PERIPHERAL VASCULAR DISORDERS PRACTICE QUESTIONS AND ANSWERS

The 66-year-old male client has his blood pressure (BP) checked at a health fair. His BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his BP checked in 1 month. 2. Instruct the client to see his health-care provider (HCP) as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an older person. Answer: 2 1. This BP is elevated, and the client should have his BP checked frequently but not before seeking medical treatment. 2. The diastolic BP should be less than 80 mm Hg, according to the American Heart Association (2017); therefore, this client should see the HCP. 3. Teaching is important, but the nurse must first make sure the client sees the HCP for a thorough checkup and antihypertensive medication prescription. Diet alone should not be recommended by the nurse. 4. This is not the normal range for an older person's BP; the diastolic should be less than 80 mm Hg. TEST-TAKING HINT: Remember, the question asks which action should be implemented first. Therefore, more than one answer is appropriate, but the first to be implemented should be the one that directly affects the client. The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing heart-healthy exercise? Select all that apply. 1. Walk briskly for at least 30 minutes a day on flat surfaces. 2. Perform heavy weightlifting three times a week. 3. Recommend high-intensity aerobics every day. 4. Encourage the client to swim laps once a week. 5. Use resistance bands at home at least twice a week. Answer: 1, 5 1. Brisk walking 30 to 45 minutes a day will help to reduce BP, weight, and stress and will increase a feeling of overall well-being (American Heart Association, 2018). 2. Heavy weight lifting should be discouraged because performing this activity can raise systolic BP, although the research is controversial and can be addressed on an individual client basis. 3. The client should walk, cycle, jog, or swim as moderate-intensity aerobic activity on most days, but high-level aerobic exercise is recommended at least 2 days a week. 4. Swimming laps is recommended, but it should be daily, not once a week. 5. The use of resistance bands, a form of muscle-strengthening exercise, should be encouraged at least twice a week. TEST-TAKING HINT: Remember to look at the frequency of interventions; it makes a difference when selecting the correct answers. The HCP prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential (or primary) hypertension. Which statement is the most appropriate rationale for administering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease BP by relaxing vascular smooth muscle. Answer: 3 1. Beta-adrenergic blocking agents, not ACE inhibitors, prevent the beta receptor stimulation in the heart, which decreases heart rate and cardiac output. 2. Alpha-adrenergic blockers, not ACE inhibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. 3. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, and this, in turn, prevents vasoconstriction and sodium and water retention. 4. Vasodilators, not ACE inhibitors, reduce BP by relaxing vascular smooth muscle, especially in the arterioles. TEST-TAKING HINT: The test taker needs to understand how the major classifications of medications work to answer this question. The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? 1. Notify the HCP if the potassium level is 3.8 mEq. 2. Question administering the medication if the BP is less than 90/60 mm Hg. 3. Do not administer the medication if the client's radial pulse is greater than 100. 4. Monitor the BP while the client is lying, standing, and sitting. Answer: 2 1. The potassium level is within normal limits (3.5 to 5.3 mEq/L), and it is not usually checked before administering beta blockers. 2. The nurse should question administering the beta blocker if the BP is low because this medication will cause the BP to drop even lower, leading to hypotension. 3. The nurse would not administer the medication if the apical (not radial) pulse were less than 60 beats per minute. 4. The nurse needs to assess the BP only once before administering the medication (not take all three BPs before administering the medication). TEST-TAKING HINT: Be sure to read the entire question and all the answer options and note the specific numbers that are identified. The test taker must know normal laboratory data and assessment findings. The male client diagnosed with essential hypertension has been prescribed an alpha-adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from a lying to sitting position. Answer: 4 1. The potassium level is not affected by an alpha-adrenergic blocker. 2. Alpha-adrenergic blockers, on rare occasions, can cause sexual problems. Noncompliance with taking prescribed medications can occur in male clients who experience impotence. The noncompliance should be reported to the HCP immediately so that the medication can be changed. Impotence, however, is not an expected side effect. 3. The medication can be taken on an empty or a full stomach, depending on whether the client becomes nauseated after taking the medication. 4. Orthostatic hypotension may occur when the BP is decreasing and may lead to dizziness and light-headedness, so the client should change position slowly. TEST-TAKING HINT: The test taker should understand the side effects of medications. The test taker not knowing the answer may realize that hypertension is being treated and that hypotension is the opposite of hypertension and might be a complication of treating hypertension. Only option "4" refers to hypotension, providing advice on how to avoid orthostatic hypotension. The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease and a BP of 170/100. 2. The client diagnosed with DVT and reporting chest pain. 3. The client diagnosed with pneumonia and a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis and nonbloody diarrhea. Answer: 2 1. This BP is elevated, but it is not life-threatening. 2. The chest pain could be a pulmonary embolus secondary to DVT and requires immediate intervention by the nurse. 3. A pulse oximeter reading of greater than 93% is within normal limits. 4. Nonbloody diarrhea is an expected clinical manifestation of ulcerative colitis and would not require immediate intervention by the nurse. TEST-TAKING HINT: The nurse should assess the client with abnormal assessment data or a life-threatening condition first when determining which client is a priority. The client diagnosed with essential hypertension asks the nurse, “Why do I have high blood pressure?” Which response by the nurse would be most appropriate? 1. “You probably have some type of kidney disease that causes the high BP.” 2. “More than likely, you have had a diet high in salt, fat, and cholesterol.” 3. “There is no specific cause for hypertension, but there are many known risk factors.” 4. “You are concerned that you have high blood pressure. Let’s sit down and talk.” Answer: 3 1. Kidney disease leads to secondary hypertension; secondary hypertension is elevated BP resulting from an identifiable underlying process. 2. A high-salt, high-fat, high-cholesterol diet is a risk factor for essential hypertension, but it is not the only cause; therefore, this would be an incorrect answer. 3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, sex)—are risk factors for essential hypertension. 4. This is a therapeutic reply that is inappropriate because the client needs facts. TEST-TAKING HINT: When clients request information, the exchange should not address emotions. Just facts should be given. Therefore, option “4” can be eliminated as a correct answer. The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? 1. “I should eat at least four to five servings of vegetables a day.” 2. “I should eat meat that has a lot of white streaks in it.” 3. “I should drink no more than two glasses of whole milk a day.” 4. “I should decrease my grain intake to no more than twice a week.” Answer: 1 1. The DASH diet has proved beneficial in lowering BP. It recommends eating a diet high in vegetables, fruits, and whole grains (National Heart, Lung, and Blood Institute, n.d.). 2. The DASH diet recommends two or fewer servings of lean meats, which have very few white streaks; the white streaks indicate the meat is high in fat. 3. The DASH diet recommends two to three servings of nonfat or low-fat milk, not whole milk. 4. The DASH diet recommends six to eight servings of grain a day. TEST-TAKING HINT: The test taker is looking for correct information about the DASH diet. A recommended diet for hypertension would limit fatty meats and whole milk. The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? 1. The telemetry reads normal sinus rhythm. 2. The client has a weight gain of 2 kg within 1 to 2 days. 3. The client’s BP is 148/92. 4. The client’s serum potassium level is 4.5 mEq. Answer: 2 1. Normal sinus rhythm indicates that the client’s heart is working normally. 2. Rapid weight gain—for example, 2 kg in 1 to 2 days—indicates that the loop diuretic is not working effectively; 2 kg equals 4.4 lb; 1 L of fluid weighs 1 kg. 3. This BP is not life-threateningly high and does not require immediate intervention. 4. Loop diuretics cause an increase in potassium excretion in the urine; therefore, the potassium level should be assessed, but 4.5 mEq/L is within normal limits (3.5 to 5.3 mEq/L). TEST-TAKING HINT: The phrase “requires immediate intervention” should make the test taker think that the correct answer will be abnormal assessment data that require medical intervention or indicate conditions that are life-threatening. The client diagnosed with essential hypertension asks the nurse, “I don’t know why the doctor is worried about my blood pressure. I feel just great.” Which statement by the nurse would be the most appropriate response? 1. “Damage can be occurring to your heart and kidneys even if you feel great.” 2. “Unless you have a headache, your blood pressure is probably within normal limits.” 3. “When is the last time you saw your doctor? Does he know you are feeling great?” 4. “Your blood pressure reflects how well your heart is working.” Answer: 1 1. Even if the client feels great, the BP can be elevated, causing damage to the heart, kidney, and blood vessels. 2. A headache may indicate an elevated BP, but the client diagnosed with essential hypertension can be asymptomatic and still have a very high BP reading. 3. This response does not answer the client’s question as to why the doctor is worried about the client’s BP. 4. The BP does not necessarily reflect how well the heart is working. Many other diagnostic tests assess how well the heart is working, including an electrocardiogram (ECG), an ultrasound, and a chest x-ray. TEST-TAKING HINT: The test taker should select the option that provides the client with correct information in a nonthreatening, nonjudgmental approach. The intensive care unit nurse is calculating the total intake for a client diagnosed with a hypertensive crisis. What is the total intake for this client? Intake and Output Record - Oral (oz): Water (8 oz), Milk (4 oz), Chicken broth (6 oz) - Intravenous (mL): 680 mL (D5W), 100 mL (0.9% NS), 200 mL (D5W) - Urine (mL): 1,480 mL Answer: 1,520 mL total intake The urinary output is not used in this calculation. The nurse must add up both intravenous fluids and oral fluids to obtain the total intake for this client: 680 + 100 + 200 = 980 IV fluids Oral fluids (1 ounce = 30 mL): 8 ounces × 30 mL = 240 mL, 4 ounces × 30 mL = 120 mL, 6 ounces × 30 mL = 180 mL 240 + 120 + 180 = 540 mL oral fluids Total intake is 980 + 540 = 1,520 mL. The nurse is teaching a class on essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? 1. Include information on retinopathy and nephropathy. 2. Discuss a sedentary lifestyle and smoking cessation. 3. Include discussions on family history and sex. 4. Provide information on a low-fiber and high-salt diet. Answer: 2 1. Retinopathy and nephropathy are complications of uncontrolled hypertension, not modifiable risk factors. 2. A sedentary lifestyle is discouraged in clients diagnosed with hypertension; daily isotonic exercises are recommended. Smoking (cigars cause problems too) increases the atherosclerotic process in and causes vasoconstriction of vessels. Carbon monoxide adheres to hemoglobin, decreasing oxygen levels. 3. Family history and sex are nonmodifiable risk factors. The question is asking for information on modifiable risk factors. 4. A low-salt diet is recommended because increased salt intake causes water retention, which increases the workload of the heart. A high-fiber diet is recommended because it helps decrease cholesterol levels. TEST-TAKING HINT: Remember to look at the adjectives. The stem of the question is asking about "modifiable risk factors." The client comes to the clinic reporting muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? 1. Peripheral vascular disease. 2. Intermittent claudication. 3. Deep vein thrombosis. 4. Dependent rubor. Answer: 2 1. Peripheral vascular disease is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. 2. This is the classic symptom of peripheral arterial disease. 3. This is characterized by calf tenderness, calf edema, and a positive Homans' sign. 4. This term is a clinical manifestation of peripheral arterial disease; the legs are pale when elevated but are dark red when in the dependent position. TEST-TAKING HINT: The test taker could eliminate options "1" and "3" as possible answers if the words "medical term" were noted. Both options "1" and "3" are disease processes, not medical terms. Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? 1. Encourage the client to use a heating pad on the lower extremities. 2. Demonstrate to the client the correct way to apply elastic support hose. 3. Instruct the client to walk daily for at least 30 minutes. 4. Tell the client to check both feet for red areas at least once a week. Answer: 3 1. External heating devices are avoided to reduce the risk of burns. 2. Elastic support hose reduce the circulation to the skin and are avoided. 3. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. 4. The feet must be checked daily, not weekly. TEST-TAKING HINT: The test taker must note the noun "week" in option "4," which could eliminate this distracter as a possible answer. The nurse is teaching the client diagnosed with peripheral artery disease. Which interventions should the nurse include in the teaching? Select all that apply. 1. Wash legs and feet daily in warm water. 2. Apply moisturizing cream to feet. 3. Buy shoes in the morning hours only. 4. Avoid crossing the legs. 5. Wear clean white cotton socks. Answer: 1, 2, 4, 5 1. Cold water causes vasoconstriction, and hot water may burn the client's feet; therefore, warm (tepid) water should be recommended. 2. Moisturizing prevents drying of the feet. 3. Shoes should be purchased in the afternoon when the feet are the largest. 4. Crossing the legs will decrease circulation to the legs. 5. Colored socks have dyes, and dirty socks may cause foot irritation that may lead to breaks in the skin. TEST-TAKING HINT: The test taker must select all appropriate interventions; option "3" could be eliminated as a correct answer because of "only," which is an absolute word. There are very few absolutes in health care. Which assessment data would warrant immediate intervention in the client diagnosed with peripheral arterial disease? 1. The client has 2+ pedal pulses. 2. The client is able to move the toes. 3. The client has numbness and tingling. 4. The client’s feet are red when standing. Answer: 3 1. These are normal pedal pulses and would not require any intervention. 2. Moving the toes is a good sign in a client diagnosed with peripheral arterial disease. 3. Numbness and tingling are paresthesias, which are a clinical manifestation of a severely decreased blood supply to the lower extremities. 4. Reddened extremities are expected secondary to increased blood supply when the legs are in the dependent position. TEST-TAKING HINT: “Warrants immediate intervention” indicates that the test taker must select the distracter that is abnormal, unexpected, or life-threatening for the client’s disease process. Sometimes if the test taker flips the question and thinks which assessment data are normal for the disease process, it is easier to identify the correct answer. Which client problem would be a priority in a client diagnosed with peripheral arterial disease, admitted to the hospital with a foot ulcer? 1. Impaired skin integrity. 2. Activity intolerance. 3. Ineffective health maintenance. 4. Risk for peripheral neuropathy. Answer: 1 1. The client has a foot ulcer; therefore, the protective lining of the body—the skin—has been impaired. 2. This is an appropriate problem but would not take priority over impaired skin integrity. 3. The client needs teaching, but it does not take priority over a physiological problem. 4. The client has peripheral neuropathy, not a risk for it; this is the primary pathological change in a client diagnosed with peripheral arterial disease. TEST-TAKING HINT: Remember Maslow's hierarchy of needs; physiological needs are a priority. The client diagnosed with peripheral arterial disease is 1 day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement? 1. Keep the right leg in the dependent position. 2. Apply sequential compression devices to lower extremities. 3. Monitor the client's pedal pulses every shift. 4. Assess the client's leg dressing every 4 hours. Answer: 4 1. The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent DVT, but it should not be on the leg with an operative incision site. 3. The client is 1 day postoperative, and the pedal pulses must be assessed more than once every 8 or 12 hours. 4. The leg dressing needs to be assessed for hemorrhaging or findings of infection. TEST-TAKING HINT: The test taker must be observant of time ("1 day postoperative"), and doing an intervention every "shift" should cause the test taker to eliminate this distracter. The test taker must know terms used to describe positioning, such as dependent, prone, and supine. The nurse is unable to assess a pedal pulse in the client diagnosed with peripheral arterial disease. Which intervention should the nurse implement first? 1. Complete a neurovascular assessment. 2. Use the Doppler device. 3. Instruct the client to hang the feet off the side of the bed. 4. Wrap the legs in a blanket. Answer: 1 1. An absent pulse is not uncommon in a client diagnosed with peripheral arterial disease, but the nurse must ensure that the feet can be moved and are warm, which indicates adequate blood supply to the feet. 2. To identify the location of the pulse, the nurse should use a Doppler device to amplify the sound, but it is not the first intervention. 3. This position will increase blood flow and may help the nurse palpate the pulse, but it is not the first intervention. 4. Cold can cause vasoconstriction and decrease the ability to palpate the pulse, and warming will dilate the arteries, helping the nurse find the pedal pulse, but it is not the first intervention. TEST-TAKING HINT: The stem asks the test taker to identify the first intervention, and the test taker should apply the nursing process and implement an assessment intervention. The spouse of a client diagnosed with peripheral arterial disease tells the nurse, “My husband says he is having rest pain. What does that mean?” Which statement by the nurse would be most appropriate? 1. “It describes the type of pain he has when he stops walking.” 2. “His legs are deprived of oxygen during periods of inactivity.” 3. “You are concerned that your husband is having rest pain.” 4. “This term is used to support that his condition is getting better.” Answer: 2 1. The pain stops when the client quits walking; therefore, it is not rest pain. 2. Rest pain indicates a worsening of the peripheral arterial disease; the muscles of the legs are not getting enough oxygen when the client is resting to prevent muscle ischemia. 3. This is a therapeutic response and does not answer the spouse’s question. 4. Rest pain indicates that the peripheral arterial disease is getting worse. TEST-TAKING HINT: The nurse should answer questions with factual information; therefore, option “3” could be eliminated as a possible answer. Pain usually does not indicate that a condition is getting better, which would cause the test taker to eliminate option “4.” The nurse is assessing the client diagnosed with long-term peripheral arterial disease. Which assessment data support the diagnosis? 1. Hairless skin on the legs. 2. Brittle, flaky toenails. 3. Petechiae on the soles of feet. 4. Nonpitting ankle edema. Answer: 1 1. The decreased oxygen over time causes the loss of hair on the tops of the feet and ascending both legs. 2. The toenails are usually thickened as a result of hypoxemia. 3. Petechiae are tiny purple or red spots that appear on the skin as a result of minute hemorrhages within the dermal layer; this does not occur with peripheral arterial disease. 4. There may be edema, but it is usually pitting; nonpitting edema resolves with elevation but not in clients diagnosed with peripheral arterial disease. TEST-TAKING HINT: The test taker should apply the pathophysiological concept that arterial blood supplies oxygen and nutrients, and if the hair cannot get nutrients, it will not grow. The HCP ordered a femoral angiogram for the client diagnosed with peripheral arterial disease. Which interventions should the nurse implement? Select all that apply. 1. Explain that this procedure will be done at the bedside. 2. Discuss bedrest orders and bathroom privileges with the client. 3. Inform the client that no intravenous access will be needed. 4. Inform the client that fluids will be increased after the procedure. 5. Teach the client that a local anesthetic will be used during the procedure. Answer: 4, 5 1. This procedure will be done in a catheterization laboratory or special room, not at the bedside, because machines are used to visualize the extent of the arterial occlusion. 2. The client will have to keep the leg straight for at least 6 hours after the procedure to prevent bleeding from the femoral artery. 3. An intravenous contrast medium is injected, and vessels are visualized using fluoroscopy and x-rays. 4. Fluids will help flush the contrast dye out of the body and help prevent kidney damage. 5. A local anesthetic will be used to numb the skin at the insertion site. TEST-TAKING HINT: The test taker must be knowledgeable of diagnostic tests. If not, the test taker could dissect the word "angiogram"; angio- means "vessel," which could help eliminate option "3" as a possible answer because some type of dye would have to be used to visualize a vessel. Adjectives should be noted—anything done in the femoral artery would require pressure at the site to prevent bleeding—this information could help the test taker to eliminate option "2" as a possible answer. Very few diagnostic tests are done at the bedside. Which medication should the nurse expect the HCP to order for a client diagnosed with peripheral arterial disease? 1. An anticoagulant medication. 2. An antihypertensive medication. 3. An antiplatelet medication. 4. A muscle relaxant. Answer: 3 1. Anticoagulant medication is prescribed for venous problems, such as DVT. 2. Peripheral arterial disease is caused by atherosclerosis, which may cause hypertension as well, but antihypertensive medications are not prescribed for peripheral arterial disease. 3. Antiplatelet medications, such as aspirin or clopidogrel (Plavix), inhibit platelet aggregations in the arterial blood. 4. A muscle relaxant will not help the leg pain because the origin of the pain is decreased oxygen to the muscle. TEST-TAKING HINT: The test taker should apply the knowledge learned in anatomy and physiology class. Platelets are part of the arterial blood; therefore, this would be an excellent selection if the test taker did not have any idea about the answer. The RN and an unlicensed assistive personnel (UAP) are caring for a 64-year-old client 4 hours postoperative bilateral femoral-popliteal bypass surgery. Which nursing task should be delegated to the UAP? 1. Monitor the continuous passive motion machine. 2. Assist the client to the bedside commode. 3. Feed the client the evening meal. 4. Elevate the foot of the client's bed. Answer: 4 1. A continuous passive motion machine is used for a client with a total knee replacement, not for this type of surgery. 2. The client will be on bedrest at 4 hours after the surgery. Remember, the client had bilateral surgery on the legs. 3. There is nothing in the stem that would indicate the client could not self-feed. The nurse should encourage independence as much as possible. 4. After the surgery, the client's legs will be elevated to help decrease edema. The surgery has corrected the decreased blood supply to the lower legs. TEST-TAKING HINT: A concept that is applicable to surgery is decreasing edema, and extremity surgeries usually include elevating the affected extremity. The test taker must apply basic concepts when answering questions. The nurse is teaching a class on coronary artery disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis? 1. Stress. 2. Age. 3. Sex. 4. Family history. Answer: 1 1. A modifiable risk factor is a risk factor that can possibly be altered by modifying or changing behavior, such as developing new ways to deal with stress. 2. The client cannot do anything about getting older, so it cannot be modified. 3. Sex is a risk factor that cannot be changed. 4. Having a family history of coronary artery disease predisposes the client to a higher risk, but this cannot be changed by the client. TEST-TAKING HINT: The test taker needs to key in on adjectives when reading the stem of a question. The word "modifiable" should cause the test taker to select "stress" because it is the only answer option referring to something that can be changed or modified. The client asks the nurse, “My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?” Which response by the nurse would be the best response? 1. “The muscle fibers and endothelial lining of your arteries have become thickened.” 2. “The next time you see your HCP, ask what atherosclerosis means.” 3. “The valves in the veins of your legs are incompetent so your legs hurt.” 4. “You have a hardening of your arteries that decreases the oxygen to your legs.” Answer: 4 1. The nurse should assume the client is a layperson and should not explain disease processes using medical terminology. 2. This is passing the buck; the nurse should have the knowledge to answer this question. 3. Atherosclerosis involves the arteries, not the veins. 4. This response explains in plain terms why the client’s legs hurt from atherosclerosis. TEST-TAKING HINT: If the test taker knows medical terminology, option “3” could be eliminated because athero- means “arteries,” not veins. The test taker should be very cautious when choosing an option that asks the HCP to answer questions that nurses should be able to answer. The client diagnosed with peripheral vascular disease is overweight, has smoked two packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor in the development of atherosclerotic lesions? 1. Being overweight. 2. Sedentary lifestyle. 3. High-fat, high-cholesterol diet. 4. Smoking cigarettes. Answer: 4 1. Being overweight is not a risk factor for atherosclerotic lesions, but it does indicate that the client does not eat a healthy diet or exercise as needed. 2. Lack of exercise is a risk factor, but it is not the strongest. 3. Although the stem did not explicitly identify diet, the nurse should assume that an obese client would not eat a low-fat, low-cholesterol diet. 4. Although tobacco use has declined in the United States, tobacco use is still the strongest factor in the development of atherosclerotic lesions. Nicotine decreases blood flow to the extremities and increases heart rate and BP. It also increases the risk of clot formation by increasing the aggregation of platelets.