Because of its widespread vasodilating effects, nitroglycerin often produces side effects such as headache, hypotension, and dizziness. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Vasodilation and venous pooling can increase the amount of blood in the cranial space, resulting in increased intracranial pressures; this can cause persistent, throbbing headaches, along with confusion, fever, vertigo, nausea, vomiting, and visual disturbances.

Option A: Nitroglycerin produces hypotension instead of hypertension due to its vasodilating effects. Many of these adverse effects are secondary to the hypotensive effects of nitroglycerin. Patients may report symptoms of orthostatic hypotension which manifest as dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in patients with preload-dependent conditions.
Option B: Stomach cramps are not a side effect of nitroglycerin. Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses. Nitroglycerin is both a protein-bound drug, and it undergoes hepatic metabolism. Therefore it has numerous drug interactions. Before prescribing, providers should determine if the patient is taking any medications that may interact with nitroglycerin.
Option D: Difficulty of breathing is one of the side effects of nitroglycerin. In the event of overdose, monitoring of vital signs may be necessary to monitor the hemodynamic effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended. As intracranial pressure increases, symptoms will progress to dyspnea secondary to a reduced respiratory effort, heart block, bradycardia, paralysis, seizures, coma, and, eventually, death.

An increase in LDL cholesterol concentration has been documented as a risk factor for the development of atherosclerosis. LDL cholesterol is not broken down into the liver but is deposited into the wall of the blood vessels. As the LDL particles leave the blood and enter the arterial intima, they accumulate by being trapped by proteoglycans and are modified. While the modifications of LDL are not elucidated, oxidative modification generating oxidized LDL appears to be an attractive candidate.

Option B: High-density lipids are called the “good” cholesterol. They absorb cholesterol and carry it back to the liver. The liver then flushes it from the body. HDL is known for its anti-atherogenic and anti-inflammatory properties, thanks to its uptake and return of the cholesterol stored in the foam cells of atherosclerotic plaques to the liver. Thus, reducing the size of the plaque and its associated inflammation.
Option C: Triglycerides are the type of fat found in the blood. When we eat, the body converts any calories it doesn’t need to use right away into triglycerides. These are stored into fat cells. Later, hormones release triglycerides for energy between meals.
Option D: Low levels of LDL or the “bad” cholesterol reduces the risk for atherosclerosis and PVD. Modified LDL is taken up by scavenger receptors (SR) such as SRA and CD36 resulting in foam cell formation since cellular cholesterol content does not regulate these SRs. Following endothelial dysfunction induced by LDL, smoking, diabetes, hypertension, among others, there is a deficiency of NO and prostacyclin and/or an increase in plasminogen activator inhibitor type 1 (PAI-1) and cell adhesion molecules (CAMs).

There is a potential alteration in renal perfusion manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross-clamping during the surgery. Intervention or surgical treatment risks versus benefits of repair in patients at increased risk for open surgery should be considered, and no intervention may be appropriate in some cases. Patients should be well informed regarding their options, risks of repair, and potential postoperative complications.

Option A: Wound infection may occur with a poorly dressed postoperative site, but it is not a priority after surgery. During postoperative care, the nurse has to be familiar with potential complications of the surgery and notify the interprofessional team if the patient has abdominal or back pain, wound discharge, fever, oliguria, or hypotension.
Option B: Ineffective coping can be a possible diagnosis after a surgery, however, it is not considered as an immediate risk. The nurse should also ensure that the appropriate consulting physician/dietitian/social workers have seen the patient and the surgeon notified prior to discharge. Open communication between the interprofessional team is vital to ensure good outcomes.
Option C: Electrolyte imbalance cannot be considered a potential diagnosis for a client who just had a surgery for repair of aortic aneurysm since there are no GI complications associated with this surgery. The nurse should also auscultate for bowel sounds and convey the results to the interprofessional team so that feeding can be initiated. Prior to discharge, the pharmacist and nurse should educate the patient on the importance of medication compliance, the need to control blood pressure, and avoiding tobacco.

Good sources of vitamin B12 are dairy products and meats. Among animal products, those from ruminants are particularly rich in vitamin B12, which is naturally synthesized by the ruminal microflora and transferred to milk. Dairy products retain, in general, a major part of the vitamin B12 naturally present in milk, some processing conditions may even add to the basal level by production of vitamin B12 from propionic bacteria in Swiss-type cheeses.

Option B: Vegetables are good sources of potassium, dietary fiber, folate, vitamin A, and vitamin C. Adding vegetables can help increase intake of fiber and potassium, which are important nutrients that many Americans do not get enough of in their diet.
Option C: Grains are important sources of complex carbohydrates, dietary fiber, thiamin, riboflavin, niacin, folate, iron, magnesium, and selenium. Consuming whole grains as part of a healthy diet may reduce the risk of heart disease. Consuming whole grain foods that contain fiber, as part of an overall healthy diet, can support healthy digestion.
Option D: Broccoli is rich in fiber, vitamin C, potassium, vitamin B6, and vitamin A. Broccoli is also packed with phytochemicals and antioxidants. Phytochemicals are chemicals in plants that are responsible for color, smell and flavor. Research shows that they have numerous healthful benefits, according to the American Institute for Cancer Research. Phytochemicals in broccoli are good for the immune system. They include glucobrassicin; carotenoids, such as zeaxanthin and beta-carotene; and kaempferol, a flavonoid.

Aplastic anemia decreases the bone marrow production of RBCs, white blood cells, and platelets. The client is at risk for bruising and bleeding tendencies. Aplastic anemia refers to the syndrome of chronic primary hematopoietic failure from injury leading to diminished or absent hematopoietic precursors in the bone marrow and attendant pancytopenia.

Option A: GI abnormalities may occur with aplastic anemia but it is not an alarming anomaly. Aplastic anemia presents at any age with equal distribution among gender and race. Symptoms related to the absent cell lineage (anemia, progressive weakness, pallor, and dyspnea; neutropenia, frequent and persistent minor infections, or sudden onset febrile illness; thrombocytopenia, ecchymoses, mucosal bleeding, and petechiae).
Option B: Peripheral sensation among clients with aplastic anemia are unaffected. Splenomegaly is not seen, and its presence suggests an alternative diagnosis. Labs will demonstrate macrocytic normochromic anemia with reticulopodia, neutropenia, and thrombocytopenia. There must be no cytologic abnormalities as this would suggest an underlying hematologic process.
Option D: Intake and output may be disturbed, especially if the client is undergoing chemotherapy, but it can be managed. The most common complications of aplastic anemia include bleeding, infections, or transformation to lymphoproliferative disorders. These are managed by surveillance and symptomatic treatment including antibiotics, chemotherapy, and/or transfusions.