Chapter 30: Disorders of Blood Flow in the Systemic Circulation

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states which of the following?

- "Capillaries permit the exchange of material between the blood and interstitial fluid." Explanation:Capillaries have thin walls that permit the exchange of materials between blood and interstitial fluid. Arteries have a three-layer wall with a thick tunica media. Arterioles transport blood away from the heart and help control blood pressure. Veins have internal valves. pg. 740

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?

- "I should have my LDL monitored." Explanation:Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease their considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM. pg. 755-756

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching?

- "I'm resolving to eat organic foods from now on and to drink a lot more water." Explanation:Weight loss, exercise, and salt reduction are all useful strategies in the management of hypertension. An organic diet and increased fluid intake are not known to reduce blood pressure. pg.

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

- 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 Explanation: Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Because there are no valves in the inferior vena cava or common iliac veins, blood in the abdominal veins must be supported by the valves located in the external iliac or femoral veins. Immobility may cause DVTs (a secondary cause of varicose veins). Peritoneal dialysis has no effect on the development of varicose veins. pg. 761

The physician understands that which of the following clients is at risk for developing primary hyperlipoproteinemia?

- A client with familial hypercholesterolemia Explanation: Many types of primary hyperlipoproteinemia have a genetic basis. The LDL receptor is deficient or defective in the genetic disorder known as familial hypercholesterolemia. The other options cause secondary hyperlipoproteinemia. pg. 745

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?

- A pulsating mass in the abdomen Explanation: Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection. pg. 757

Which is an accurate statement about acute arterial occlusion?

- A quick forming arterial occlusion is more likely to cause tissue death. Explanation:Acute arterial occlusion is a sudden event that interrupts arterial flow to the affected tissues or organ. A quick forming occlusion of the artery, such as an acute arterial occlusion, causes an increase in complications and infarction rate than a slower progressive occlusion. Most acute arterial occlusions are the result of an embolus or a thrombus. pg. 754

Which of the following types of aortic aneurysms is the most common?

- Abdominal aortic Explanation: Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis. pg. 757

Select the priority of care for the medical management of a client with a dissecting aortic aneurysm.

- Administration of sodium nitroprusside and β-adrenergic blocking medications Explanation:Administration of nitroprusside and β-adrenergic blocking medications would be an expected treatment to lessen the force of systolic blood ejection from the heart. The client would be NPO for immediate surgery (not 1 week later), and the blood pressure needs to be lowered rather than elevated. pg. 759

Which of the following clients should most likely be assessed for orthostatic hypotension?

- An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom Explanation:Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension. pg.

In pregnancy, which of the following data are diagnostic for pre-eclampsia and eclampsia?

- Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Explanation:Pre-eclampsia and eclampsia are defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (≥300 in 24 hours) developing after 20 weeks of gestation. pg.

A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect?

- By decreasing vascular volume by increasing sodium and water excretion Explanation: Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing sodium and water excretion) and cardiac output. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I, and calcium channels blockers inhibit the movement of calcium into arterial smooth muscle. Common antihypertensives do not act directly on the pituitary. pg. 778

A client who stands upright but immobile for long periods at her job reports that her feet often become swollen. Which is the most likely etiology of the client's condition?

- By standing and not walking, she has not used the muscular pump to assist with venous Explanation: The skeletal muscle pump helps blood return to the heart. Each time the gastrocnemius contracts, it pushes blood back toward the heart. By standing in line all day, she did not contract her gastrocnemius enough and blood pooled in her feet, resulting in edema. This is not the venous of emboli or changes in osmotic pressure. pg. 760

The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of:

- Deep vein thrombosis Explanation: Venous insufficiency with deep vein thrombus formation is characterized by discoloration, edema, pain, tenderness, and warmth most commonly in the mid- or lower calf area of the legs. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present. pg. 763

The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that which of the following is the most common cause of this condition?

- Deep vein thrombosis (DVT) Explanation: Secondary varicose veins result from impaired blood flow in the deep venous channels. The most common cause of secondary varicose veins is DVT. Other causes include congenital or acquired AV fistulas, congenital venous malformations, and pressure on the abdominal veins caused by pregnancy or tumors. pg. 761

The nurse is assessing the electrical activity of the heart recorded on the ECG. What does the P wave represent?

- Depolarization of the sinoarterial node Explanation: The P wave represents depolarization of the sinoartrial node. The QRS complex represents the depolarization of the ventricular conduction system. The T wave represents repolarization of the ventricles and not the artium. pg. 723

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the patient to be in atrial fibrillation. Which of the following tests will the practitioner order to find the source of the emboli?

- Echocardiogram Explanation: Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fib) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart. pg. 754

A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?

- Elevation of triglycerides Explanation: In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL and minimal or modest elevation of LDL. High-calorie intake and diabetes mellitus increase the production of VLDL. pg. 745

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?

- Fibrous atheromatous plaque Explanation: The lesions associated with atherosclerosis are of three types - the fatty streak, the fibrous atheromatous plaque, and the complicated lesion. Fatty streaks are thin, flat, yellow intimal discolorations. The fibrous atheromatous plaque grows larger and proliferates into the smooth muscle. As they increase in size, they encroach on the lumen of the artery. More advanced complicated lesions contain hemorrhage, ulceration, and scar deposits and can cause thrombus formation which may occlude the vessel. pg. 748

Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?

- Fingers Explanation: Raynaud disease is a disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes. pg. 755

The client with pancreatitis is noted to have a high triglyceride count. Which medications could the practitioner initiate to decrease triglyceride level?

- Gemfibrozil Explanation: The fibrates (e.g. fenofibrate and gemfibrozil) decrease the synthesis of VLDL by the liver, but also enhance the clearance of triglycerides. Cholestyramine, a bile acid-binding resin, is used as an adjunct to statin therapy to reduce LDL and increase HDL. Simvastatin, an inhibitor of HMG CoA reductase, can reduce or block the hepatic synthesis of cholesterol. These drugs are cornerstones of LDL-reducing therapy. pg. 747

The nurse is teaching a class on reduction of cardiovascular disease. Which of the following demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?

- Going for a brisk walk with a friend and talking to him about continuing to exercise regularly Explanation: The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and transfats. Testing for al hypercholesterolemia is not a modifiable risk factor. pg. 746

Which of the following facilitates the clearance of cholesterol from the periphery (including atheromatous plaques) and transports it to the liver where it may be excreted?

- HDL Explanation: HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver where it can be excreted. Like chylomicrons, VLDLs carry their tryglycerides to fat and muscle cells, where triglycerides are removed. While most of the LDL receptors are also in the liver, the LDL molecule is degraded, causing free cholesterol to be released into the cytoplasm. pg. 744

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?

- HDL Explanation: HDL is known as the "good" cholesterol because it transports cholesterol back to the liver for metabolism. LDL, VLDL, and IDL transport cholesterol to the tissues. pg. 743

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?

- Heavy lifting Explanation: Varicose veins develop from prolonged standing and increased abdominal pressure (heavy lifting). The risk of development would greatly increase with weight gain and prolonged standing and would not be affected by bone structure. pg. 761

A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?

- High-dose corticosteroid therapy and cytotoxic immunosuppressant agents Explanation:Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins complaints of anorexia, weight loss, fever, and fatigue often accompanied by signs of organ involvement. Myalgia, arthralgia, and arthritis are common, as are peripheral neuropathies such as paresthesias, pain, and weakness. Skin lesions may also occur and are highly variable. They include reddish blue, mottled areas of discoloration of the skin of the extremities called livedo reticularis, purpura (i.e., black- and-blue discoloration from bleeding into the skin), urticaria (i.e., hives), and ulcers. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and signs of organ involvement such as hematuria and abnormal liver function test results. Diagnosis is confirmed through biopsy specimens demonstrating necrotizing vasculitis of the small and large arteries. Treatment involves use of high-dose corticosteroid therapy and often-cytotoxic immunosuppressant agents (e.g., azathioprine, cyclophosphamide). pg. 753

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?

- Hypercholesterolemia Explanation: The cause or causes of atherosclerosis have not been determined with certainty. However, epidemiologic studies have identified predisposing risk factors, which include a major risk factor of hypercholesterolemia. Other risk factors include increasing age, family history of premature coronary heart disease, and male sex. pg. 747-748

In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis?

- Immune-mediated inflammation Explanation: The two most common pathogenic mechanisms of vasculitis are direct invasion of the vascular wall by an infectious agent and immune-mediated inflammation. The most common mechanisms that initiate noninfectious vasculitis are pathological immune responses that result in endothelial activation, with subsequent vessel obstruction, and ischemia of the dependent tissue. In almost all forms of vasculitis, the triggering event initiating and driving the inflammatory process is unknown. Medium-size vessel vasculitides produce necrotic tissue damage. Large-vessel vasculitides involve mononuclear cells. Wegener granulomatosis is characterized by a triad of acute necrotizing granulomatous lesions of the upper respiratory tract (ear, nose, sinuses, and throat), necrotizing vasculitis of the affected small- to medium-sized vessels of the lungs and respiratory airways, and renal disease in the form of focal necrotizing glomerulonephritis. pg. 752

The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

- It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. Explanation:Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver. pg. 749

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?

- LDL Explanation: LDL is the main carrier of cholesterol. HDL is 50 percent protein; VLDL carries a large amount of triglycerides. IDLs are fragments of VLDLs after the triglycerides are removed and can be recycled to form VLDLs or converted to LDLs. pg. 74.

Because cholesterol is insoluble in plasma, it is mainly carried by which of the following lipoproteins?

- Low-density lipoprotein (LDL) Explanation: Although all of the lipoproteins contain cholesterol and triglycerides, LDL is the main carrier of cholesterol. pg. 743

The nurse is teaching the client with chronic venous insufficiency. Which part of the body is particularly prone to development of stasis dermatitis?

- Lower leg Explanation: The lower part of the leg is particularly prone to development of stasis dermatitis and venous ulcers. pg. 762

Which statements are true concerning deep-vein thrombosis (DVT)? Select all that apply.

- Many individuals with DVT have no symptoms. -Deep muscle tenderness is a common symptom of DVT. -Sedimentation rates are a common diagnostic test for DVTs. -Inflammation is the root cause of many of the symptoms of DVTs. Explanation:Many people with venous thrombosis are asymptomatic; as much as 50% of people with DVT are asymptomatic. Lack of signs and symptoms is probably because the vein is not totally occluded or because of collateral circulation. When present, the most common signs and symptoms of venous thrombosis are those related to the inflammatory process, including pain, swelling, and deep muscle tenderness. Fever, general malaise, and an elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. pg. 763

Which of the following individuals is at greatest risk for developing a venous thrombosis resulting from venous stasis?

- Patient on bed rest Explanation: Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperreactive blood coagulation that can also result in venous thrombosis. pg. 763

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.

- Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL Explanation:Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas, another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease. pg. 746

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:

- Percutaneous transluminal angioplasty and stent placement Explanation:Treatment includes measures directed at protection of the affected tissues and preservation of functional capacity. Percutaneous or surgical intervention is typically reserved for the client with disabling claudication or limb-threatening ischemia. Surgery (i.e., femoropopliteal bypass grafting using a section of the saphenous vein) may be indicated in severe cases. Percutaneous transluminal angioplasty and stent placement, in which a balloon catheter is inserted into the area of stenosis and the balloon inflated to increase vessel diameter, is another form of treatment. pg. 755

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes?

- Peripheral vascular resistance Explanation: The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily. pg. 885-886

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

- Pulmonary embolism Explanation: Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli. pg. 762

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?

- Pulmonary embolism Explanation: The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system. pg. 763

A female client tells the health care provider that she has recently been experiencing episodes of changes occuring in the color of her fingertips especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:

- Raynaud phenomenon Explanation: Raynaud phenomenon is seen in otherwise healthy young women, and it often is precipitated by exposure to cold or by strong emotions and usually is limited to the fingers. The ischemic phase of Raynaud phenomenon is manifested by changes in skin color that progress from pallor to cyanosis and progress to hyperemia. The other conditions do not manifest these changes. pg. 755-756

A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?

- Raynaud's disease Explanation: The symptoms of this patient represent Raynaud's disease. Frostbite would most likely have affected the feet and the hands. The others apply more to the lower extremities. pg. 756

A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?

- Sclerotherapy or surgery Explanation:Sclerotherapy, which often is used in the treatment of small residual varicosities, involves the injection of a sclerosing agent into the collapsed superficial veins to produce fibrosis of the vessel lumen. Surgical treatment consists of removing the varicosities and the incompetent perforating veins, but it is limited to persons with patent deep venous channels. Sclerotherapy produces fibrosis of the vessel lumen. There is no fibrotherapy for varicose veins. There is no Trendelenburg therapy for varicose veins. There is a Trendelenburg test that is diagnostic for primary or secondary varicose veins. pg. 762

Which one of the following organs are the two primary sites of lipoprotein synthesis?

- Small intestine and liver Explanation: There are two sites of lipoprotein synthesis—the small intestine and the liver pg. 408

A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?

- Statins Explanation: Inhibitors of HMG CoA reductase (e.g., atorvastatin, rosuvastatin, simvastatin), a key enzyme in the cholesterol biosynthetic pathway, can reduce or block the hepatic synthesis of cholesterol and are the cornerstone of low-density lipoprotein (LDL)-reducing therapy. Statins also reduce triglyceride levels and increase high-density lipoprotein (HDL) levels. Statin therapy has been shown to reduce the risk for acute coronary syndromes and stroke in secondary prevention pg. 747

The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?

- Sympathetic Explanation:A network of vasomotor nerves of the sympathetic component of the autonomic nervous system supplies the smooth muscle in the blood vessels. These nerves and circulating hormones are responsible for vasoconstriction of the vessel walls. pg. 741

A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:

- Tearing or ripping-type pain in the chest or back Explanation: A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated. pg. 759

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the:

- Temporal Explanation: Giant cell (temporal) arteritis, the most common of the large vessel vasculitides, is an acute and chronic inflammation of large to small arteries. It mainly affects arteries of the head—especially the temporal arteries—but may include the vertebral and ophthalmic arteries. The most common clinical presentations are headache and tenderness over the superficial temporal artery. pg. 753

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?

- The client must protect the entire body from cold, not just the extremities. Explanation: Treatment measures are directed toward eliminating factors that cause vasospasm. Abstinence from smoking and protection from cold are priorities. The entire body must be protected from cold, not just the extremities. Avoidance of stress and anxiety is another important factor, as they may precipitate vascular spasm in predisposed people. Vasoconstrictor medications, such as decongestants, should be avoided. Treatment with vasodilator drugs may be indicated. pg. 756

Which of the following blood vessel layers is composed primarily of smooth muscle cells?

- Tunica media Explanation: The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells. pg. 740

Which of the following blood vessel cells form the predominant cellular layer in the tunica media and produce vasoconstriction and/or dilation of blood vessels?

- Vascular smooth muscle cells (SMCs) Explanation: Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels. pg. 741

Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?

- Venous thrombosis Explanation: Venous thrombosis is associated with stasis of blood, increased blood coagulability, and vessel wall injury. Varicose veins are dilated, tortuous veins of the lower extremeties and lead to venous insufficiency. PAD is caused by atherosclerosis in arteries of the lower extremities. pg. 763

Assessment of an older adult's lower legs reveals brownish pigmentation on the ankles and shins as well as ankle and foot edema. The nurse recognizes this client is at risk for development of which complication?

- Venous ulcers. Explanation: The client's presentation is consistent with venous insufficiency and a consequent risk for venous ulcers. Arterial occlusion and insufficiency do not cause pigment changes and edema. Similarly, this presentation is not consistent with atherosclerosis. pg. 762

A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status?

-"We don't really understand why some women get high blood pressure when they're pregnant." Explanation:The cause of pregnancy-induced hypertension is largely unknown. pg. 783

By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.

-140; 90 Explanation: Hypertension is a consistent systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. pg. 780

Which of the following is a non-modifiable risk factor for the development of primary hypertension?

-African American race Explanation: Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Blacks also tend to experience greater cardiovascular and renal damage at any level of pressure. High salt intake and obesity are modifiable risk factors for hypertension. Male gender is not identified as a risk factor for hypertension. pg.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:

-Apply sequential pneumatic compression devices to lower extremities Explanation:The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction. pg. 764

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?

-C-reactive protein Explanation: C-reactive protein is a serum marker for systemic inflammation. Elevated homosysteine levels inhibit elements of the anticoagulation cascade and are associated with endothelial damage. Lipoprotein(a) is similar to LDL and can cause atherosclerosis by promoting foam cell formation and the deposition of cholesterol in atherosclerotic plaques. Triglycerides are not associated with inflammation. pg. 748

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

-Hypertension Explanation: The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors .The other options are nonmodifiable risk factors for atherosclerosis. pg. 747

The client reports a sudden onset of excruciating pain in the anterior chest and describes it as "tearing or ripping." The physician is unable to palpate a pulse in the client's right arm. Based on the client's history and physical examination, which treatment would be implemented?

-Intravenous sodium nitroprusside Explanation: Diagnosis of aortic dissection is based on history and physical examination. The major symptom of a dissecting aneursym is the abrupt presence of excruciating pain described as tearing or ripping. Medical treatment focuses on control of hypertension and the use of drugs that lessen the force of systolic blood ejection from the heart. Two commonly used drugs, given in combination, are intravenous sodium nitroprusside and a beta-adrenergic-blocking drug. IV epinephrine and atropine both increase cardiac output. Heparin, an anticoagulant, is not indicated, especially due to the risk of aneurysm rupture. pg. 759

The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?

-Kawasaki disease Explanation: Kawasaki disease involves large, medium-sized and small arteries (frequently the coronaries) and usually occurs in small children. Takayasu arteritis, a large vessel vasculitis, is a granulomatous inflammation of the aorta, usually in people younger than 50 years of age. Microscopic polyangiitis and Wegener's granulomatosis, both small vessel vasculitises, involve the respiratory and renal systems. pg. 752

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Which responses is best for the nurse to educate this client about? Select all that apply.

-Smoking cessation -Dietary measures to reduce LDL levels -Weight reduction if overweight Explanation:The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence. pg. 746

Although Raynaud's phenomenon and thromboangiitis are both characterized by ischemia, Raynaud's phenomenon and thromboangiitis obliterans are caused by which of the following?

-Vasospasm; inflammation Explanation: Raynaud's disease is caused by vasospasms of small distal arteries; thromboangiitis obliterans is caused by an inflammatory process that also affects veins and nerves. pg. 760