Test 4 disorders of blood flow and blood pressure regulation ch 26
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure?
Systemic vasoconstriction maintained the diastolic pressure.
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
A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?
Temporal
A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (vasculitis). Which condition is the most common of the vasculitides?
Temporal arteritis
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate?
"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure?
Decrease vascular volume
The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states:
"Capillaries permit the exchange of material between the blood and interstitial fluid."
During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to the hospital. Which statement should the nurse include in the response to this expectant mother?
"Essentially, experts don't really know why so many pregnant women develop high blood pressure."
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."
According to the latest guidelines by the American Heart Association, which blood pressure reading would be classified as stage 1 hypertension?
137/85 mm Hg
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
140/90
The nurse knows that which client is at greatest risk for malignant hypertension?
A 25-year-old black man
Which client is at greatest risk for orthostatic hypotension?
A 66-year-old postoperative client on bed rest
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up.
Which clients are at risk for venous thrombosis? Select all that apply.
A client on bed rest after an acute myocardial infarction A client taking oral contraceptives A client who has had total hip replacement surgery
Which is an accurate statement about acute arterial occlusion ?
A quick forming arterial occlusion is more likely to cause tissue death.
A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?
Activation of the renin-angiotensin-aldosterone mechanism
Which type of aortic aneurysm is the most common?
Abdominal aortic
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate?
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism
The nurse knows that acute regulation of blood pressure involves which physiologic processes? Select all that apply.
Arterial chemoreceptors Vagal nerve impulses Adrenergic (sympathetic) stimulation Carotid baroreceptors
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
Arterioles
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.
Baroreceptors
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Black and South Asian people
Which risk factor for the development of primary hypertension is nonmodifiable?
Black ethnicity
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy
A client is diagnosed with gestational hypertension. The nurse recognizes which findings are characteristics of this condition? Select all that apply.
Blood pressure greater than 140/90 Development after 20th week of pregnancy Blood pressure back to normal by 12 weeks postpartum
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
A client is receiving home care for the treatment of a wound on the inside of the lower leg described as 3 cm in diameter with a yellow wound bed draining clear exudate. Assessment of the client's legs reveals edema and a irregularly darkened pigmentation on the ankles and shins of both legs. How would the home care nurse document these findings?
Chronic venous insufficiency
Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis?
Client on bed rest
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.
Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure
Decrease vascular volume
A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?
Vigilant blood pressure monitoring
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?
Elevated total cholesterol
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
Elevation of triglycerides
Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in the:
Fingers
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity 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
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity 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
A nurse is educating a client about modifiable risk factors of primary hypertension. Which topics will the nurse be discussing with this client? Select all that apply.
High blood cholesterol levels Cigarette smoking Obesity Alcohol consumption
Which intervention by the client will decrease overall cardiovascular risk?
Higher levels of fitness and exercise
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
Hypotension
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
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol?
LDL
The nurse is assessing a client with arteriosclerosis obliterans. Which assessment sign would the nurse expect to see?
Limb color blanches with elevation of the leg
Several steps characterize the development of atherosclerosis. Which is the correct order in which atheromas develop?
Lipoprotein oxidation, foam cells produced, fibrous plaques develop, a thrombus forms
Which lipoprotein is the main carrier of cholesterol?
Low-density lipoprotein (LDL)
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.
Which goal is a priority for a nurse caring for a client diagnosed with orthostatic hypotension?
Preventing falls
The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?
Promotes retention of water
Which of the following is the site of chylomicron synthesis?
Small intestine
Which one of the following organs are the two primary sites of lipoprotein synthesis?
Small intestine and liver
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
The nurse knows that systolic hypertension carries risk for which cardiovascular events? Select all that apply.
Thrombosis Damage to elastic elements of blood vessel walls Atherosclerosis Risk for aneurysm
Which blood vessel layer is composed primarily of smooth muscle cells?
Tunica media
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
hypertension
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state:
it is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is ≥140 mm Hg.
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. The nurse knows that the client's blood pressure would be classified as ________ according to American Heart Association guidelines?
stage 1 hypertension
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
unknown
When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension?
In the morning before arising from bed
A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" What is the best response?
"Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen."
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
64 mm Hg
Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm?
Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers)
The nurse is discussing risk factors for hypertension with a client. Which factors are nonmodifiable risk factors for development of hypertension? Select all that apply.
Advanced age Ethnicity
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
Which client should most likely be assessed for orthostatic hypoten
An older adult client who has experienced two falls since admission while attempting to ambulate to the bathroom.
Which client should most likely be assessed for orthostatic hypotension?
An older adult client who has experienced two falls since admission while attempting to ambulate to the bathroom.
A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
Angiotensin-converting enzyme (ACE) inhibitors
A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation?
Anticoagulation therapy and elevation of the leg
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which blood pressure finding can be characteristic of this condition?
Blood pressure in arms 20 mm Hg higher than in the legs
The nurse recognizes which blood pressure levels are normal, age-related levels? Select all that apply.
Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure at age 10 days is 78 mm Hg systolic. Blood pressure at age 25 years is ideal at 120 mm Hg systolic.
What action should the nurse take if a client's blood pressure has increased from 100/80 to 130/90 mm Hg during monitored exercise?
Continue with the exercise.
A client has developed secondary hypertension. The nurse knows that which factors may be a cause of secondary hypertension? Select all that apply.
Cushing syndrome Oral contraceptives Aortic coarctation Pheochromocytoma
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
Deep vein thrombophlebitis of the leg
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process?
Decreased elasticity in arterial connective tissue
The nurse is educating a client diagnosed with pre-hypertension about reducing modifiable risk factors. Which risk factors will the nurse address? Select all that apply.
Decreasing salt intake Decreasing alcohol consumption. Increasing dietary potassium
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?
Deep vein thrombosis
The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that the most common cause of this condition is:
Deep vein thrombosis (DVT)
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the the knowledge is understood when the client correctly matches which drug category to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?
Diuretics
The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated?
Diuretics
An older adult client is diagnosed with orthostatic hypotension. For which clinical manifestation should the nurse assess?
Dizziness and fainting
A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?
Echocardiogram
An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?
Encouraging the client to maintain hydration throughout the day
A nurse is evaluating hypertension risk factors with a black male who works as a lawyer in a busy legal firm. His history is positive for family hypertension; his paternal grandfather had a stroke; he drinks four beers/day and eats salted popcorn every evening; and he has gained 15 lb (6.8 kg) in the past year. Which are modifiable risk factors associated with this diagnosis? Select all that apply
Excessive alcohol consumption Obesity
A nurse is evaluating hypertension risk factors with a black male who works as a lawyer in a busy legal firm. His history is positive for family hypertension; his paternal grandfather had a stroke; he drinks four beers/day and eats salted popcorn every evening; and he has gained 15 lb (6.8 kg) in the past year. Which are modifiable risk factors associated with this diagnosis? Select all that apply.
Excessive alcohol consumption Obesity
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?
Exercise can increase blood vessel growth and help to decrease symptoms.
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
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is:
Hypertension
The nurse recognizes that insulin resistance and compensatory hyperinsulinemia may be related to development of which of the following? Select all that apply.
Hypertension Type 2 diabetes Hyperlipidemia Glucose intolerance
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?
Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction
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.
The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?
Measure his blood pressure and show him how much higher it is when he is smoking.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
Obesity High salt consumption Inactive lifestyle
A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?
Periodic severe headache and marked variability in blood pressure
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?
Peripheral vascular resistance
Which measure is the best modality to diagnose hypertension?
Repeated blood pressure determinations
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
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:
Pulmonary embolism
A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.
Race Family history
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?
Raynaud disease
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
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition
Renal artery stenosis
The nurse caring for a client with malignant hypertension knows that which possible complications can occur with malignant hypertension? Select all that apply.
Renal failure Arteriolar wall damage Cerebral edema Intravascular coagulation
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?
The kidneys
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:
Stasis of blood, hypercoagulability, vessel wall injury
The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet?
Steak
When a person rises from a lying to a standing position, heart rate increases. What description would the nurse use to explain the physiologic basis for this response?
Stretch on baroreceptors in the heart and blood vessels
A client is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure ≥160 mm Hg
A 69-year-old man is admitted to the hospital following a popliteal embolectomy. He asks the nurse why he had to have surgery on his leg. What is the best response by the nurse?
The artery that runs behind your knee was blocked by a blood clot, and the doctor removed it.
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?
The client just smoked a cigarette.
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.
The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse?
The client states his hand is numb.
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)
The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which therapy could be implemented to prevent tissue injury?
Wearing correctly fitted, elastic support stockings
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II
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.
A nurse is teaching a client newly prescribed with an angiotensin-converting (ACE) inhibitor. Which information is very important to include in the teaching plan?
Avoid salt substitutes and foods high in potassium.
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
An older adult client has been diagnosed with orthostatic hypotension. When planning the client's subsequent care, the nurse should prioritize which diagnosis?
Risk for falls
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?
Sympathetic
A client with persistent primary hypertension remains apathetic about having high blood pressure, stating, "I do not feel sick, and it does not seem to be causing me any problems that I can tell." How would the nurse best respond to this client's statement?
"You may not sense any problems, but it really increases your risk of heart disease and stroke."
At 4 AM the hemodynamic monitoring for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure (MAP) is at the low end of the normal range; at 5 AM the client's MAP has fallen definitively below normal. The nurses should prioritize assessments for:
organ damage and hypovolemic shock.
