Lab 8-Atherosclerosis
Please read Chapter20 in Dudek and consult your lecture notes on atherosclerosis.
Pre-lab talk on the significance of each of the blood parameters below to atherosclerosis and on the relationship of diet to each of the blood parameters mentioned below.
Data below may represent any given 55 year old male or female.
With clinically significant Without clinically significantatherosclerotic disease atherosclerotic disease
-plasma triglycerides5.08 1.13
-plasma cholesterol 11.66 2.59
-plasma HDL-cholesterol 0.52 1.30
-plasma cholesterol:HDL-c ratio 22.5 2.0
-plasma LDL-cholesterol 4.92 2.07
-plasma LDL size(angstroms)250 270
-plasma Lp(a)(mg/dl) 50 1
-plasma VLDL-cholesterol2.33 0.52
-plasma chylomicrons-triglyceride 0.90 0.61
(4 hours post-prandial)
-blood pressure(mm Hg) 180/100 110/80
-height
-weight
-BMI(kg/m2) 35 22
-waist circumference(cm)110 60
-platelet reactivity bleeding time 2.5 6.0
(minutes)
All lipid or lipoprotein-lipid levels are mmol/L plasma and represent fasting values except where noted otherwise.
Please do the case study on page 488 in Dudek (8th edition).
NCLEX STYLE QUESTIONS
Hyperlipidemia/atherosclerotic heart disease:
Page 263-Q 36-what information should the nurse include when teaching a client with heart disease about cholesterol
a) can be found in both plant and animal sources
b) causes an increase in serum high density lipoprotein
c) should be eliminated because it causes the disease process
d) decreases when unsaturated fats are substituted for saturated fats
a) animal only
b) exercise and not dietary cholesterol increases HDL-c
c) saturated fats are more of the problem in elevating serum cholesterol and as well cholesterol is already made in the body and turned into pro-vitamin D3, hormones (adrenocortical and sex steroid) and bile salts
d) correct- dietary unsaturated fats decrease serum cholesterol while dietary saturated fats increase serum cholesterol
Page 263-Q 37.-which instructions should the nurse include in the teaching plan for a client with hyperlipidemia who is be discharged with a prescription for cholestyramine (Questran)?
a) increase your intake of fibre and fluid
b) take the medication before you go to bed
c) check your pulse before taking your medications
d) contact your health care provider if your skin or sclera turn yellow
a) most common adverse effect of cholestyramine is constipation- fluid and fibre help reduced constipation by providing bulk to faeces
b) medication should be taken with meals
c) pulse is not affected by cholestyramine
d) cholestyramine binds bile in the intestine and therefore reduces the incidence of jaundice
page 263-Q 38- A nurse is providing dietary insruction to a client with cardiovascular disease. Which dietary selection by the client indicates the need for further instruction?
a) whole milk with oatmeal
b)garden salad with olive oil
c) tuna fish with small apple
d) soluble fibre cereal with skim milk
a) although oatmeal is a soluble fibre, whole milk is high in saturated fat and should be avoided
b) olive oil contains unsaturated fat including the cholesterol lowering oleic acid
c) most fish have a low fat content; the omega 3 content of fish helps lower triglycerides and platelet reactivity which contributes to myocardial infarction risk reduction
d) soluble fibre helps to lower cholesterol, skim milk does not contain fat.
Page 263-Q39- A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies the following foods. Select all that apply.
a) olive oil
b) chicken broth
c) enriched whole milk
d) red meats such as beef
e) vegetables and whole grains
f) liver and other glandular organ meats
a) unsaturated fat which is an healthy choice
b) this is high in sodium and should be avoided to prevent fluid retention and elevated blood pressure
c) this is high in saturated fats and contributes to hyperlipidemia; skim milk is the healthier choice
d) these are high in saturated fats and should be avoided
e) vegetables and grains are low in fat and have soluble fibre which may reduce the risk for heart disease
f) these are high in cholesterol and should be avoided
Page 263-question 40: Which instructions should the nurse include in the teaching plan for a client who will be taking simvastatin (Zocor) when discharged? Select all that will apply.
a) increase dietary intake of potassium
b) avoid prolonged exposure to the sun
c) schedule regular ophthalmic examinations
d) take the medication at least a half hour before meals
e) contact your health care provider if skin becomes grey-bronze
a) taking simvastatin (Zocor) does affect levels of potassium
b) taking Simvastatin (Zocor) increases photosensitivity;the client should avoid sun exposure and use sunblock
c) client should be monitored for adverse effects of glaucoma and cataracts
d) the medication is most effective when taken at bedtime as cholesterol synthesis is highest at night
e) grey-bronze skin and unexplained muscle pain are indicators of rhabdomyolysis. Rhabdomyolysis, a life threatening response, is the disintegration of muscle associated with myoglobin in the urine
Page 263-question 41: Which topic should the nurse determine is most appropriate when presenting health related instructions to clients from an African-American (or African Canadian/African Nova Scotian) community?
a) osteoporosis
b) hypertension
c) uterine cancer
d) thyroid disorders
a) African-American (or African Canadians/Africans Nova Scotians) have approximately 50 % less risk for osteoporosis than do American or Canadian Caucasians
b) Among African-American (or African Canadians/Africans Nova Scotians), hypertension is 78 % more prevalent than among American or Canadian Causcasians
c)American or Canadian Caucasian females are 30 % more likely to be diagnosed with uterine cancer than African- American/-Canadian/-Nova Scotian women
d) statistics indicate that African-American (or African Canadians/Africans Nova Scotians) are less likely to develop thyroid cancers than Caucasian Americans/Canadians
Page 267-Q 90- A nurse is leading a discussion in a senior citizen centre about the risk factors for developing coronary artery disease (CHD) for women versus men. What should the nurse respond when asked to identify the most significant risk factor?
a) obesity
b) diabetes
c) elevate CRP levels
d) high levels of HDL-c
a) obesity is a risk factor for CHD for both men and women
b) diabetes is twice as a high a predictor for CHD in women compared to men. Diabetes cancels the cardiac protection the oestrogen provides pre-menopausal women
c) an elevated level of CRP, a marker for the inflammatory process, is heart specific in predicting the likelihood of future coronary events in both men and women
d) low (< 35 mg/dl or < 0.9. mmol/L) , not high levels of HDL-c, have a greater bearing on predicting CHD in women than in men.
Page 267-Q 91-A nurse is teaching a group of clients about risk factors for heart disease. Which factors increase a client’s risk for a myocardial infarction?
a) obesity
b) hypertension
c) increased HDL
d) diabetes insipidus
e) Asian-American ancestry
a) obesity increases cardiac workload associated with vascular changes that lead to ischemia, which causes a myocardial infarction.
b) hypertension damages blood vessels and increases peripheral resistance and cardiac workload which may lead to a myocardial infarction
c) increased levels of LDL, not HDL, increase the risk for heart disease
d) diabetes mellitus, not diabetes insipidus, is a risk factor for a myocardial infarction
e) the risk is higher for African-Americans, African-Canadians, African-Nova Scotians