Cardiovascular System in Older Adults (NCLEX questions)

A patient presents with complications relating to peripheral vascular disease. Which intervention would help promote blood flow?

• Crossing of the legs when sitting

• Walking to stimulate venous return

• Decreased saturated fat content in diet

• Deep tissue massage in lower extremities

Answer explanation

Walking helps stimulate venous return; no massage because of adverse effects; crossing of legs will apply pressure to affected area; a decrease in fat pertains to coronary artery disease

A 60-year-old male presents to his health care provider for an annual checkup. Patient states since being on retirement he’s been living a sedentary lifestyle, finds himself smoking more than usual and has had trouble sleeping. After labs are drawn, the physician notices his total cholesterol level at 130 mg/dl and raises concern for coronary artery disease. Which nursing intervention would best decrease his risk for coronary artery disease? Select all that apply.

• Order a statin drug

• Prescribe Lasix

• Encourage patient to exercise 150 minutes per week

• Limit salt intake

• Maintain total cholesterol level of 240

Answer explanation

150 minutes per week of exercise and limiting of salt intake are both ways to decrease risk for coronary artery disease; a nurse cannot order/prescribe drugs; total cholesterol should be below 200

A nursing student is giving a presentation on the effects of aging related to cardiovascular changes. The student nurse should include which of the following changes? Select all that apply.

• Decreased cardiac output

• Increased atherosclerosis

• Increased elasticity of heart muscle

• Decreased incidence of heart failure

• Decreased incidence of MI

Answer explanation

Decreased cardiac output and increased atherosclerosis are both cardiovascular changes with aging. Elasticity of the heart muscle will decrease as you age. Because of the decreased cardiac output, the incidence of heart failure will increase, and because of the increased atherosclerosis the incidence of MI will increase.

The nurse is teaching a patient about the use of the following: compression stockings, pneumatic compression pumps, Unna boots, and being aware of situations that may cause injury to feet due to temperature sensation being decreased. These are all interventions that help with what?

• Skin ulcers and altered sensations related to inadequate circulation

• Decrease of blood flow to lower extremities

• A patient’s gait

• Vasoconstriction

Answer explanation

Inadequate circulation leads to skin ulcers and altered sensations, we want adequate blood flow to lower extremities not a decrease, these interventions are not interventions used to help a patient’s gait, vasoconstriction to lower extremities will result in inadequate circulation.

Your 64-year-old female patient has undiagnosed hypertension. Hypertension is commonly called the silent killer. This is because hypertension often goes undetected until other symptoms occur. These symptoms could be caused by which of the following?

• Stroke (CVA)

• Hepatic disease

• Myocardial infarction (MI)

• Respiratory disease

Answer explanation

Stroke (CVA) Hypertension is referred to as the silent killer for adults, because until the adult has damage to other systems, hypertension may go undetected. Strokes can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease. However, Heart failure can be directly related to hypertension.

Management of stress and weight are important components of hypertension therapy; however, the primary goal is compliance. You are working at a clinic, a new patient with hypertension is admitted. He is a 64-year-old male that appears apprehensive. You have not received orders for medications. What nursing intervention(s) would you use to help this hypertensive patient? (select all that apply)

• Provide calm, restful surroundings

• Minimize environmental activity and noise

• Provide comfort measures

• Stand next to the head of the patient's bed while gathering data

• Reassure your patient that all will be ok

Answer explanation

Correct answers: a, b, c. Comfort measures such as guided imagery or distractions will take the patient's mind off of the symptoms. Making sure the room temperature, comfortable sitting position, or patient not sitting on tubes or wires. Decrease discomfort and reduce sympathetic stimulation, prompting relaxation.

Incorrect answers: d. Standing next to the head of the patient, places the nurse in a position of authority. The nurse should be on the same level and face the patient, sitting would be better. e. We never reassure a patient, ALL will be ok.

Your 64-year-old patient has been diagnosed with hypertension, what would be the most important long-term goal for this patient?

• Learn how to avoid stress

• Change jobs

• Commit to long term treatment

• Control high blood pressure through diet alone

Answer explanation

Commit to long term treatment, compliance is most critical to treatment of hypertension. Lifelong treatment in most hypertensive patients is required, hypertension cannot be managed successfully without drug therapy.

A 46-year-old male patient presents to a physician with a history of smoking, high blood pressure, a BMI of 35, a family history of cardiac disease, and is recently unemployed. Which disorder is this patient most at risk for developing?

• GERD

• Heart disease

• Syncope

• Sepsis

Answer explanation

Heart disease, smoking, high blood pressure, obesity, and stress are all modifiable risk factors, family history of cardiac disease is a non-modifiable risk factor of heart disease. Incorrect answers: GERD is a result of frequent acid reflux, things like alcohol, chocolate, spicy and acidic foods tend to make symptoms worse; Syncope is passing out or fainting caused by a sudden drop in blood pressure; Sepsis is the body’s response to an infection.

John, a 76-year-old patient has complaints of lightheadedness, dizziness, palpitations, and headaches. It is determined that he has orthostatic hypotension. What patient teaching should his nurse provide to help with the symptoms associated with his diagnosis? Select all that apply.

• Drink less water

• Avoid crossing legs while sitting

• Stand up slowly with assistance

• Lay bed in a flat position

• Drink less alcohol

Answer explanation

Correct answers: B, crossing legs puts more pressure on your veins, C, standing slowly may reduce the dizziness and lightheadedness associated with orthostatic hypotension, E, alcohol causes dehydration, also stops the return of blood to the head and upper extremities by preventing blood vessels from tightening in a usual manner which may cause a decrease in blood pressure.

Incorrect answers: A, drinking less water can lead to dehydration, dehydration can lead to low blood pressure, D, the head of the bed should be elevated, this helps to reduce the blood from pooling in the abdomen and improve symptoms upon standing.

According to the CDC, cancer, accidents, chronic lower respiratory diseases, and stroke are among the top 5 diseases responsible for death in the United States. Which of the following is the leading cause of death in the United States?

• Diabetes

• Alzheimer's Disease

• Heart disease

• Pneumonia

Answer explanation

Correct answer: C, heart disease is the leading cause of death according to the CDC being responsible for over 600,000 deaths annually.

Incorrect answers: Alzheimer’s disease, diabetes, and pneumonia all have significantly less deaths annually than heart disease.