Chapter 30: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation, Chapter 31: Assessment and Management of Patients With Hypertension, Chapter 32: Assessment of Hematologic Function and Treatment Modali...

Hematocrit

Percentage of total blood volume consisting of RBCs

Absolute neutrophil count

A calculation of the number of circulating neutrophils, derived from the total WBCs and the percentage of neutrophils counted in a microscope's visual field

Myeloid

Pertaining to non-lymphoid blood cells that differentiate into RBCs, platelets, macrophages, mast cells, and various WBCs

Poikilocytosis

Variation in shape of RBCs

Erythrocyte

Carries hemoglobin to provide oxygen to tissues; average lifespan is 120 days

Basophil

Contains histamine; integral part of hypersensitivity reactions

Monocyte

Enters tissue as macrophage; highly phagocytic, especially against fungus; immune surveillance

Neutrophil

Essential in preventing or limiting bacterial infection via phagocytosis

Thrombocyte

Fragment of megakaryocyte; provides basis for coagulation to occur; maintains hemostasis; average lifespan is 10 days

Granulocyte

Granulated WBC (neutrophil, eosinophil, basophil); sometimes used synonymously with neutrophil

Nucleated RBC

Immature form of RBC; portion of nucleus remains within RBC

Natural killer cells

Immune cells that accumulate in lymphoid tissue that are potent killers of virus-infected and cancer cells

Left shift, or shift to the left

Increased release of immature forms of WBCs from the bone marrow in response to need

Lymphocyte

Integral component of immune system

Hemostasis

Intricate balance between clot formation & dissolution

Eosinophil

Involved in allergic reactions (neutralizes histamine); digests foreign proteins

Hemoglobin

Iron-containing protein of RBC that delivers O2 to tissues

T lymphocyte

Responsible for cell-mediated immunity; recognizes material as "foreign" (surveillance system)

B lymphocytes

Responsible for humoral immunity; many mature into plasma cells to form antibodies

Plasma cell

Secretes immunoglobulin (antibody); most mature form of B lymphocytes

Reticulocytes

Slightly immature RBCs, usually only 1% of total circulating RBCs

Band cell

Slightly immature neutrophil

D-dimer

Test to measure fibrin breakdown; considered more specific than fibrin degradation products in the diagnosis of disseminated intravascular coagulation

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? a) "Sit quietly for 5 minutes prior to taking blood pressure." b) "Be sure the forearm is well supported above heart level while taking blood pressure." c) "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." d) "Sit with legs crossed when taking your blood pressure."

a) "Sit quietly for 5 minutes prior to taking blood pressure." Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffiene for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure.

A patient is being evaluated for a diagnosis of chronic myeloid leukemia (CML). The nurse understands that a diagnostic indicator is: a) A leukocyte count >100,000/mm3. b) Lymphadenopathy. c) Increased number of blast cells. d) An enlarged liver.

a) A leukocyte count >100,000/mm3. Although there is an increase in the production of blast cells, and the patient may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic. Lymphadenopathy is rare.

A patient with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause this distressing symptom? (Select all that apply.) a) Alcohol consumption b) Allergic reaction to the red blood cell increase c) Temperature change d) Exposure to water of any temperature e) Aspirin

a) Alcohol consumption c) Temperature change d) Exposure to water of any temperature Pruritus is very common, occurring in up to 70% of patients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water.

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? a) B12 b) Thiamine c) Folate d) Iron

a) B12 The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).

A nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all answers that apply. a) Encourage the client to take deep breaths every 4 hours while awake. b) Place fresh flowers on a shelf on the opposite wall from the client. c) Auscultate lung sounds every shift and prn. d) Assess skin and mucus membranes every shift. e) Provide oral hygiene once daily.

a) Encourage the client to take deep breaths every 4 hours while awake. c) Auscultate lung sounds every shift and prn. d) Assess skin and mucus membranes every shift. Interventions for risk for infection include assessing skin and mucus membranes every shift, auscultating lung sounds every shift and prn, and encouraging deep breaths every 4 hours while the client is awake. No fresh flowers are allowed in the room because of germs found in stagnant water. Oral hygiene should be provided after meals and every 4 hours while the client is awake.

A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? a) Phlebotomy b) Blood transfusions c) Radiation d) Chelation therapy

a) Phlebotomy The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.

A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0 ?l, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. He has a single lumen central venous catheter in place and the physician has ordered the nurse to administer imipenem cilastatin (Primaxin) 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B (Fungizone) 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products? a) Platelets, imipenem cilastatin, amphotericin B, packed RBCs b) Packed RBCs, platelets, imipenem cilastatin, amphotericin B c) Amphotericin B, imipenem cilastatin, platelets, packed RBCs d) Packed RBCs, amphotericin B, imipenem cilastatin, platelets

a) Platelets, imipenem cilastatin, amphotericin B, packed RBCs Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts him at risk for spontaneous hemorrhage, the most immediate and serious risk he faces. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, he's currently asymptomatic. The absence of clinical manifestations makes his need for a transfusion less urgent.

The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) a) Sleep with the foot of the bed elevated about 6 inches. b) Sit as much as possible to rest the valves in the legs. c) Avoid constricting garments. d) Sit on the side of the bed and dangle the feet. e) Elevate the legs above the heart level for 30 minutes every 2 hours.

a) Sleep with the foot of the bed elevated about 6 inches. c) Avoid constricting garments. e) Elevate the legs above the heart level for 30 minutes every 2 hours. Elevating the legs decreases edema, promotes venous return, and provides symptomatic relief. The legs should be elevated frequently throughout the day (at least 15 to 20 minutes four times daily). At night, the patient should sleep with the foot of the bed elevated about 15 cm (6 inches). Prolonged sitting or standing in one position is detrimental; walking should be encouraged. When sitting, the patient should avoid placing pressure on the popliteal spaces, as occurs when crossing the legs or sitting with the legs dangling over the side of the bed. Constricting garments, especially socks that are too tight at the top or that leave marks on the skin, should be avoided.

Which of the following is the hallmark of polycythemia vera (PV)? a) Splenomegaly b) Headache c) Ruddy complexion d) Blurred vision

a) Splenomegaly Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, paresthesias, and blurred vision).

Which of the following are complications related to polycythemia vera (PV)? Select all that apply. a) Ulcers b) CVA c) MI d) Splenomegaly e) Hematuria

a) Ulcers b) CVA c) MI e) Hematuria Patients with PV are at increased risk for thromboses resulting in a CVA or myocardial infarction. Bleeding can be significant and can occur in the form of nosebleeds, ulcers, frank gastrointestinal bleeding, and intracranial hemorrhage. Splenomegaly is a clinical manifestation of PV, not a complication.

Which assessment findings support the client's diagnosis of AML (acute myeloid leukemia)? Select all that apply. a) Weakness and fatigue b) Enlarged heart c) Enlarged lymph nodes d) Bone pain e) Petechiae

a) Weakness and fatigue c) Enlarged lymph nodes d) Bone pain e) Petechiae Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: a) forcing blood into the deep venous system. b) providing warmth to the extremity. c) encouraging ambulation to prevent pooling of blood. d) elevating the extremity to prevent pooling of blood.

a) forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Are you having chest pain or shortness of breath?" b) "Have you taken your prescribed Catapres today?" c) "Did you take any medication for your headache?" d) "Do you have a dry mouth or nasal congestion?"

b) "Have you taken your prescribed Catapres today?" The nurse must ask if the patient has taken his prescribed Catapres. Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of Catapres is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire if the patient has taken his prescribed HTN medication given the patient's severely elevated BP.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." b) "I will receive parenteral vitamin B12 therapy for the rest of my life." c) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." d) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

b) "I will receive parenteral vitamin B12 therapy for the rest of my life." Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: a) 2.5 to 3.0 times the baseline control. b) 1.5 to 2.5 times the baseline control. c) 4.5 times the baseline control. d) 3.5 times the baseline control.

b) 1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

According to the DASH diet, how many servings of vegetables should a person consume per day? a) 7 or 8 b) 4 or 5 c) 2 or fewer d) 2 or 3

b) 4 or 5 Four or five servings of vegetables are recommended in the DASH diet.

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? a) A 24-year-old female taking oral contraceptives b) A 72-year-old patient with a history of cancer c) A 40-year-old patient with a history of hypertension d) A 52-year-old patient with acute kidney injury

b) A 72-year-old patient with a history of cancer Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.

Following bone marrow aspiration of a 19-year-old client, analysis reveals more than 20% immature blast cells. Platelet counts are 9000/mm³. What nursing interventions should the nurse employ for the care of this client? Select all answers that apply. a) Recommend taking ibuprofen for mild aches and pains. b) Administer prescribed docusate (Colace) daily. c) Assess for mental state changes. d) Apply pressure to venipuncture sites for 1 to 2 minutes. e) Discuss the withholding of oral contraceptives.

b) Administer prescribed docusate (Colace) daily. c) Assess for mental state changes. The client has leukemia with immature blast cells and an extremely low platelet count. The client is at increased risk for bleeding. Interventions that would address bleeding include assessing for mental status changes (because bleeding could occur in the brain) and administering stool softeners to prevent constipation (which would increase the risk of bleeding from the rectum). Oral contraceptives would be administered to induce amenorrhea. Ibuprofen would be avoided because this medication inhibits platelet function. The nurse is to apply pressure to venipuncture sites for 5 minutes.

A client is receiving chemotherapy for acute myeloid leukemia and has poor nutritional intake. The first action of the nurse is to a) Provide mouth care before each meal. b) Ask, "Are you experiencing nausea?" c) Caution the client to chew carefully after administration of the prescribed lidocaine (Xylocaine Viscous). d) Provide nutritional supplements in addition to a diet that has a soft texture and moderate temperature.

b) Ask, "Are you experiencing nausea?" All these options are things the nurse can do to assist the client to obtain better nutrition. The nurse first needs to assess the reason for poor nutritional intake. It could be because of nausea, in which case the nurse would implement interventions to address the client's nausea.

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. a) Gradual muscle paralysis b) Bone pain in the back of the ribs c) Debilitating fatigue d) Severe thrombocytopenia

b) Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; patients may report that they have less pain on awakening but the pain intensity increases during the day.

Which of the following is a characteristic of an arterial ulcer? a) Brawny edema b) Border regular and well demarcated c) Ankle-brachial index (ABI) > 0.90 d) Edema may be severe

b) Border regular and well demarcated Characteristics of an arterial ulcer include a border that is regular and demarcated. Brawny edema, ABI > 0.90, and edema that may be severe are characteristics of a venous ulcer.

A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? a) Polycythemia vera b) Decreased serum protein c) Increased urinary protein d) Decreased calcium level

b) Decreased serum protein A characteristic finding in multiple myeloma is protein in the urine. Other laboratory findings include increased serum protein, hypercalcemia, anemia, and hyperuricemia. Polycythemia vera is not found in multiple myeloma.

A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, the nurse now assesses for a) Hair loss b) Diarrheal stools c) Adventitous lung sounds d) Laryngeal edema

b) Diarrheal stools Side effects of radiation therapy are limited to the area being irradiated. Clients who have abdominal radiation therapy may experience diarrhoea. If the lesions were in the upper chest, then the client may experience adventitious lung sounds or laryngeal oedema as side effects. Hair loss is associated more with chemotherapy than radiation therapy.

The thalassemias are a group of hereditary anemias characterized by which of the following? Select all that apply. a) Thrombocytopenia b) Hypochromia c) Hemolysis d) Anemia e) Extreme microcytosis

b) Hypochromia c) Hemolysis d) Anemia e) Extreme microcytosis The thalassemias are a group of hereditary anemias characterized by hypochromia, extreme microcytosis, destruction of blood elements (hemolysis), and variable degrees of anemia. Thrombocytopenia is not associated with thalassemias.

A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? a) Decreased serum protein b) Increased urinary protein c) Polycythemia vera d) Decreased calcium level

b) Increased urinary protein A characteristic finding in multiple myeloma is protein in the urine. Other laboratory findings include increased serum protein, hypercalcemia, anemia, and hyperuricemia. Polycythemia vera is not found in multiple myeloma.

A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness? a) Blood urea nitrogen (BUN) and creatinine levels b) Leukocyte and platelet count c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels d) Hemoglobin and hematocrit

b) Leukocyte and platelet count Hydroxyurea is often used in patients with primary myelofibrosis to control high leukocyte and platelet counts and to reduce the size of the spleen.

What type of cancer is the most common type of secondary malignancy in patients with Hodgkin's disease? a) Breast b) Lung c) Colon d) Bone

b) Lung Lung cancer is the most common type of secondary malignancy in patients with Hodgkin's disease, particularly following combination chemotherapy and radiation. Breast, colon, and bone are not the most common type of secondary malignancy.

A patient has completed induction therapy and has diarrhoea and severe mucositis. What is the appropriate nursing goal? a) Place client in reverse isolation. b) Maintain nutrition. c) Address issues of negative body image. d) Administer pain medication.

b) Maintain nutrition. Maintaining nutrition is the most important goal after induction therapy because the patient experiences severe diarrhea and can easily become nutritionally deficient as well as develop fluid and electrolyte imbalance. The patient is most likely not in pain at this point, and this is an intervention not a goal.

A pregnant woman is hospitalized as the result of sickle-cell crisis. A finding that indicates the outcome has been achieved for this client is that the client a) Exhibits a temperature less than 100.3°F b) Reports joint pain less than 3 on a scale of 0 to 10 c) Describes the importance of staying cool d) Takes hydroxyurea (Hydrea) during her pregnancy

b) Reports joint pain less than 3 on a scale of 0 to 10 An expected outcome for a client experiencing a sickle-cell crisis is control of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm.

Jeremiah, a 10-year-old boy with hemophilia, is a patient on the pediatric unit where you practice nursing. Jeremiah was admitted to your floor via the ED after sustaining an injury while playing outdoors with friends. Initially, he presented with severe bleeding but has since stabilized. Which of the following interventions will the nurse include in her care plan for Jeremiah? Select all that apply. a) Obtain an oral temperature to ensure accuracy. b) Support painful joints on pillows. c) Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals. d) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

b) Support painful joints on pillows. c) Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals. d) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Interventions are implemented to reduce pain and discomfort and to prevent further bleeding episodes. NSAIDs and aspirin are eliminated because these drugs can increase bleeding tendencies. The nurse takes the temperature over the temporal artery or tympanically to avoid oral or rectal injuries and checks the urine and stools for signs of bleeding.

A patient with AML has pale mucous membranes and bruises on his legs. What is the primary nursing intervention? a) Assess the patient's pulses and blood pressure. b) Check the patient's history. c) Assess the patient's hemoglobin and platelets. d) Assess the patient's skin.

c) Assess the patient's hemoglobin and platelets. Patients with AML may develop pallor from anemia and bleeding tendencies from low platelet counts. Assessing the patient's hemoglobin and platelets will help to determine if this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? a) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." b) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease." c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." d) "The older I get the higher my risk for peripheral arterial disease gets."

c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

When monitoring a patient who has hypertension and chronic kidney disease, the target pressure for this individual should be less than which blood pressure reading? a) 120/70 mm Hg b) 110/60 mm Hg c) 130/80 mm Hg d) 140/90 mm Hg

c) 130/80 mm Hg For individuals with diabetes or chronic kidney disease, JNC 7 specifies a target pressure of less than 130/80 mm Hg.

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)? a) Idarubicin b) Imatinib c) Allogeneic stem cell transplant d) Cytarabine

c) Allogeneic stem cell transplant Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).

A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm? a) Saccular b) False c) Anastomotic d) Dissecting

c) Anastomotic An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? a) Talk to the family about not visiting so the client can obtain rest. b) Provide sedentary activities only, such as watching television. c) Assist the client to sit in a chair for meals. d) Have the client maintain complete bedrest.

c) Assist the client to sit in a chair for meals. Fatigue is a common symptom with clients who have leukemia. Despite the fatigue, clients still need to maintain some physical activity. An example of physical activity is having the client sit in a chair for meals. The nurse does not want to encourage complete bedrest or sedentary activities, such as watching television, due to possible deconditioning. The nurse has not discussed with the client about limiting family visits. The client may want some family to visit.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? a) Oral b) Subcutaneous (subQ) c) I.M. d) I.V.

c) I.M. A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

A nurse assesses a patient who has been diagnosed with DIC. Which of the following indicators are consistent with this diagnosis? Select all that apply. a) Capillary fill time <3 seconds b) Polyuria c) Increased blood urea nitrogen (BUN) and creatinine d) Cyanosis in the extremities e) Dyspnea and hypoxia f) Increased breath sounds

c) Increased blood urea nitrogen (BUN) and creatinine d) Cyanosis in the extremities e) Dyspnea and hypoxia Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased. Refer to Table 20-4 in the text.

A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient? a) Fatigue related to decreased hemoglobin and hematocrit b) Risk for falls related to complaints of dizziness c) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit d) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients

c) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? a) Hemolytic anemia b) Leukemia c) Multiple myeloma d) Polycythemia vera

c) Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

You are caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? a) Osteolytic activating factor weakens bones producing fractures. b) Osteopathic tumors destroy bone causing fractures. c) Osteoclasts break down bone cells so pathologic fractures occur. d) Osteosarcomas form producing pathologic fractures.

c) Osteoclasts break down bone cells so pathologic fractures occur. The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This in turn causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a 'punched-out' or 'honeycombed' appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. Options A, C, and D are distractors for this question.

The hospitalized client is experiencing gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse a) Teaches the client to vigorously floss the teeth to prevent infections b) Requests a prescription of diphenoxylate/atropine (Lomotil) for loose stools c) Performs a neurologic assessment with vital signs d) Uses contact precautions with this client

c) Performs a neurologic assessment with vital signs With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate/atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a) Platelet count, blood glucose levels, and white blood cell (WBC) count b) Thrombin time, calcium levels, and potassium levels c) Platelet count, prothrombin time, and partial thromboplastin time d) Fibrinogen level, WBC, and platelet count

c) Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.

You are caring for a client with thalassemia who is being transfused. What is your role during a transfusion? a) To administer vitamin B12 injections b) To assess for enlargement and tenderness over the liver and spleen c) To closely monitor the rate of administration d) To instruct the client to rest immediately if chest pain develops

c) To closely monitor the rate of administration In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which of the following would not be included in the client's discharge instructions? a) Plan for frequent periods of rest. b) Avoid contact with family/friends who are sick. c) Use a disposable razor when shaving. d) Encourage frequent handwashing.

c) Use a disposable razor when shaving. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Avoiding contact with people who are sick reduces the risk of acquiring an infection. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? a) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." b) "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." c) "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." d) "Flex your calf muscles, avoid alcohol, and change positions slowly."

d) "Flex your calf muscles, avoid alcohol, and change positions slowly." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

A client with peripheral arterial disease asks the nurse about using a heating pad to warm the feet. The nurse's best response is which of the following? a) "It is better to soak your feet in hot water as long as the water temperature is below 110 degrees F." b) "A heating pad to your feet is a good idea because it increases the metabolic rate." c) "A heating pad to your feet is fine as long as the temperature stays below 105 degrees F." d) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet."

d) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." It is safer to apply a heating pad to the abdomen, causing a reflex vasodilation in the extremities. Heat may be applied directly to ischemic extremities; however, the temperature of the heating source must not exceed body temperature. Excess heat may increase the metabolic rate of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery.

A patient was admitted to the hospital with the following lab values: hemoglobin 5 g/dL, abnormally shaped erythrocytes, leukocyte count 2000/mm3 with hypersegmented neutrophils and a platelet count of 48,000/mm3. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that patient most likely has which of the following diagnoses? a) Thalassemia b) Sickle cell anemia c) Hemolytic anemia d) Folic acid deficiency

d) Folic acid deficiency Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4 to 5 g/dL, the leukocyte count 2,000 to 3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem? a) A hemolytic reaction to mismatched blood b) A hemolytic reaction caused by bacterial contamination of donor blood c) A hemolytic reaction to Rh-incompatible blood d) A hemolytic allergic reaction caused by an antigen reaction

d) A hemolytic allergic reaction caused by an antigen reaction Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnoea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypermagnesemia b) Hypernatremia c) Hyperkalemia d) Hypercalcemia

d) Hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

Clinical assessment of a patient with AML includes observing for signs of infection, the major cause of death for AML. The nurse should assess for indicators of: a) Neutropenia. b) Thrombocytopenia. c) Bone marrow expansion. d) Splenomegaly.

d) Splenomegaly. Acute myeloid leukemia starts inside the bone marrow and prevents the formation of white blood cells. A bone marrow analysis that shows greater than 30% of immature blast cells is indicative of an AML diagnosis.

A patient with sickle cell disease comes to the emergency department complaining of severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? a) Administer aspirin b) Administer ibuprofen c) Begin oxygen at 2 L/M d) Start an intravenous line with dextrose 5% in 0.25 normal saline

d) Start an intravenous line with dextrose 5% in 0.25 normal saline Adequate hydration is important during a painful sickling episode. Oral hydration is acceptable if the patient can maintain adequate fluid intake; IV hydration with dextrose 5% in water (D5W) or dextrose 5% in 0.25 normal saline solution (3 L/m2/24 h) may be required for a sickle crisis. Supplemental oxygen may also be needed.

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: a) to a standing position so he can urinate. b) to the bathroom. c) to the bedside commode. d) onto the bedpan.

d) onto the bedpan. A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.

Stroma

Component of the bone marrow not directly related to hematopoiesis but serves important supportive roles in this process

Blast cell

Primitive WBC

Cytokines

Proteins produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Increased abdominal and back pain b) Elevated blood pressure and rapid respirations c) Decreased pulse rate and blood pressure d) Retrosternal back pain radiating to the left arm

a) Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." b) "If you feel pain during the walk, keep walking until the end of the hallway is reached." c) "As soon as you feel pain, we will go back and elevate your legs." d) "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

a) "Walk to the point of pain, rest until the pain subsides, then resume ambulation." The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? a) 1500 b) 1115 c) 1600 d) 1530

a) 1500 Administration time for PRBCs should not exceed 4 hours because of the increased risk of bacterial proliferation. For the first 15 minutes, the transfusion should be run slowly- no faster than 5 mL/min.

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate? a) Administer the ordered paracetamol 500 mg po b) Notify the physician c) Administer the ordered aspirin (ASA) 325 mg po d) Reposition the patient to a high Fowler's position and continue to monitor the pain

a) Administer the ordered paracetamol 500 mg po After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most patients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., paracetamol) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

A patient is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in patient teaching prior to discharge? a) Application of graduated compression stockings b) Methods of keeping the wound area dry c) Adequate carbohydrate intake d) Prophylactic antibiotic therapy

a) Application of graduated compression stockings Graduated compression stockings usually are prescribed for patients with venous insufficiency. The amount of pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? a) Computed tomography angiography (CTA) b) Magnetic resonance angiography (MRA) c) Doppler ultrasound d) Angiography

a) Computed tomography angiography (CTA) A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion.

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Diminished or absent pulses b) Aching, cramping pain c) Pulses are present, may be difficult to palpate d) Superficial ulcer

a) Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? a) Disposing of the blood container and tubing in biohazard waste. b) Notifying the blood bank of the reaction. c) Documenting the reaction in the client's medical record. d) Informing the client to leave a urine sample after the client's next void.

a) Disposing of the blood container and tubing in biohazard waste. The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction. A urine sample is collected as soon as possible to detect hemoglobin in the urine. Documenting the client's reaction in the medical record is an appropriate action.

A client receiving a blood transfusion complains of shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the healthcare provider? a) Ensure there is an oxygen delivery device at the bedside. b) Place the client in a recumbent position with legs elevated. c) Remove the intravenous line. d) Administer prescribed PRN anti-anxiety agent.

a) Ensure there is an oxygen delivery device at the bedside. The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. d) Increasing the force of cardiac output to overcome peripheral resistance.

a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. Increasing the force of cardiac output would only increase peripheral resistance, thus increasing blood pressure. The other actions would all help regulate hypertension.

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Sodium reduction b) Adopting the DASH approach to eating c) Weight reduction d) Physical activity

c) Weight reduction Although all approaches are effective modifications to manage hypertension, weight reduction can result in a 5 to 20 mm Hg/10 kg lowering of blood pressure readings.

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, the nurse should do which of the following? a) Infuse each unit over 30-60 minutes per client tolerance. b) Flush the intravenous line with a liter of saline between units. c) Monitor vital signs closely before transfusion and once per shift. d) Administer each unit slowly over 3-4 hours.

a) Infuse each unit over 30-60 minutes per client tolerance. Infuse each unit of FFP over 30-60 minutes per client tolerance. Platelet clumping will occur if administered too slowly. Vital signs should be monitored before and throughout the transfusion, not just once per shift. A liter of saline is too large an amount to flush the intravenous line and would contribute to fluid overload.

A 67-year-old client at the free clinic where you practice nursing has a history of seizures and presents with severe fatigue, frequent headaches, and a sore and beefy red tongue. Which of the following could be causing her current condition? Select all that apply. a) Intestinal disorders b) Lack of vitamin B c) Lack of meat consumption d) Alcoholism

a) Intestinal disorders d) Alcoholism Older adults and clients with alcoholism, intestinal disorders that affect food absorption, malignant disorders, and chronic illnesses often have a folic acid deficiency because of poor nutrition.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Keeping the legs in a neutral or dependent position b) Use of antiembolytic stockings c) Elevation of the legs above the heart d) Application of ace wraps from the toe to below the knees

a) Keeping the legs in a neutral or dependent position Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? a) Maintain adequate dietary intake of potassium b) Stop alcohol intake c) Limit aerobic physical activity to 15 minutes, three times per week d) Reduce smoking to no more than four cigarettes per day

a) Maintain adequate dietary intake of potassium In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet the daily need for potassium. The patient should be guided to stop smoking. The general guideline is to advise the patient to increase aerobic activity to 30 to 45 minutes most days of the week. In general, alcohol intake should be limited to no more than 1 oz of ethanol per day.

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? a) Older adults have impaired cardiovascular reflexes. b) Older adults require large doses of these medications to control their blood pressure. c) Older adults have trouble remembering to measure their blood pressure at home. d) These medications often cause rebound hypertension.

a) Older adults have impaired cardiovascular reflexes. Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. Older adults have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. Older adults are more sensitive to the effects of these medications and so usually require lower doses. Most older clients can remember very well to measure their blood pressure at home.

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Renal dysfunction resulting from atherosclerosis b) Emphysema related to poor gas exchange c) Hyperglycemia resulting from insulin receptor resistance d) Anemia resulting from bone marrow suppression

a) Renal dysfunction resulting from atherosclerosis The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Enteric fistula c) Graft occlusion d) Hemorrhage and shock

a) Renal failure Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include? a) Seven to eight whole grain products per day b) Seven to eight fruits per day c) Three to four regular dairy foods per day d) Four to five servings of meat, fish, or poultry per day

a) Seven to eight whole grain products per day The DASH diet is based on 2,000 calories per day and includes: 7 to 8 whole servings of whole-grain products per day 4 to 5 servings of vegetables per day 4 to 5 servings of fruits per day 2 to 3 servings of low-fat or fat-free dairy foods per day 2 or fewer servings of meat, fish, or poultry per day 4 to 5 servings of nuts, seeds, and dry beans per week.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) a) Sharp pain that may be relieved by the elevation of the extremity b) Full superficial veins c) Initial absence of edema d) Cool and cyanotic skin e) Brisk capillary refill of the toes

a) Sharp pain that may be relieved by the elevation of the extremity b) Full superficial veins d) Cool and cyanotic skin Postthrombotic syndrome is characterized by chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis. The patient may notice the symptoms less in the morning and more in the evening. Obstruction or poor calf muscle pumping in addition to valvular reflux must be present for the development of severe postthrombotic syndrome and stasis ulcers. Superficial veins may be dilated.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a) left calf circumference 1" (2.5 cm) larger than the right. b) a decrease in the left pedal pulse. c) loss of hair on the lower portion of the left leg. d) pallor and coolness of the left foot.

a) left calf circumference 1" (2.5 cm) larger than the right. Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client? a) Neupogen is taken intramuscularly on a weekly basis. b) Assist the client in identifying appropriate subcutaneous injection sites. c) Do not eat before arriving to receive the intravenous administration of Neupogen. d) Take this medication by mouth at bedtime each night.

b) Assist the client in identifying appropriate subcutaneous injection sites. Neupogen is administered subcutaneously on a daily basis.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? a) Purplish stools b) Bluish urine c) Redness of the upper part of the feet d) Coldness of the soles

b) Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action? a) Tell the client that 2 units of blood will be needed. b) Explain the time frame needed for autologous donation. c) Provide the client with a list of the nearest donation centers. d) Remind the client to take supplemental iron before donation.

b) Explain the time frame needed for autologous donation. Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? a) Monitor the partial thromboplastin time (PTT). b) Prepare to administer protamine sulfate. c) Decrease the heparin infusion rate. d) Start an I.V. infusion of dextrose 5% in water (D5W).

b) Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary 10 mm Hg or more between arms. b) Pressures should not differ more than 5 mm Hg between arms. c) Pressures must be equal in both arms. d) Pressures may vary, with the higher pressure found in the left arm.

b) Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant. (

A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a) Reduce the blood pressure by 50% within the first hour of treatment. b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure to about 140/80 mm Hg.

b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate? a) Sclerotherapy is used to cure varicose veins. b) The severity of discomfort isn't related to the size of varicosities. c) Primary varicose veins are caused by deep vein thrombosis (DVT) and inflammation. d) Varicose veins are more common in men than in women.

b) The severity of discomfort isn't related to the size of varicosities. Clients with varicose veins commonly complain of aching, heaviness, itching, moderate swelling, and unsightly appearance of the legs. However, the severity of discomfort is hard to assess and seems unrelated to the size of varicosities. Varicose veins are more common in women than in men. Primary varicose veins typically result from a congenital or familial predisposition that makes the vein wall less elastic; secondary varicosities occur when trauma, obstruction, DVT, or inflammation damages valves. Sclerotherapy, in which a sclerosing agent is injected into a vein, is used to treat varicose veins; it doesn't cure them.

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To stop smoking and increase physical activity to 30 minutes/day most days of the week b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less d) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minuetes per day most days of the week.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Neither venous nor arterial insufficiency b) Venous insufficiency c) Arterial insufficiency d) Trauma

b) Venous insufficiency Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

A nurse providing education to a community group about hypertension is reviewing appropriate lifestyle modifications. Which of the following are among changes that can help prevent and control hypertension? Choose all that apply. a) Increased intake of dietary sodium b) Weight reduction c) Increased physical activity d) Increased intake of dietary protein e) Substitution of low-fat for whole dairy products in diet

b) Weight reduction c) Increased physical activity e) Substitution of low-fat for whole dairy products in diet Lifestyle modifications to prevent and manage hypertension include weight reduction, adopting the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium reduction, physical activity, and moderation of alcohol consumption.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) place a heating pad around the affected calf. b) keep the affected leg level or slightly dependent. c) shave the affected leg in anticipation of surgery. d) elevate the affected leg as high as possible.

b) keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

When teaching a patient with iron deficiency anemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a) Fruits high in vitamin C, such as organs and grapefruits b) Berries and orange vegetables c) Beans, dried fruits, and leafy green vegetables d) Dairy products

c) Beans, dried fruits, and leafy green vegetables Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

Which of the following observations regarding ulcer formation on the patient's lower extremity indicates that the ulcer is a result of venous insufficiency? a) Is deep, involving the joint space b) Base is pale to black c) Border of the ulcer is irregular d) Is very painful to the patient, even though superficial

c) Border of the ulcer is irregular The border of an ulcer caused by arterial insufficiency is circular. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color. Venous insufficiency ulcers are usually superficial.

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? a) Kidneys and autonomic nervous system b) Brain and sympathetic nervous system c) Heart and blood vessels d) Lung and arteries

c) Heart and blood vessels Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP= CO (cardiac output)× PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? a) Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. b) Slow the transfusion and monitor the client closely. c) Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank. d) Stop the transfusion, notify the blood bank, and administer antihistamines.

c) Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank. When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the physician and blood bank should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentation, and monitoring and treating for shock. Because they can cause red blood cell hemolysis, dextrose solutions shouldn't be infused with blood products. Antihistamines are administered for a mild allergic reaction, not a hemolytic reaction.

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? a) Within 12 hours b) Within the first 24 hours c) In 3 to 5 days d) In 2 days

c) In 3 to 5 days Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) The taste buds never adapt to decreased salt intake. b) A person with hypertension should never consume alcohol. c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. d) There is usually no need to change alcohol consumption for clients with hypertension.

c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake.

A 44-year-old client has a history of hypertension. As her nurse, you engage her in client education to make her aware of structures that regulate arterial pressure. Which of the following structures is a component of that process? a) Parasympathetic nervous system b) Lungs c) Kidneys d) Limbic system

c) Kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statements except: a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. d) Maintain a normal body mass index of about 24.

c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week.

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? a) Blood pressure every 2 hours b) Ankle-arm indices every 12 hours c) Peripheral pulses every 15 minutes following surgery d) Color of the leg every 4 hours

c) Peripheral pulses every 15 minutes following surgery The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable.

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a) Rejection of foreign tissue b) Production of antibodies called immunoglobulin (Ig) c) Phagocytosis d) Destruction of tumor cells

c) Phagocytosis The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? a) Stage 1 hypertension b) Normal c) Prehypertension d) Stage 2 hypertension

c) Prehypertension A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.

Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Diabetes b) Hyperlipidemia c) Stroke d) Heart failure e) Retinal damage

c) Stroke d) Heart failure e) Retinal damage Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye. Hyperlipidemia and diabetes are risk factors for development of hypertension.

A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause? a) The patient is experiencing normal sensations associated with this condition. b) The aneurysm has become obstructed. c) The aneurysm may be preparing to rupture. d) The patient is experiencing inflammation of the aneurysm.

c) The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension? a) Pheochromocytoma b) Dissecting aortic aneurysm c) Untreated hypertension d) Pyelonephritis

c) Untreated hypertension Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: a) a 30-second filling time for the veins. b) no rubor for 10 seconds after the maneuver. c) dependent pallor. d) elevational rubor.

c) dependent pallor. If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "Reduce your level of exercise." b) "Consider cutting down on your smoking." c) "See the physician if complications occur." d) "Practice meticulous foot care."

d) "Practice meticulous foot care." Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

A nurse is providing education about maintaining tissue integrity to a client with peripheral arterial disease. Which of the following statements by the client indicates a need for clarification? a) "It is important to apply sunscreen to the top of my feet when wearing sandals." b) "I can use lamb's wool between my toes if necessary." c) "I should apply powder daily because my feet perspire." d) "Shoes made of synthetic material are best for my feet."

d) "Shoes made of synthetic material are best for my feet." The client should wear leather shoes with an extra-depth toebox. Synthetic shoes do not allow air to circulate.

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure? a) Pack the wound with half-inch sterile gauze b) Elevate the head of the bed to 45 degrees c) Administer a topical analgesic to control pain at the site d) Apply pressure over the site for 5-7 minutes

d) Apply pressure over the site for 5-7 minutes Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

A client reports feeling tired, cold, and short of breath at times. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order? a) Chest radiograph b) Antibiotic c) ECG d) CBC

d) CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased.

The treatment goal for those with stage 2 hypertension (hypertension with compelling indications or complications) includes lifestyle modifications and multiple drug therapies. Thiazide diuretics are part of this treatment approach for most complications except for: a) Diabetes mellitus b) Heart failure c) Recurrent stroke prevention d) Chronic kidney disease

d) Chronic kidney disease Since thiazides are diuretics, they would not be the drugs of choice for patients with chronic kidney disease, in whom renal function is already compromised.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Higher than normal blood pressure and falling hematocrit b) Constant, intense headache and falling blood pressure c) Slow heart rate and high blood pressure d) Constant, intense back pain and falling blood pressure

d) Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? a) Cimetidine (Tagamet) b) Metoprolol (Lopressor) c) Hydrocortisone (Solu-Cortef) d) Epinephrine

d) Epinephrine Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? a) Secondary hypertension b) Hypertensive emergency c) Primary hypertension d) Hypertensive urgency

d) Hypertensive urgency Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage (Chobanian et al., 2003). Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours (Rodriguez et al., 2010).

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? a) No arterial insufficiency b) Very mild arterial insufficiency c) Tissue loss to that foot d) Moderate to severe arterial insufficiency

d) Moderate to severe arterial insufficiency Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

Aortic dissection may be mistaken for which of the following disease processes? a) Stroke b) Angina c) Pneumothorax d) Myocardial infarction (MI)

d) Myocardial infarction (MI) Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Pulmonary insufficiency c) Peripheral edema d) Stroke

d) Stroke A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Options A, B, and D are not usually consequences of untreated chronic hypertension.

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: a) Hormonal secretion. b) Independent arterial wall activity. c) The influence of circulating chemicals. d) The sympathetic nervous system.

d) The sympathetic nervous system. Stimulation of the sympathetic nervous system causes vasoconstriction thus regulating blood flow. Norepinephrine is the responsible neurotransmitter.

The most common site of aneurysm formation is in the: a) aortic arch, around the ascending and descending aorta. b) descending aorta, beyond the subclavian arteries. c) ascending aorta, around the aortic arch. d) abdominal aorta, just below the renal arteries.

d) abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: a) match the room temperature to the client's body temperature. b) maintain room temperature at 78° F (25.6° C). c) keep the client uncovered. d) keep the client warm.

d) keep the client warm. The nurse should keep the client covered and expose only the portion of the client's body that she's assessing. The nurse should also keep the client warm by maintaining his room temperature between 68° F and 74° F (20° and 23.3° C). Extreme temperatures aren't good for clients with PVD. The valves in their arteries and veins are already insufficient, and exposing them to vast changes in temperature could affect assessment findings. Keeping the client uncovered would cause him to become chilled. Matching the room temperature to the client's body temperature is inappropriate.