Chapter 16: Altered Perfusion

HDL

A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?

Cholesterol 250 mg/dL (6.47 mmol/L) and HDL 32 mg/dL (0.83 mmol/L)

A 56-year-old male client has been diagnosed with hypercholesterolemia. Which laboratory result supports this diagnosis?

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight

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.

Will prevent the conversion of angiotensin I to angiotensin II

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

see the doctor for evaluation immediately.

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

Diuretic, ACE inhibitor, beta-blocker

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure?

Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.

Raising the head of the bed to a high Fowler's position

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Endocarditis

About a week after dental cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis?

fills rapidly; compresses

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

Backflow from the left ventricle to left atrium

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?

Hypertrophic cardiomyopathy (HCM)

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?

Compensatory mechanisms

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?

Hypertrophy

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

The kidneys

The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?

Diuretics

The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated?

Action decreases metabolic demands of the heart.

ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

History of cigarette smoking and elevated blood pressure

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

Hypertension

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:

improving quality of life by relieving symptoms.

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

LDL

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?

Decreased cardiac output

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Structural heart defects

What is the primary cause of heart failure in infants and children?

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.

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?

An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom

Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?

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

Which clients would be at high risk for developing varicose veins? Select all that apply.

Client on bed rest

Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis?

Low-density lipoprotein (LDL)

Which lipoprotein is the main carrier of cholesterol?

Can be corrected or cured by surgery or specific medical treatment Accounts for 5% to 10% of hypertension cases May be caused by oral contraceptives Has an independent risk factor for obstructive sleep apnea Is most commonly caused by kidney disease

Which statements most accurately describe secondary hypertension? Select all that apply.

Vascular smooth muscle cells (SMCs)

Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?

Peripheral vascular resistance

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 physiologic process?

Valvular regurgitation

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:

Administer epinephrine (adrenaline).

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?

Increased heart rate

A health care provider is providing care for a client who developed deep vein thrombosis (DVT) and a pulmonary embolism following a period of bed rest. Which factor is the provider likely to rule out as a contributor to this sequence of events?

Stable angina

The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which diagnosis?

The client states his hand is numb.

The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.

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?

Simvastatin, an HMG-CoA reductase inhibitor or 'statin'

Which medication will likely be prescribed for a client with elevated LDL and triglyceride levels?

Troponin

Which serum biomarker is highly specific for myocardial tissue?