CH. 18 Pathophysiology

Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? A) Leukocytosis B) Homocysteine C) Serum lipoprotein D) C-reactive protein

D) C-reactive protein

A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status? A) "We don't really understand why some women get high blood pressure when they're pregnant." B) "This is likely a result of your nervous system getting overstimulated by pregnancy." C) "Hypertension is a common result of all the hormonal changes that happen during pregnancy." D) "Even though you're a healthy person, it could be that you have an underlying heart condition."

A) "We don't really understand why some women get high blood pressure when they're pregnant."

Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply. A) A 47-year-old waitress who works 12-hour shifts three or four times/week B) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week C) A 56-year-old male who has been immobile due to back surgery and has developed a deep vein thrombosis D) A Marathon runner who has completed three marathons in the past 3 months E) A new peritoneal dialysis client who has been utilizing a home machine and performing dialysis every evening beginning at 8 PM

A) A 47-year-old waitress who works 12-hour shifts three or four times/week B) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week

Which of the following is a nonmodifiable risk factor for the development of primary hypertension? A) African American race B) High salt intake C) Male gender D) Obesity

A) African American race

A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect? A) By decreasing vascular volume by increasing sodium and water excretion B) By blocking the release of antidiuretic hormone from the posterior pituitary C) By inhibiting the conversion of angiotensin I to angiotensin II D) By inhibiting the movement of calcium into arterial smooth muscle cells

A) By decreasing vascular volume by increasing sodium and water excretion

A client is receiving home care for the treatment of a wound on the inside of her lower leg that is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the client's legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this client's most likely diagnosis? A) Chronic venous insufficiency B) Deep vein thrombosis C) Varicose veins D) Peripheral arterial disease

A) Chronic venous insufficiency

Which of the following children may be considered high risk for developing hypertension? Select all that apply. A) Diagnosed with coarctation of the aorta as an infant B) Recent scan showing a pheochromocytoma C) Has a history of epilepsy with weekly seizures D) Takes cyclosporine daily since a kidney transplant E) Has a history of frequent sinus infections treated with antibiotics

A) Diagnosed with coarctation of the aorta as an infant B) Recent scan showing a pheochromocytoma D) Takes cyclosporine daily since a kidney transplant

Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? A) High-calorie diet B) Diabetes mellitus C) Bile-binding resin D) Cholesterol ingestion

A) High-calorie diet

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A) Peripheral vascular resistance B) Electrical impulses in the heart C) Release of stress hormones D) Rigidity of the ventricular walls

A) Peripheral vascular resistance

The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A) Ulceration B) Thrombosis C) Fatty streaks D) Fibrous plaque

B) Thrombosis

An elderly client newly diagnosed with systolic hypertension asks her health care provider why this happens. The most accurate response would be: A) "Everyone over the age of 50 tends to have their blood pressure creep up over the years." B) "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." C) "Your heart has to work harder to pump blood through your vessels as you get older." D) "If you slow down and rest more, your blood pressures will more than likely return to its normal level."

B) "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein? A) "Your neighbor probably has higher amounts of good cholesterol (HDL) as well." B) "You more than likely have small, dense type of 'bad cholesterol' (LDL)." C) "Your neighbor has larger 'bad cholesterol' particles that can move into blood vessels but park in joints/tendons." D) "You must have a genetic predisposition to having clogged arteries."

B) "You more than likely have small, dense type of 'bad cholesterol' (LDL)."

A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the client's increased blood pressure? A) Increased levels of adrenocortical hormones B) Activation of the renin-angiotensin-aldosterone mechanism C) Increased sympathetic stimulation by the autonomic nervous system (ANS) D) Coarctation of the client's aorta

B) Activation of the renin-angiotensin-aldosterone mechanism

Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: A) Edema B) Calf pain C) Varicosities D) Strong pulse

B) Calf pain

A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications? A) Peripheral edema in lower legs from renal disease B) Crackles in bilateral lung bases caused by left-sided heart failure C) Ascites due to liver damage D) Confusion due to atherosclerosis of the carotid arteries

B) Crackles in bilateral lung bases caused by left-sided heart failure

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo: A) Surgery to remove the saphenous vein B) Percutaneous transluminal angioplasty and stent placement C) Injection of a potent anticoagulant into lower leg veins D) Whirlpool therapy with tight wrapping of lower legs immediately following

B) Percutaneous transluminal angioplasty and stent placement

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? A) "I've starting going to the gym before work three times a week." B) "I'm trying to cut back on the amount of salt that I cook with and add to my food." C) "I'm resolving to eat organic foods from now on and to drink a lot more water." D) "I'm planning to lose 15 pounds before the end of this year."

C) "I'm resolving to eat organic foods from now on and to drink a lot more water."

A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? A) "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." B) "That's true, but it's an indicator that you're not taking very good care of yourself." C) "You may not sense any problems, but it really increases your risk of heart disease and stroke." D) "You're right, but it's still worthwhile to monitor it in case you do develop problems."

C) "You may not sense any problems, but it really increases your risk of heart disease and stroke."

Because of its location, the presence of an abdominal aortic aneurysm may first be manifested as: A) Constipation B) Indigestion C) A pulsating mass D) Midabdominal pain

C) A pulsating mass

Which of the following clients should most likely be assessed for orthostatic hypotension? A) A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics B) A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in her ankles C) An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom D) A 42-year-old client who has a history of poorly controlled type 1 diabetes

C) An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom

A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately? A) Actions of the renin-angiotensin-aldosterone system B) Release of antidiuretic hormone (vasopressin) by the posterior pituitary C) Renal monitoring and adjustment of extracellular fluid volume D) Integration and modulation of the autonomic nervous system (ANS)

C) Renal monitoring and adjustment of extracellular fluid volume

A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" Which of the following is the best response? A) "Nothing to worry about. We all develop this as we age." B) "We better order a CT scan. It might be due to a blood clot in your radial artery." C) "This sounds like an inflammation in the lining of your veins. You need to take some NSAIDs." D) "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen."

D) "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen."

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client? A) Analgesics and use of a pneumatic compression device B) Massage followed by vascular surgery C) Frequent ambulation and the use of compression stockings D) Anticoagulation therapy and elevation of the leg

D) Anticoagulation therapy and elevation of the leg

The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of: A) Stasis ulcerations B) Arterial insufficiency C) Primary varicose veins D) Deep vein thrombosis

D) Deep vein thrombosis

In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis? A) Necrotizing granulomatous B) Tissue necrosis C) Mononuclear cells D) Immune-mediated inflammation

D) Immune-mediated inflammation