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Chapter 11: Applying Clinical Judgment to Promote Nutrition for Cardiovascular Wellness

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Chapter 11: Applying Clinical Judgment to Promote Nutrition for Cardiovascular Wellness

16 problems · 0 figures

Case Study 11.1.1 §11.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mr. Thompson reports to the provider and nurse that he has had difficulty achieving and maintaining an erection and has noticed worrisome leg swelling. He also states that he was told by a nurse at a health fair a month ago that he should have his blood pressure checked, because it was 139/93 mm Hg. Today his blood pressure is 126/88 mm Hg. The swelling in his legs appears to be dependent edema that is only present when his legs are downward for periods of time and appears to be due to insufficiency of blood return in the lower extremities.

Based on these findings, what would the nurse expect the provider to conclude?
  1. a.
    The client has an elevated blood pressure, peripheral arterial disease, and erectile dysfunction.
  2. b.
    The client has hypertension, peripheral arterial disease, and erectile dysfunction.
  3. c.
    The client has hypertension, peripheral vascular disease, and erectile dysfunction.
  4. d.
    The client has elevated blood pressure, peripheral vascular disease, and erectile dysfunction.

Answer

C. The client has hypertension, peripheral vascular disease, and erectile dysfunction.
The client’s blood pressure meets the criteria for hypertension, which is a systolic blood pressure greater than or equal to 129 mm Hg and/or a diastolic blood pressure greater than or equal to 80 mm Hg. Peripheral vascular disease causes blood return issues, while peripheral arterial disease will cause ischemia and blood flow restrictions. This client has symptoms of erectile dysfunction which can be directly related to the decreased blood flow caused by hypertension.

Case Study 11.1.2 §11.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mr. Thompson reports to the provider and nurse that he has had difficulty achieving and maintaining an erection and has noticed worrisome leg swelling. He also states that he was told by a nurse at a health fair a month ago that he should have his blood pressure checked, because it was 139/93 mm Hg. Today his blood pressure is 126/88 mm Hg. The swelling in his legs appears to be dependent edema that is only present when his legs are downward for periods of time and appears to be due to insufficiency of blood return in the lower extremities.

Which of the following tests would the nurse expect the provider to order initially to evaluate heart function?
  1. a.
    Electrocardiogram
  2. b.
    Echocardiogram
  3. c.
    Troponin
  4. d.
    Chest X-ray

Answer

A. Electrocardiogram
An electrocardiogram evaluates the electrical function of the heart and can provide initial indication of heart disease or heart damage.

Case Study 11.2.3 §11.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Mr. Thompson has returned for his one-week follow-up. His cholesterol values are:

• Total cholesterol: 269 mg/dL

• LDL: 139 mg/dL

• HDL: 130 mg/dL

His blood pressure is 133/87 mm Hg, and his weight has increased by 2 lb. The nurse calculates his BMI to be 21 kg/m2 and his waist size is 42 inches.

Based on these results, what recommendations should the nurse include in Mr. Thompson’s dietary education?
  1. a.
    Increase red meat intake.
  2. b.
    Decrease caffeine intake.
  3. c.
    Increase fiber intake.
  4. d.
    Decrease dairy consumption.

Answer

C. Increase fiber intake.
Increasing fiber intake has several health benefits. It lowers cholesterol and blood pressure and decreases the risk of heart disease.

Case Study 11.2.4 §11.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Mr. Thompson has returned for his one-week follow-up. His cholesterol values are:

• Total cholesterol: 269 mg/dL

• LDL: 139 mg/dL

• HDL: 130 mg/dL

His blood pressure is 133/87 mm Hg, and his weight has increased by 2 lb. The nurse calculates his BMI to be 21 kg/m2 and his waist size is 42 inches.

The nurse starts to discuss the diet and exercise recommendations with Mr. Thompson, but he insists he is following a heart-healthy diet and that the tests are wrong. What food selection in Mr. Thompson’s 24-hour diet recall illustrates inaccuracy in his statement?
  1. a.
    Freshly squeezed orange juice
  2. b.
    Steamed broccoli
  3. c.
    Baked fish
  4. d.
    Grilled beef cheeseburger

Answer

D. Grilled beef cheeseburger
A cheeseburger contains red meat and cheese, both of which contain saturated fats that contribute to heart disease.

Case Study 11.4.5 §11.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Mr. Thompson has returned for his 3-month follow-up. He claims to be compliant with all the required changes he and the provider and nurse previously discussed, and he said he is feeling great. The nurse documents that his blood pressure is 122/78 mm Hg, his BMI is 20 kg/m2 (a slight change), and his waist measurement is 38 inches.

Based on these results, what would the nurse conclude about the dietary and exercise changes?
  1. a.
    They appear effective.
  2. b.
    They appear ineffective.
  3. c.
    They are not effective enough.
  4. d.
    This is not enough information to determine.

Answer

A. They appear effective.
It appears that the changes are effective, as the client’s blood pressure is coming down. The goal of the diet is to reduce blood pressure and, secondarily, cholesterol levels. Cholesterol can be affected by much more than just diet, and it may take more than 3 months for levels to decrease.

Case Study 11.4.6 §11.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Mr. Thompson has returned for his 3-month follow-up. He claims to be compliant with all the required changes he and the provider and nurse previously discussed, and he said he is feeling great. The nurse documents that his blood pressure is 122/78 mm Hg, his BMI is 20 kg/m2 (a slight change), and his waist measurement is 38 inches.

When evaluating the client’s caloric intake versus their activity level, what would the nurse document based on these findings?
  1. a.
    The client appears to be compliant.
  2. b.
    The client appears to be partially compliant.
  3. c.
    The client is not compliant.
  4. d.
    There is not enough information to determine.

Answer

A. The client appears to be compliant.
The client’s BMI was never an issue, so they do not have to lose a lot of weight. However, the client needed to lessen their waist size and is currently on track with that goal.

11-1 §11.RQ source ↗

The nurse is educating a client with hypertension about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement by the client indicates the need for further teaching?
  1. a.
    “The DASH diet increases my sodium intake.”
  2. b.
    “The DASH diet increases my vegetable intake.”
  3. c.
    “The DASH diet increases my potassium intake.”
  4. d.
    “The DASH diet decreases my sugar intake.”

Answer

A. “The DASH diet increases my sodium intake.”
The DASH diet has beneficial effects for clients with heart disease, including decreasing sodium intake to control hypertension.

11-2 §11.RQ source ↗

The nurse is reviewing a client’s medical record and notes that the last two blood pressure readings were 130/81 mm Hg and 122/99 mm Hg. Which diagnosis does the nurse anticipate for this client?
  1. a.
    Normal blood pressure
  2. b.
    Elevated blood pressure
  3. c.
    Low blood pressure
  4. d.
    Hypertensive blood pressure

Answer

D. Hypertensive blood pressure
Hypertension is defined as a systolic blood pressure greater than 129 mm Hg and/or a diastolic blood pressure greater than 80 mm Hg.

11-3 §11.RQ source ↗

The nurse is educating a client on ways to promote heart health. Which food modification would the nurse recommend for a heart-healthy diet?
  1. a.
    Red meat at 2 meals a day
  2. b.
    Prepackaged meat products
  3. c.
    Pineapple slices
  4. d.
    Caffeinated unsweetened tea

Answer

C. Pineapple slices
A heart-healthy diet, such as the DASH diet, promotes increasing intake of fruits, including pineapple.

11-4 §11.RQ source ↗

The nurse is evaluating a client at a follow-up appointment who reports following a heart-healthy nutritional plan for 3 months. Which objective data should the nurse utilize to support the client’s statement?
  1. a.
    BMI change from 30 to 29 kg/m2
  2. b.
    LDL change from 100 to 110 mg/dL
  3. c.
    Blood pressure from 142/88 to 144/86 mm Hg
  4. d.
    Increased shortness of breath

Answer

A. BMI change from 30 to 29 kg/m2
The client’s body mass index (BMI) has decreased from 30 kg/m2, in the obese range, to 29 kg/m2, in the overweight range.

11-5 §11.RQ source ↗

The nurse in the outpatient cardiology clinic is assessing a client who had an acute myocardial infarction 6 months ago and has completed an outpatient cardiac rehabilitation program. Which cholesterol level indicates to the nurse that the client has achieved a desired level?
  1. a.
    Total cholesterol 202 mg/dL
  2. b.
    LDL 130 mg/dL
  3. c.
    HDL 48 mg/dL
  4. d.
    Triglycerides 242 mg/dL

Answer

C. HDL 48 mg/dL
The HDL level of 48 mg/dL falls within the normal range of greater than 40 mg/dL.

11-6 §11.RQ source ↗

The nurse is caring for a client with newly diagnosed atrial fibrillation. Which food should the nurse educate the client to avoid?
  1. a.
    Coffee
  2. b.
    Oranges
  3. c.
    Milk
  4. d.
    Fish

Answer

A. Coffee
Coffee should be avoided because caffeine can trigger or aggravate atrial fibrillation.

11-7 §11.RQ source ↗

The nurse is caring for a client with a history of cardiac arrest due to torsades de pointes. Which laboratory value is a priority for the nurse to monitor in this client?
  1. a.
    Total cholesterol
  2. b.
    Calcium levels
  3. c.
    Magnesium levels
  4. d.
    Potassium levels

Answer

C. Magnesium levels
Torsades de pointes is primarily caused by an extremely low magnesium level, so the priority of care with this client is to monitor their serum magnesium level.

11-8 §11.RQ source ↗

The nurse notes a very high and peaked T-wave abnormality on a client’s electrocardiogram (ECG). Which laboratory value should the nurse expect the provider to order?
  1. a.
    Magnesium level
  2. b.
    Sodium level
  3. c.
    Calcium level
  4. d.
    Potassium level

Answer

D. Potassium level
A high serum potassium level may cause peaked tall or high T-wave ECG.

11-9 §11.RQ source ↗

The nurse is caring for a client who has hyperlipidemia. Which food choice by the client is appropriate?
  1. a.
    Cake
  2. b.
    Oatmeal
  3. c.
    Fried chicken
  4. d.
    Hot dog

Answer

B. Oatmeal
Oatmeal is not only low in cholesterol but is high in fiber, which helps to lower LDL.

11-10 §11.RQ source ↗

The nurse is caring for a client who is prescribed the DASH diet to manage their high cholesterol levels. What food choice in the client’s 72-hour diet recall requires further teaching?
  1. a.
    Whole milk
  2. b.
    Potatoes
  3. c.
    Oysters
  4. d.
    Orange juice

Answer

A. Whole milk
Whole milk is high in fat and cholesterol. The DASH diet promotes fat-free or low-fat dairy products.

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Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.