in the affected extremities due to poor arterial circulation. Therefore, this finding does not align with the expected assessment results for advanced PAD.

A. "Diuretics are the first line therapy to control hypertension.": This statement is accurate. Thiazide diuretics are commonly recommended as first-line treatment for mild hypertension, as they help reduce blood volume and lower blood pressure effectively.

B. "Reaching your goal blood pressure will occur within 2 months.": While treatment can lead to improvements in blood pressure, the timeline for reaching target levels can vary significantly among individuals based on adherence to lifestyle changes and medication. It's important to communicate that achieving the goal may take longer than two months.

C. "Plan to add saturated fats to 10 percent of your daily calorie intake.": This recommendation is misleading. Guidelines generally suggest limiting saturated fats to less than 10 percent of total daily calories to promote heart health, not adding them.

D. "Limit your alcohol consumption to three drinks a day.": This statement is also inaccurate. For most adults, the recommendation is to limit alcohol to no more than two drinks per day for men and one drink per day for women to help manage blood pressure effectively.

A) Vitamin A: While vitamin A can affect various bodily functions, it is not known to have a direct interaction with warfarin. Therefore, it is not considered incompatible with warfarin therapy.

B) Alprazolam: This medication, a benzodiazepine, is primarily used to treat anxiety and does not have a significant interaction with warfarin. Thus, it is not incompatible with warfarin therapy.

C) Vitamin K: This vitamin is a critical consideration when a client is on warfarin therapy. Warfarin works by inhibiting vitamin K-dependent clotting factors, so an increased intake of vitamin K can counteract the effects of warfarin, making this the correct answer. Clients on warfarin should maintain a consistent intake of vitamin K to prevent fluctuations in their INR levels.

D) Furosemide: This loop diuretic is used to manage conditions such as heart failure and edema. While it may affect electrolyte levels, it does not have a direct interaction that would render it incompatible with warfarin. It can be safely used alongside warfarin with appropriate monitoring.

A. Low fat diet: While a low-fat diet can be beneficial for overall cardiovascular health, it is not the most critical intervention for a client with Buerger's Disease. The primary concern is addressing the underlying causes of the disease rather than just dietary modifications.

B. Blood glucose control: This is important for clients with diabetes but is not specific to Buerger's Disease. Effective management of blood glucose levels does not directly address the primary issues associated with this condition.

C. Blood pressure control: Managing blood pressure is important for overall cardiovascular health; however, it is not the most immediate concern for a client with Buerger's Disease compared to smoking cessation.

D. Smoking cessation: This is the most critical intervention. Buerger's Disease is strongly associated with tobacco use, and smoking cessation is essential to halt the progression of the disease and improve symptoms. Educating the client about the importance of quitting smoking can lead to significant improvements in their condition and overall vascular health.

A) Increase of high-density lipoproteins: While higher levels of high-density lipoproteins (HDL) are generally associated with a lower risk of cardiovascular disease, enalapril is not primarily used to target lipid levels. Its main purpose is to manage blood pressure and reduce the risk of heart failure and renal complications, rather than specifically affecting HDL levels.

B) Decreased pain from intermittent claudication: Intermittent claudication is typically related to peripheral artery disease, which may not be directly improved by enalapril. While managing blood pressure can indirectly benefit circulation, enalapril is not indicated specifically for alleviating pain associated with claudication.

C) Decreased blood pressure: Enalapril is an ACE inhibitor used primarily to treat hypertension. A significant decrease in blood pressure is a direct therapeutic effect of the medication, indicating that it is effectively managing the client’s condition. Monitoring blood pressure helps assess the medication's efficacy in achieving the desired therapeutic outcome.

D) Decrease in low-density lipoproteins: Although reducing low-density lipoprotein (LDL) levels can benefit cardiovascular health, enalapril is not primarily prescribed for this purpose. Its effects on lipid levels are minimal compared to its role in lowering blood pressure and protecting renal function, making a decrease in LDL levels an irrelevant indicator of its therapeutic effect.

A) Ventricular tachycardia: Ventricular tachycardia is characterized by a rapid heart rate exceeding 100 bpm, typically arising from abnormal ventricular activity. In this case, the heart rate is 59 bpm, which does not support this interpretation. Additionally, ventricular tachycardia usually presents with wide QRS complexes and no discernible P waves, neither of which is true in this scenario.

B) Sinus tachycardia: Sinus tachycardia is defined by a heart rate exceeding 100 bpm originating from the sinoatrial (SA) node, with a regular rhythm and normal P waves. The heart rate of 59 bpm in this client is too low for a diagnosis of sinus tachycardia, making this option incorrect.

C) Sinus bradycardia: Sinus bradycardia occurs when the heart rate is less than 60 bpm, with a regular rhythm and a normal PR interval and QRS duration. The provided data shows a heart rate of 59 bpm, a regular rhythm, one P wave for every QRS complex, a PR interval of 0.20 seconds, and a QRS duration of 0.10 seconds, which aligns perfectly with the criteria for sinus bradycardia.

D) Normal sinus rhythm: Normal sinus rhythm typically presents with a heart rate of 60-100 bpm, a regular rhythm, and appropriate P waves for each QRS complex. Given the heart rate of 59 bpm, this does not meet the criteria for normal sinus rhythm, as it falls below the acceptable range.

A) Blood pressure 102/76: While this blood pressure reading is on the lower side, it does not typically warrant withholding carvedilol unless the client exhibits symptoms of hypotension, such as dizziness or fainting. Carvedilol is an antihypertensive, but the reading itself is not critically low enough to necessitate holding the medication.

B) Temperature of 100.3 F: A mild fever at this temperature does not directly relate to carvedilol administration. It may indicate an underlying infection or inflammation, but it is not a contraindication for administering the medication. Monitoring the client’s temperature is important, but it does not require notifying the healthcare provider in this context.

C) Respiratory rate 10: A respiratory rate of 10 breaths per minute indicates bradypnea, which can be concerning. However, it is not the primary reason to withhold carvedilol unless the client shows significant respiratory distress. Monitoring is essential, but the decision to withhold the medication would depend on the overall clinical picture.

D) Heart rate of 49: A heart rate of 49 bpm is considered bradycardia and is a significant concern when administering carvedilol, a beta-blocker that can further decrease heart rate. It is essential to hold the medication and notify the healthcare provider, as this bradycardia could lead to potential adverse effects or complications. Monitoring the client's heart rate is crucial in managing their medication safely.

A) Apply cold therapy to the affected leg: Cold therapy may be used for certain conditions to reduce swelling and pain, but in the case of suspected deep vein thrombosis (DVT) indicated by redness, warmth, tenderness, and pain in the calf, cold therapy is not appropriate. Instead, the focus should be on confirming the diagnosis before applying any treatment.

B) Monitor Homan's sign: Homan's sign involves dorsiflexion of the foot to assess for pain in the calf, which can suggest DVT. However, it is no longer considered a reliable diagnostic tool. Instead, confirmation through imaging or other diagnostic measures is preferred, so simply monitoring this sign would not be sufficient in this situation.

C) Obtain a venous duplex ultrasound: A venous duplex ultrasound is the gold standard for

diagnosing DVT. Given the client’s symptoms—redness, warmth, tenderness, and pain in the calf—the appropriate order is to obtain this ultrasound to confirm the presence of a thrombus. This imaging study provides critical information for diagnosis and subsequent management.

D) Obtain impedance plethysmography: While impedance plethysmography can assess venous flow and help diagnose DVT, it is less commonly used than venous duplex ultrasound. The more direct and widely accepted method for diagnosing DVT in this scenario is the ultrasound, making this option less suitable as the initial order.

A) "I will apply my compression stockings." Compression stockings are a standard recommendation for clients with peripheral venous disease (PVD). They help improve venous return and reduce symptoms like swelling and discomfort, indicating that the client understands the importance of managing their condition.

B) "I will limit long periods of standing." This statement reflects an understanding of the need to avoid activities that can exacerbate venous stasis and contribute to worsening symptoms in PVD. Limiting long periods of standing helps promote better blood flow and reduces the risk of complications.

C) "I may develop a brownish discoloration to my lower extremities." This statement indicates an awareness of a potential complication of PVD, often caused by venous stasis and pooling of blood. Brownish discoloration, or stasis dermatitis, can occur in the lower extremities, showing the client’s understanding of the condition.

D) "With this problem, I may have lower extremity hair loss." This statement is accurate as well; hair loss on the lower extremities can occur with PVD due to reduced blood flow and oxygen supply to the tissues. This recognition indicates that the client understands the potential effects of their diagnosis.

E) "I will only take my cholesterol lowering medication every other day in the afternoon." This statement reflects a misunderstanding of medication management. Clients with PVD should take prescribed medications as directed to manage their condition effectively, and altering the dosing schedule without consulting a healthcare provider can lead to adverse outcomes.

A) "These tests will enable the provider to determine the heart structure and mobility of the heart valves." This statement is incorrect because cardiac enzyme tests, including troponin levels, do not assess heart structure or valve mobility. Imaging studies like echocardiograms are typically used for evaluating heart structure and function.

B) "Cardiac enzymes assist in diagnosing the presence of congestive heart failure." While cardiac enzymes can provide some information about heart function, they are not specifically used to diagnose congestive heart failure. The primary role of cardiac enzymes, particularly troponin, is in diagnosing myocardial injury, such as an acute myocardial infarction.

C) "Cardiac enzymes like troponin shows there has been damage to the heart tissues and muscle." This statement accurately reflects the purpose of measuring troponin levels. Troponin is a protein released into the bloodstream when heart muscle cells are damaged, making it a crucial biomarker for diagnosing an acute myocardial infarction.

D) "Cardiac enzymes will identify the exact location of the MI." This statement is misleading. While troponin levels can indicate that damage has occurred, they do not provide information about the specific location of the myocardial infarction. Other imaging techniques, such as an angiogram, are needed to determine the exact location of blockages or damage.

A) Tachycardia: Propranolol is often used to manage tachycardia by reducing heart rate and controlling excessive adrenergic activity. Therefore, this diagnosis would not warrant clarification of the order; it is an appropriate use of the medication.

B) End-stage kidney failure: While caution is necessary when administering medications in clients with renal impairment, propranolol is primarily metabolized by the liver, and its use is not contraindicated in end-stage kidney failure. However, renal function can affect dosing, so monitoring would be important, but this diagnosis alone wouldn't require clarification.

C) Hypertension: Propranolol is commonly prescribed to manage hypertension, making this diagnosis a valid reason for the medication order. The use of propranolol in this context would not need clarification.

D) Asthma: Propranolol is a non-selective beta-blocker, which can cause bronchoconstriction and exacerbate asthma symptoms. This diagnosis would require the nurse to clarify the order, as beta-blockers are generally contraindicated in clients with asthma due to the risk of respiratory complications. If the client has reactive airway disease, an alternative medication should be considered.

A) Ambulating soon after surgery: Early ambulation is encouraged for postoperative clients to promote circulation and reduce the risk of venous thromboembolism (VTE). Mobilizing helps prevent stasis of blood in the veins, making this an appropriate action rather than an unsafe one.

B) Flexing her ankles: Ankle flexion exercises can help improve venous return and circulation in the lower extremities. This action is generally recommended to prevent VTE, making it a safe and beneficial practice for postoperative clients.

C) Massaging her legs: Massaging the legs is considered unsafe for a client at risk for VTE. This action can dislodge a thrombus (blood clot) if one is present, leading to potential complications such as pulmonary embolism. Therefore, the nurse should instruct the client to avoid leg massages.

D) Elevating her feet: Elevating the feet is a recommended practice to promote venous return and reduce swelling in postoperative clients. This action can help prevent VTE and is generally considered safe and beneficial.

A) Smoking cessation: Quitting smoking is one of the most critical interventions for clients with peripheral arterial disease (PAD). Smoking contributes to vascular damage and worsens arterial circulation, so cessation can significantly slow disease progression and improve overall cardiovascular health.

B) Wear compression stockings: While compression stockings may be helpful for venous conditions, they are generally not recommended for clients with PAD. In fact, they can impair arterial flow, so this intervention should not be included in the teaching plan.

C) Use a heating pad directly on the legs: Using a heating pad directly on the legs is unsafe for clients with PAD, as it can lead to burns or injuries due to impaired sensation in the extremities. Additionally, excessive heat can exacerbate circulation issues.

D) Exercising will help increase circulation: Regular exercise is beneficial for clients with PAD. Supervised exercise programs, such as walking, can improve circulation and enhance functional capacity, helping to manage symptoms and slow disease progression.

E) Soak feet in hot water daily: Soaking feet in hot water can pose risks, particularly for individuals with PAD, as they may have reduced sensation and are at higher risk for burns or injuries. This practice should not be recommended.

F) Decrease saturated fats in daily diet: Reducing saturated fats in the diet can help improve overall cardiovascular health and lower cholesterol levels, which is beneficial for clients with PAD. A heart-healthy diet can help limit disease progression and improve circulation.

A) Troponins: These are primarily used to assess for cardiac damage, such as in myocardial infarction. They are not directly related to the effects of spironolactone, so monitoring troponins is not necessary in this context.

B) Potassium: Spironolactone is a potassium-sparing diuretic, which can lead to elevated potassium levels (hyperkalemia). This can have serious implications, including cardiac arrhythmias. Therefore, it is crucial to monitor potassium levels regularly in clients taking

spironolactone to prevent potential complications.

C) Albumin: While albumin levels can provide information about the client's nutritional status and liver function, they are not specifically affected by spironolactone. Monitoring albumin is not a priority when considering the use of this medication.

D) Bicarbonate: Bicarbonate levels are important for assessing acid-base balance. Although spironolactone may have some impact on acid-base status, monitoring bicarbonate is not as critical as monitoring potassium levels, which are directly affected by the medication's action.

A) Furosemide: This is a loop diuretic that can lead to dehydration and electrolyte imbalances, both of which can contribute to orthostatic hypotension. The medication's diuretic effect can cause a significant drop in blood volume, increasing the risk of low blood pressure upon standing.

B) Simvastatin: This medication is used to lower cholesterol levels and is not associated with orthostatic hypotension. It does not have a direct impact on blood pressure or volume.

C) Losartan: As an angiotensin II receptor blocker (ARB), losartan is used to treat hypertension. It can cause vasodilation and may lead to orthostatic hypotension, particularly in elderly clients or those who are volume-depleted.

D) Nifedipine: This calcium channel blocker is used to treat hypertension and can cause vasodilation. It may lead to orthostatic hypotension as well, especially during dose adjustments or if the client is dehydrated.

E) Clopidogrel: This antiplatelet medication is used to prevent blood clots and does not directly cause orthostatic hypotension. Its primary action is to inhibit platelet aggregation, not to affect blood pressure.

A) Provide discharge instructions for a client who has a new skin graft: This task should not be delegated to an assistive personnel (AP) as it requires clinical judgment and knowledge about the specific care needs associated with a new skin graft. Discharge instructions must be provided by a qualified nurse.

B) Weigh a client who is on fluid restriction: This task can be delegated to an AP. Weighing a client is a straightforward procedure that does not require nursing judgment and is within the scope of practice for an AP.

C) Check a blood product with another nurse prior to administration: This task must be performed by a licensed nurse to ensure patient safety and compliance with protocols. Checking blood products requires knowledge of the client's specific needs and potential reactions.

D) Perform an admission assessment on a client: Admission assessments require nursing expertise and critical thinking. This task cannot be delegated to an AP, as it involves evaluating the client's condition and creating a care plan based on the assessment findings.

E) Ambulate an older adult client who has hypertension: This task can be delegated to an AP, provided the client is stable and there are no other complications. Assisting with ambulation is within the scope of practice for an AP, and it can help promote mobility and independence for the client.