cardiac 2 exam 2
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply. A: Smoking cessation B: Dietary measures to reduce LDL levels C: Weight reduction if overweight D: Decreasing physical activity E: Increased intake of fats and sodium
A,B,C
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol? A: LDL B: HDL C: VLDL D: IDL
A: LDL LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs.
The nurse is educating a client diagnosed with pre-hypertension about reducing modifiable risk factors. Which risk factors will the nurse address? Select all that apply. A: Decreasing salt intake B:Decreasing alcohol consumption. C: Working less to decrease stress level D: Have genetic counseling E: Increasing dietary potassium
A,B,E Lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
The nurse is teaching a group about cardiovascular risk factors and complications. Which clients are at risk for developing an aortic dissection? Select all that apply. A: A client who is 36 weeks' pregnant B: A male with acute renal failure C: A 59-year-old male with a blood pressure of 180/100 D: A client who has recently had coronary artery bypass grafting. E: A 30-year-old female with Marfan syndrome
A,C,D,E Aortic dissection is most common in the 40- to 60-year-old group and is more prevalent in men than women. Two risk factors predispose to aortic dissection: hypertension and degeneration of the medial layer of the vessel wall. It may also occur during pregnancy. Aortic dissection is a potential complication of cardiac surgery. Aortic dissection is also associated with connective tissue diseases such as Marfan syndrome. Acute renal failure is not a risk factor for aortic dissection. Marfan syndrome is a heritable disorder of the fibrillin 1 (FBN1) gene, which encodes the connective tissue protein fibrillin-1. In most patients, the connective tissue disorder leads to abnormalities of the aortic wall, causing progressive aortic dilatation, thus increasing the risk of acute aortic dissection.
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply. A: It is the most common cardiovascular disorder. B: The diastolic pressure is equal to 80 mm Hg. C: It is often associated with individuals of normal weight. D: The systolic pressure is ≥140 mm Hg. T E: he incidence increases with age.
A,D,E Hypertension (systolic pressure >140 mm Hg and/or diastolic pressure >90 mm Hg) is one of the most common cardiovascular disorders. The incidence of essential hypertension increases with age; the condition is seen more frequently among black persons, and it may be associated with a family history of high blood pressure, metabolic syndrome, obesity, and increased sodium intake.
A client is concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. Which responses by the nurse are most accurate? Select all that apply. A: Control blood glucose levels B: Increase LDL levels C: Decrease smoking D: Control hypertension E: Maintain normal weight
A,D,E The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. Cigarette smoking must be stopped completely, not simply decreased.
The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states: A: "Capillaries permit the exchange of material between the blood and interstitial fluid." B: "Arteries include internal valves to aid in the unidirectional flow of blood toward the heart." C: "Veins have a three-layered wall with a thick tunica media, which gives it the properties of contractility and elasticity." D: "Venules transport blood away from the heart and help control blood pressure."
A: "Capillaries permit the exchange of material between the blood and interstitial fluid." Capillaries have thin walls that permit the exchange of materials between blood and interstitial fluid. Arteries have a three-layer wall with a thick tunica media. Arterioles transport blood away from the heart and help control blood pressure. Veins have internal valves.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition? A: A pulsating mass in the abdomen B: Syncope C: The pulse is unobtainable in one or both arms D:Hemiplegia
A: A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? A: Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. B: Oxidized free radicals produce toxic metabolic waste that can kill liver cells. C: The end result of oxidation is rupture of the plaque, resulting in hemorrhage. D:Activated cells roam the vascular system looking for inflammatory cells to engulf.
A: Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia? A: Elevated total cholesterol B:Decreased low-density lipoproteins C:Decreased triglycerides D: Normal cholesterol and triglycerides
A: Elevated total cholesterol Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.`
If a client experiences sympathetic nervous stimulation of the heart, the nurse will observe which changes in manifestations? A: Increased heart rate and increased contractility B: Increased heart rate and decreased contractility C: Decreased contractility and decreased heart rate D: Decreased rate and force of contraction
A: Increased heart rate and increased contractility The sympathetic nervous system has an excitatory influence on heart rate and contractility, and it serves as the final common pathway for controlling the smooth muscle tone of the blood vessels. With stimulation of sympathetic nervous system, both heart rate and contractility would increase.
Which of the following are characteristic signs of acute arterial embolism? A: Pallor, pulselessness, and pain B:Paralysis, warmth, and paranoia C: Purpura, muscle weakness, and shortness of breath D: Pain, increased blood pressure, and warmth
A: Pallor, pulselessness, and pain The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.
The heart is a four-chambered pump. What is the function of the right ventricle? A: Pumps blood to the lungs B: Receives blood returning to the heart from the systemic circulation C: Receives oxygenated blood from the lungs D: Pumps blood into the systemic circulation
A: Pumps blood to the lungs The right ventricle pumps blood to the lungs. The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The left ventricle pumps blood into the systemic circulation.
Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury? A: Venous thrombosis B: Peripheral artery disease (PAD) C: Varicose veins D: Chronic venous insufficiency
A: Venous thrombosis Venous thrombosis is associated with stasis of blood, increased blood coagulability, and vessel wall injury. Varicose veins are dilated, tortuous veins of the lower extremities and lead to venous insufficiency. PAD is caused by atherosclerosis in arteries of the lower extremities.
Which client will likely experience difficulty maintaining lipoprotein synthesis, resulting in elevated LDL levels? A:35-year-old client with history of hepatitis C and B with end-stage liver disease. B: 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis. C: 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD). D: 27-year-old client with pancreatitis related to alcohol abuse
A:35-year-old client with history of hepatitis C and B with end-stage liver disease. There are two sites of lipoprotein synthesis—the small intestine and the liver. The liver synthesizes and releases VLDL and HDL. They are taken to the liver and recycled to form VLDL, or converted to LDL in the vascular compartment. Liver disease will result in this mechanism not working as expected. COPD, cervical cancer, and pancreatitis are not involved in elevated LDL levels.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: A;Pulmonary embolism B:Vasculitis C:Polyarteritis nodosa D: Arterial insufficiency
A;Pulmonary embolism Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli. Vasculitis is inflammation of blood vessels. It causes changes in the blood vessel walls, including thickening, weakening, narrowing or scarring. These changes can restrict blood flow, resulting in organ and tissue damage. There are many types of vasculitis, and most of them are rare. Polyarteritis nodosa (PAN) is a condition that causes swollen arteries. It primarily affects small and medium arteries, which can become inflamed or damaged. This is a serious disease of the blood vessels caused by an immune system malfunction. Arterial insufficiency is any condition that slows or stops the flow of blood through the arteries. Arteries are blood vessels that carry blood from the heart to other places in the body.
A nurse is evaluating hypertension risk factors with a Black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply. A: Stress B: Family history C: Excessive alcohol consumption D: Race E: Obesity
B,D Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors that can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. A: The capillaries pump blood. B: The arterial system distributes oxygenated blood to the tissues. C: The heart exchanges gases, nutrients, and wastes. D: The venous system collects deoxygenated blood from the tissues.
B,D The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.
The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as: A: Fusiform aneurysm B: Berry aneurysm C: Dissecting aneurysm D: Saccular aneurysm
B: Berry aneurysm The description of the aneurysm describes a berry aneurysm usually found at the circle of Willis. A saccular aneurysm appears sac-like, while the fusiform aneurysm is characterized by a gradual, progressive dilatation of the vessel
The nurse obtains a blood pressure reading of 150/96 mm Hg from a client at the clinic. What instructions for follow-up does the nurse anticipate giving to this client? A: Education about antihypertensive medications B: Confirm within 2 months C: Recheck in 1 year D: Recheck in 2 years
B: Confirm within 2 months It is recommended that for clients with a blood pressure reading of 150/96 mm Hg be rechecked in 2 months. A systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg are normal, and systolic pressures between 120 and 139 mm Hg and diastolic pressures between 80 and 89 mm Hg are considered prehypertensive. A diagnosis of hypertension is made if the systolic blood pressure is 140 mm Hg or higher and the diastolic blood pressure is 90 mm Hg or higher. We need to consider other factors before immediately assuming they have hypertension after one reading. Look at trends in the patient's blood pressure. Has it been trending high? Could they have "white coat hypertension?" Is the blood pressure being measured accurately?
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate? A: The endocardium over an acute myocardial infarction B: Deep vein thrombosis of the leg C: The hepatic vein in chronic passive congestion of the liver D: atherosclerotic plaque in the aorta
B: Deep vein thrombosis of the leg Deep vein thrombosis (DVT) may be a precursor to pulmonary embolism. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT.
client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms? A: Papilledema and lethargy B: Headache and confusion C: Restlessness and nervousness D: Stupor and hyperreflexia
B: Headache and confusion Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency. Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: A:Family history of heart disease B: Hypertension C: Being male D:55 years of age
B: Hypertension The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. The other options are nonmodifiable risk factors for atherosclerosis.
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client? A: Aneurysms are commonly a result of poorly controlled diabetes mellitus. B: Hypertension is a frequent modifiable contributor to aneurysms. C: Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. D: Aneurysms can normally be resolved with lifestyle and diet modifications.
B: Hypertension is a frequent modifiable contributor to aneurysms. Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.
The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following? A: Decreases serum lipid levels and increases inflammation, thereby promoting hyperlipidemia B: Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development C: Promotes vasodilation and decreases peripheral resistance, thereby increasing cardiac workload D: Increases serum HDL levels, thereby promoting fat oxidation
B: Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development Endothelial damage may be worsened by cigarette smoking. Damage to the endothelium is an early marker that can later become atherosclerotic and eventually may occlude the vessel or predispose to thrombus formation. Smoking increases serum lipid levels and decreases HDL. Smoking promotes vasoconstriction.
The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol? A: It transports cholesterol away from cells to the liver for excretion. B: It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. C: It is associated with a low intake of saturated fats. D:It has a low cholesterol content.
B: It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver.
The older adult client tells the health care provider about experiencing dizziness when changing from a lying to a sitting position. The provider will document which condition in the medical record? A: Decrease in peripheral vascular resistance B: Orthostatic hypotension C: Increased responsiveness to catecholamines D: Systolic hypertension
B: Orthostatic hypotension Orthostatic hypotension, or a significant drop in systolic pressure (dizziness) on assumption of the upright position, is more common among older adults. Compensatory cardiovascular mechanisms are delayed or insufficient. The heart becomes less responsive to catecholamines. The peripheral vascular resistance rises steadily with age, increasing the blood pressure. Systolic hypertension, the increase of systolic blood pressure, occurs as a consequence of increased arterial stiffness.
The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control? A: Increases osmolality of body fluids B: Promotes retention of water C: Produces prolonged increase in blood pressure D: Decreases blood volume
B: Promotes retention of water Vasopressin increases the permeability to water of the collecting ducts of the kidney, promoting renal reabsorption of water. Vasopressin is released in response to decreased blood volume or increased osmolality. Vasopressin also constricts some vascular beds. However, it cannot maintain an increase in blood pressure.
The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse? A: Pulses are present in the radial artery. B: The client states his hand is numb. C: The client states his feet are cold. D: The nail beds are pink.
B: The client states his hand is numb. Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.
The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole? A: Ventricles relax and blood fills the heart. B: Ventricles contract and blood is ejected from the heart. C: Atria contract and blood is ejected from the heart. D: Atria relax and blood fills the heart.
B: Ventricles contract and blood is ejected from the heart. Systole occurs when the ventricles contract and blood is ejected from the heart. Diastole occurs when the ventricles are relaxed and blood fills the heart.
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate? A: "Everyone over the age of 50 tends to have their blood pressure creep up over the years." B: "Your heart has to work harder to pump blood through your vessels as you get older." C: "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." D: "If you slow down and rest more, your blood pressure will more than likely return to its normal level."
C: "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." Systolic blood pressure rises almost linearly between 30 and 84 years of age, whereas diastolic pressure rises until 50 years of age and then levels off or decreases. This rise in systolic pressure is thought to be related to increased stiffness of the large arteries. With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant.
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities? A: A client undergoes a stress test on a treadmill. B: A client does isotonic exercises in a wheelchair. C: A client is helped out of bed and stands up. D:A client reclines from a sitting to supine position.
C: A client is helped out of bed and stands up. During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural/orthostatic hypotension and reflects the redistribution of blood in the body.
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension? A: A 42-year-old client who has a history of poorly controlled type 1 diabetes B: A 78-year-old client who has begun reporting frequent headaches unrelieved by over-the-counter analgesics C: An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom D: A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in the ankles
C: An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom Dizziness, blurred vision, palpitations, and syncope (i.e., fainting) are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. A: Chemoreceptors B: Cardiovascular centers C: Baroreceptors D: Neural pathways
C: Baroreceptors Baroreceptors are pressure-sensitive receptors located in the walls of blood vessels and the heart. The arterial chemoreceptors are cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood. The cardiovascular center transmits impulses to the blood vessels. Neural control of the blood pressure is related to the integration and modulation of autonomic nervous system (ANS) response.
The heart controls the direction of blood flow. What is the role of the aortic valve? A: Controls the direction of blood flow from the atria to the ventricles B: Controls the direction of blood flow from the ventricles to the atria C: Controls the direction of blood flow from the left side of the heart to the systemic circulation D: Controls the direction of blood flow from the left side of the heart to the lungs
C: Controls the direction of blood flow from the left side of the heart to the systemic circulation The heart valves control the direction of blood flow from the atria to the ventricles (the AV valves), from the right side of the heart to the lungs (pulmonic valves) and from the left side of the heart to the systemic circulation (aortic valve).
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? A: Elevation of HDL B: Decreased LDL C: Elevation of triglycerides D: Decreased VLDL
C: Elevation of triglycerides In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.
An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement? A: Contacting the health care provider immediately B: Keeping the client in a supine position throughout the day C: Encouraging the client to maintain hydration throughout the day D: Administering oxygen as prescribed
C: Encouraging the client to maintain hydration throughout the day Significant drops in systolic blood pressure on assumption of the upright position (orthostatic hypotension) is more common in older adults due to compensatory cardiovascular mechanisms that are delayed or insufficient. Appropriate interventions by the nurse include encouraging the client to change positions slowly to decrease the risk of falls. Measures designed to help people prevent symptomatic orthostatic drops in BP include gradual ambulation to allow the circulatory system to adjust. Correcting the fluid deficit may help. Avoiding excess diuresis, diaphoresis, or loss of body fluids will help. There is no indication that the physician needs to be contacted, that the client needs to be placed in a supine position, or that oxygen needs to be administered at this time.
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent: A: Acute myocardial infarction B: Loss of pulses in the limb C: Pulmonary embolism D: Cerebrovascular accident
C: Pulmonary embolism The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A: A 40-year-old smoker who eats excessive amounts of salt and saturated fats B: A Black man who leads a sedentary lifestyle C: A 69-year-old woman with a diagnosis of cardiometabolic syndrome D: A 51-year-old male who has been diagnosed with glomerulonephritis
D: A 51-year-old male who has been diagnosed with glomerulonephritis Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, are associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. How will the nurse classify this client's blood pressure? A: Normal B: Elevated C: Stage 1 hypertension D: Stage 2 hypertension
C: Stage 1 hypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Elevated blood pressure is systolic 120 to 129 mm Hg and diastolic less than 80 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic and should be confirmed within 2 months. Stage 2 is systolic equal to or greater than 140 mm Hg or diastolic equal to or greater than 90 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system? A: Peripheral B: Central C: Sympathetic D: Parasympathetic
C: Sympathetic A network of vasomotor nerves of the sympathetic component of the autonomic nervous system supplies the smooth muscle in the blood vessels. These nerves and circulating hormones are responsible for vasoconstriction of the vessel walls.
A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by the health care provider. Which client statement indicates a need for further health promotion teaching? A: "I'm trying to cut back on the amount of salt that I cook with and add to my food." B:"I've starting going to the gym before work three times a week." C:"I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake." D:"I'm planning to lose 15 lb (7 kg) before the end of this year."
C:"I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake." Weight loss, exercise, and salt reduction are all useful strategies in the management of hypertension and the lowering of blood pressure. An organic diet may focus on higher vegetable intake; however, dietary fats and cholesterol are also contributing facts to hypertension.
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability. A:Serotonin B:Norepinephrine C:Histamine E: Prostaglandins
C:Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine is a powerful vasoconstrictor. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.
A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease? A: "I should stay in bed with my legs elevated." B:"I don't need to monitor my blood pressure." C: "Diabetes mellitus has no effect on my condition." D: "I should have my LDL monitored."
D: "I should have my LDL monitored." Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease the considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? A: 119 mm Hg or lower B: 120 to 129 mm Hg C: 130 to 139 mm Hg D: 140 mm Hg or higher
D: 140 mm Hg or higher Classification of blood pressure in adults defines a systolic pressure of 140 mm Hg or higher as stage 2 hypertension. Stage 1 hypertension has a systolic pressure between 130 and 139 mm Hg. Systolic blood pressure between 120 and 129 mm Hg is classified as elevated and 119 mm Hg or lower is classified as normal.
While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first? A: Athletic client reporting the kneecap popping in and out of socket. B: A client reporting painful urination and experiencing fever and chills. C: A client with a history of chronic obstructive pulmonary disease (COPD) experiencing a productive cough with green sputum. D: A client holding the abdomen and reporting a tearing and ripping feeling inside.
D: A client holding the abdomen and reporting a tearing and ripping feeling inside. A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. The location of the pain may point to the site of dissection. Because aortic dissection is a life-threatening emergency, a client with a probable diagnosis is stabilized medically even before the diagnosis is confirmed. Painful urination with fever is usually associated with a urinary tract infection and is not an imminent threat. A dislocated kneecap is extremely painful, but again not an imminent threat. The respiratory client with productive cough with green sputum likely has an infection like pneumonia and needs treatment but is not the priority when the priority client may be experiencing a dissecting aortic aneurysm.
Which type of aortic aneurysm is the most common? A: Thoracic B: Aortic arch C: Ascending aorta D: Abdominal aortic
D: Abdominal aortic Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta, or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis.
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which blood pressure finding can be characteristic of this condition? A: Blood pressure in legs 20 mm Hg higher than in the arms B: Prominent femoral pulses C: Widened pulse pressure in the legs D: Blood pressure in arms 20 mm Hg higher than in the legs
D: Blood pressure in arms 20 mm Hg higher than in the legs In coarctation of the aorta, blood flow to the lower body is reduced. Blood pressure in the arms is typically at least 20 mm Hg higher than in the legs. Pulse pressure is narrowed, and femoral pulses are weak.
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. Due to ischemia, which initial peripheral symptom is associated with this disease? A: Bulging pulse B: Edema C: Varicosities D: Calf pain
D: Calf pain The primary symptom of chronic obstructive arterial disease is pain with walking or claudication. Typically, persons with the disorder report calf pain because the gastrocnemius muscle has the highest oxygen consumption of any muscle group in the leg during walking. The extremity will be thin, dry (no edema), and have weak low-pressure pulses due to severely reduced blood flow to the distal vessels.
A client is immobilized following a hip injury. The client has developed unilateral lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings? A: Stasis ulcerations B: Arterial insufficiency C: Primary varicose veins D: Deep vein thrombosis
D: Deep vein thrombosis venous insufficiency with deep vein thrombus formation is characterized by pain, swelling [edema], and deep muscle tenderness. Fever, general malaise, and elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. Swelling may vary from minimal to maximal. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present with deep vein thrombosis.
A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli? A: Chest x-ray B: Ultrasound of the kidney C: CT of the head D: Echocardiogram
D: Echocardiogram Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fibrillation) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.
The health care team proposes a treatment plan for a client with peripheral artery disease. Which treatment measures are likely included? A: Weight training to strengthen the vastus lateralis B: Isometric exercise to increase cardiac endurance C: Aerobic exercise to decrease respiratory stress D: Exercise training like walking to increase collateral circulation
D: Exercise training like walking to increase collateral circulation Because of the effects of exercise training on vascular function and collateral circulation, it has been proposed as a mechanism for improving blood flow and decreasing exercise-related leg pain (claudication) in persons with peripheral artery disease (PAD). The vastus lateralis is the large muscle on the lateral thigh. Weight training will strengthen this muscle, but is not recommended for people with PAD. Isometric exercise does not increase the endurance of the heart. Aerobic exercise does not decrease respiratory stress.
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is: A: Elevated HDL cholesterol B: History of myocardial infarction C: Heart failure D: Hypertension
D: Hypertension Constant high blood pressure damages arterial walls and promotes formation and rupture of plaque, with subsequent stroke and myocardial infarction. Atherosclerosis can also contribute to heart failure. Elevated HDL cholesterol would mitigate the development of atherosclerosis.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: A: Late hypertensive crisis B: Chest pain radiating to the right arm C: Tonic-clonic seizures D: Tearing or ripping-type pain in the chest or back
D: Tearing or ripping-type pain in the chest or back A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for: A: ischemic stroke and ischemic heart disease. B: orthostatic hypotension and cerebral aneurysm. C: dependent edema and decreased cognition. D: organ damage and hypovolemic shock.
D: organ damage and hypovolemic shock. The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk. Low blood pressure does not normally result in aneurysms, edema, or ischemic stroke. MAP= SBP + 2xDBP / 3
Which sequence is the correct pathway for blood flow through the heart? A: left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - tricuspid valve - right ventricle - aorta B:right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - tricuspid valve - left ventricle - aorta C: left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein - right atrium - mitral valve - right ventricle - aorta D: right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
D: right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta The correct pathway for blood flow through the heart is the right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta.
.The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement? A: apply ice compresses to the site of the DVT hourly B: ensure that the client remains on bed rest C: massage legs to maintain blood flow D:apply sequential pneumatic compression devices to lower extremities
D; apply sequential pneumatic compression devices to lower extremities The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? A: Hormonal activity B: Humoral influence C: The kidneys D: Neural mechanisms
The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epineph
