Cardiac (Porth Quiz)

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?

Tunica media

The heart is a four-chambered pump. What is the function of the right ventricle?

Pumps blood to the lungs

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?

A membranous sac that encloses the heart

Select the client who may be at risk for developing an increase in resistance to blood flow.

The client admitted to the intensive care unit for extreme dehydration The viscosity of a liquid is largely related to its thickness or number of particles that it contains. The blood of the client who is extremely dehydrated will be more viscous and increase resistance to flow. Being treated for anaphylactic shock, being hypertensive, or receiving intravenous fluids at a rate of 100 mL/hour will decrease resistance to blood flow.

A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the patient's blood pressure, or teaching the patient about the deleterious effects of hypertension. It is likely unproductive to simply characterize the patient's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.

A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?

40 - 45%

The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.

140 Systolic hypertension is a consistent systolic pressure of 140 mm Hg or higher with near normal diastolic pressure.

Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

51-year-old man who has been diagnosed with glomerulonephritis

A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?

55% - 75% The normal left ventricular ejection fraction is usually 55 percent to 75 percent when determined by angiocardiography.

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

An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. 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.

A patient 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 ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.

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 Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries.

A client presents with sinus bradycardia. What is the nurse's best action?

Assess the client's history The nurse needs to assess the client's history before determining if action is necessary. Sinus bradycardia is most often benign unless it is associated with a myocardial infarction, post resuscitation, or associated with hemodynamic decompensation. It is normal in an athlete, or someone who is well conditioned. After assessing the client's history the nurse can determine if other action is necessary

The purpose of a cardioversion device is the treatment of which of the following cardiac disorders?

Atrial fibrillation Explanation: Synchronized cardioversion and defibrillation are two reliable methods for treating ventricular tachycardia, and cardioversion is the definitive treatment for atrial fibrillation. The discharge of electrical energy that is synchronized with the R wave of the electrocardiogram is referred to as synchronized cardioversion, and unsynchronized discharge is known as defibrillation

The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?

CO = SV x HR

Select the correct sequence of blood return to the heart.

Capillaries, venules, veins, right atrium The correct pathway for blood returning back to the heart is the capillaries, venules, veins, and right atrium. The other options do not support normal blood flow.

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 to decrease blood pressure?

Decrease vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion) and cardiac output.

An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess?

Dizziness and fainting Orthostatic or postural hypotension is an abnormal drop in blood pressure on assumption of the standing position The presence of orthostatic symptoms (e.g., dizziness, syncope) is more relevant to the diagnosis that the actual blood pressure readings.

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

Gemfibrozil 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.

Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?

Histamine Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility

A nurse on a geriatric medicine unit has noted that a significant majority of the clients on the unit are prescribed antihypertensive medications. Which phenomenon is the nurse most justified in ruling out as a contributing factor?

Increased sensitivity of the renin--angiotensin--aldosterone system Increased sensitivity of the renin--angiotensin--aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange. The pulmonary circulation consists of the right heart and the pulmonary artery, capillaries, and veins. It is the smaller of the systems and functions at a lower pressure to assist with gas exchange.

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 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.

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 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.

A patient is diagnosed with systolic hypertension. The nurse knows that this patient is at risk for which of the following?

Left ventricular hypertrophy Elevated systolic pressure forces the heart to work harder and can thus provoke left ventricular hypertrophy, increased myocardial oxygen demand, and eventual left-sided failure. Left-sided failure may lead to right-sided failure which can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension.

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI. Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI. Pain with angina and MI is an subjective symptom for each client. Pain with angina and MI can occur at a variety of times.

Which of the following is the difference between the end-diastolic and end-systolic volumes?

Stroke volume Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Ejection fraction is the volume ejected from the left ventricle. Cardiac reserve is determined by cardiac output. (less)

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (i.e., vasculitis). These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is the most common of the vasculitides?

Temporal arteritis Temporal arteritis (i.e., giant cell arteritis), the most common of the vasculitides, is a focal inflammatory condition of medium-sized and large arteries. It predominantly affects branches of arteries originating from the aortic arch, including the superficial temporal, vertebral, ophthalmic, and posterior ciliary arteries. Neither polyarteritis nodosa nor Raynaud disease are the most common of the vasculitides. Varicose veins are not vasculitides.

The nurse is providing care for a client who has just been diagnosed with long QT syndrome (LQTS). When planning this client's care, the nurse should recognize what implication of the diagnosis?

The client must be closely monitored for ventricular tachycardia The long QT syndrome (LQTS) is characterized by a prolongation of the QT interval that may result in a characteristic type of polymorphic ventricular tachycardia called torsades de pointes and possible sudden cardiac death (SCD). LQTS is not directly related to ACS or cardiomyopathy. Tachycardia is far more likely than bradycardia.

Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?

Transcutaneous The type of pacing described is transcutaneous because it is only form that is accessible externally.

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

Tunica media 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.

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 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.

The heart consists of four valves. Which are the semilunar values? Select all that apply.

• Pulmonary • Aortic

A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?

Paroxysmal AF is characterized as rapid disorganized atrial activation and uncoordinated contraction by the atria. It is classified into three categories: paroxysmal, persistent, and permanent. Paroxysmal AF self-terminates and lasts no longer than 7 days, whereas persistent lasts greater than 7 days and usually requires intervention such as a cardioversion. AF is classified as permanent when attempts to terminate are failed and the the person remains in AF. The symptoms of chronic AF vary. Some people have minimal symptoms, and others have severe symptoms, particularly at the onset of the arrhythmia.

The extended, severe exposure of the walls of the blood vessels to the exaggerated pressures that occur in malignant hypertension cause injuries to the walls of the arterioles. Blood vessels in the renal system are particularly vulnerable to this type of damage. Because hypertension is a chronic disease and is associated with autoregulatory changes in the blood flow to major organs, what would be the initial treatment goal for malignant hypertension?

Partial reduction in blood pressure to less critical values Because chronic hypertension is associated with autoregulatory changes in coronary artery, cerebral artery, and kidney blood flow, care should be taken to avoid excessively rapid decreases in blood pressure, which can lead to hypoperfusion and ischemic injury. Therefore, the goal of initial treatment measures should be to obtain a partial reduction in blood pressure to a safer, less critical level, rather than to normotensive levels.

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

Patient on bed rest 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.

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 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.

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 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.

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 Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?

Sustained systolic pressure equal to or greater that 160 mm Hg Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.

A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement." Bearing down during a bowel movement stimulates the vagus nerve and results in a slowing of the heart rate. Vagal stimulation as well as some medications decreases the firing rate of the sinoatrial node and conduction through the atrioventricular node to cause a decrease in heart rate.

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." 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.

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." ntermittent 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.

A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?

"Keep a diary of your activities and symptoms throughout the examination." During the period of a patient wearing a Holter monitor (usually 48 hours), the patient will be instructed to maintain a diary of activities and symptoms so that the recorded electrocardiographic reading can be correlated with the diary events. The other options are not instructions appropriate for a Holter monitor examination

A nurse is observing a patient's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating which of the following??

"The patient is experiencing premature atrial contractions (PACs)." PACs are contractions that originate in the atrial conduction pathways or atrial muscle cells and occur before the next expected SA node impulse. This impulse to contract usually is transmitted to the ventricle and back to the SA node. The location of the ectopic focus determines the configuration of the P wave. In general, the closer the ectopic focus is to the SA node, the more the ectopic complex resembles a normal sinus complex. Retrograde transmission to the SA node often interrupts the timing of the next sinus beat, such that a pause occurs between the two normally conducted beats.

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:

"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. For example, persons with extensive obstruction of a coronary blood vessel may rely on collateral circulation to meet the oxygen needs of the myocardial tissue normally supplied by that vessel. There is no indication that the client is on a blood thinner.

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 During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

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 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.

The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:

A reading that is too high The width of the bladder should be at least 40% of arm circumference and the length at least 80% of arm circumference. Undercuffing (using a cuff with a bladder that is too small) can cause an overestimation of blood pressure. This is because a cuff that is too small results in an uneven distribution of pressure across the arm, such that a greater cuff pressure is needed to occlude blood flow. Likewise, overcuffing (using a cuff with a bladder that is too large) can cause an underestimation of blood pressure.

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?

A symptomatic bradyarrhythmia This client is suffering from a symptomatic bradyarrhythmia as evidenced by a heart rate of 46 with normal P waves before every QRS, normal PR interval and symptoms of dizziness and syncope. Bradyarrhythmias can decrease oxygen delivery to the brain, along with other vital organs, causing symptoms such as dizziness, lightheadedness, fatigue and syncope

A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.

A nurse is caring for four patients. Which of the following patients is most at risk for atrial fibrillation (AF)?

An elderly male who is 2 days postcoronary artery bypass surgery AF can be seen in people without any apparent disease, or it may occur in people with coronary artery disease, mitral valve disease, ischemic heart disease, hypertension, myocardial infarction, pericarditis, congestive heart failure, digitalis toxicity, and hyperthyroidism. AF is the most common chronic arrhythmia, with an incidence and prevalence that increase with age. The incidence of AF increases with age. For example, it occurs in less than 0.5% of the population aged less than 50 years and increases by 2% at ages 60-69 years old. The prevalence is also greater in men than in women.

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client?

Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT. Interventions that are used to prevent DVT (ambulation; compression stockings; compression devices) may be harmful when a DVT is present. Surgery is not normally required, and massage has the potential to dislodge a DVT.

A 56-year-old male patient has been diagnosed with hypercholesterolemia. Which of the following are the lab results that support this diagnosis?

Cholesterol 250 mg/dL and HDL 32 mg/dL A diagnosis of hypercholesterolemia would be made based on a cholesterol level greater than 200 mg/dL and an HDL of greater than 30 mg/dL.

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrillate the patient Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.

The shape of the QRS complexes on the ECG is determined by the direction of the electrical impulse in relation to the placement of the electrode on the chest wall. QRS complexes greater than 0.12 second could indicate which of the following?

Delayed conduction in the bundle branches A bundle branch block (BBB) is an interruption in the electrical impulse's ability to travel through the bundle of His at the normal rate, which would result in QRS complexes of 0.08 to 0.12 second. The physiologic consequence of a bundle branch block is that one ventricle contracts before the other because the impulse must travel through the cardiac muscle rather than the bundle of His.

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

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

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 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.

Pregnancy-induced hypertension is a serious condition affecting between 5% and 10% of pregnant women. The most serious classification of hypertension in pregnancy is preeclampsia-eclampsia. It is a pregnancy-specific syndrome that can have both maternal and fetal manifestations. What is a life-threatening manifestation of the preeclampsia-eclampsia classification of pregnancy-induced hypertension?

HELLP syndrome Liver damage, when it occurs, may range from mild hepatocellular necrosis with elevation of liver enzymes to the more ominous hemolysis, elevated liver function tests, and low platelet count (HELLP) syndrome that is associated with significant maternal mortality.

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring Because sick sinus syndrome frequently involves intermittent or alternating types of arrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific arrhythmias that may not be clear on a traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for arrhythmia formation.

When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?.

In the morning before arising from bed To confirm orthostatic hypotension, blood pressure should be assessed while the patient is supine and then after standing for one minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure are considered orthostasis.

A nurse is monitoring a client with a resting heart rate of 120 beats/minute. The client has been diagnosed with sinus tachycardia, which is the result of a change in which characteristic of cardiac cells?

Increased automaticity Sinus tachycardia is caused by an increase in the automaticity of the SA node. Changes in excitability, conductivity, and refractoriness do not have effects that would lead to sinus tachycardia.

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential The heart has four inherent properties essential in the development and conduction of cardiac rhythms. The property of automaticity is the ability of certain cells in the myocardium to automatically or spontaneously initiate an electrical impulse called an action potential. In a normally functioning heart the rate is controlled by the sinoatrial (SA) node.

A healthy 23-year-old college basketball player is brought to the emergency room following a syncopal episode while playing. On arrival the client was alert and oriented with a heart rate of 50 and regular, blood pressure 100/60, and no complaints. The paramedic giving report to the emergency room nurse describes that on arrival the client was attached to the school's automatic implantable cardioverter defibrillator (AICD) and the initial rhythm demonstrated a heart rate of 250 with differently shaped QRS complexes that also changed size. The rhythm spontaneously converted to normal sinus rhythm before the paramedics arrived. What does the nurse anticipate was the initial rhythm?

Inherited torsade de pointes This client most likely has inherited torsade de points, which is a ventricular arrhythmia that is often caused by a prolonged QT interval. The hallmark of this rhythm is wide QRS complexes that appear to be twisting around a point as it changes negativity. There are two forms; in the genetic form persons with the acquired form involves defects in either the potassium or sodium ion channel defects. The acquired form has a variety of causes, such as electrolyte imbalance, subarachnoid hemorrhage, cocaine use, and many antiarrhythmic medications. There is no information in the question to suggest an acquired form.

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?

Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.

A nurse is monitoring a patient with sick sinus syndrome who is experiencing lightheadedness, dizziness, and syncope. Which of the following treatments will the nurse anticipate for this patient?

Insertion of a pacemaker The most common manifestations of sick sinus syndrome are lightheadedness, dizziness, and syncope. These symptoms are related to the bradyarrhythmias. Treatment depends on the rhythm problem and frequently involves implantation of a permanent pacemaker.

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar Laminar blood flow reduces friction by allowing the blood layers to slide smoothly over one another, with the axial layer having the most rapid rate of flow. Axially, crosswise, and turbulent blood flow would result in increased friction. In turbulent flow, the laminar stream is disrupted and the flow becomes mixed, moving radially (crosswise) and axially (lengthwise).

A 28-year-old client is admitted to the hospital for severe dehydration following a marathon, with fatigue the only complaint. Admission vital signs include a heart rate of 38, blood pressure 98/60, RR 16. Cardiac monitor reveals regular QRS complexes preceded by normal P waves. Which of the following does the nurse determine is the most likely cause for the bradycardia?

Large stroke volume This client most likely has a large stroke volume related to the exercise training necessary to participate in a marathon. Trained athletes can potentially develop a normal physiologic cardiomegaly. There are no signs or symptoms to support a reduction in cardiac output.

A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment is the nurse most justified in eliminating during a busy morning on the unit?

Measuring the pulse of a client taking an ACE inhibitor. ACE inhibitors act on the renin--angiotensin--aldosterone system and are thus not significant influences on heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. Beta-adrenergic blockers affect a client's heart rate and diuretics can affect electrolyte levels

A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?

Monitor the patient and document the findings. First-degree atrioventricular block is characterized by a prolonged PR interval (>0.20 second). This condition usually produces a regular atrial and ventricular rhythm. Isolated first-degree heart block usually is not symptomatic, and temporary or permanent cardiac pacing is not indicated. The patient should be monitored.

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 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.

The nurse knows that adequate levels of which of the following electrolytes has been shown to have a beneficial effect on blood pressure?

Potassium Persons with high daily consumption of potassium tend to have lower blood pressure. Sodium intake is correlated with higher blood pressure. The association of chloride and calcium with blood pressure is not established.

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex The QRS complex is representative of ventricular depolarization. The P wave is atrial depolarization, the T wave is ventricular repolarization, and the ST segment is the time to ventricular repolarization.

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?

Receives blood returning to the heart from the systemic circulation The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.

Which of the following is the correct sequence for blood flow through the heart?

Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers The atrial conduction begins with the sinoatrial (SA) node, serving as the pacemaker of the heart. Impulses originating in the SA node travel through the atria to the arterioventricular (AV) node. There are three internodal pathways between the SA node and the AV node, including the anterior (Bachmann), middle (Wenckebach), and posterior (Thorel) internodal tracts. These three tracts anastomose with each other proximally to the AV node. The AV junction connects the two conduction systems and provides for one-way conduction between the atria and the ventricles. The impulse travels through the nodal region into the natriuretic hormone region, which connects with the bundle of His (also called the AV bundle). The fibers of the AV node proceed to form the bundle of His, which extends through the fibrous tissue between the valves of the heart and into the ventricular system. The bundle of His penetrates into the ventricles and almost immediately divides into right and left bundle branches that straddle the interventricular septum. The bundle branches move through the subendocardial tissues toward the papillary muscles and then subdivide into the Purkinje fibers, which branch out and supply the outer walls of the ventricles. The Purkinje system, which initiates ventricular conduction, has large fibers that allow for rapid conduction. Once the impulse enters the Purkinje system, it spreads almost immediately to the whole ventricle.

An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include: heart rate 100, blood pressure 84/62, RR 30 and temp 37.0. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for which of the following?

Serious arrhythmias Cardiomyopathy is disease of the cardiac muscle and premature ventricular contractions increase the risk for more lethal arrhythmias to occur. Heart failure is also a possibility; however, there is not enough information in the question to support heart failure

A patient is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 sec preceding each QRS complex. Which of the following does the nurse determine the rhythm to be?

Sinus tachycardia Sinus tachycardia is a heart rate >100 bpm that has its origin in the sinoatrial node. A normal P wave and PR interval should precede each QRS complex. The mechanism of sinus tachycardia is enhanced automaticity, related to sympathetic stimulation or withdrawal of vagal tone. Sinus tachycardia is a normal response during any increase in metabolic activity such as fever, stress, anxiety, and the like

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

Statins 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.

The post-operative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which of the following assessments would be a concern for the nurse?

The client states his hand is numb. Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.

Which client will the nurse prioritize to assess first?

The client with sinus arrest The client with sinus arrest refers to failure of the SA node to discharge and results in an irregular pulse. An escape rhythm develops as other pacemakers take over, but it may result in prolonged periods of asystole and other abnormal rhythms. The client may need further interventions such as a pacemaker. The other clients need monitoring; however, their rhythm is not placing them in need of immediate assistance.

The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?

Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.

Which of the following vessel layers is made primarily of muscle?

Tunica media The outermost layer of a vessel is called the tunica externa or tunica adventitia. The middle layer is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The innermost layer is the tunica intima.

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.

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

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 Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.

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. The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk. Low blood pressure does not normally result in aneurysms, edema, or ischemic stroke.

Which of the following statements regarding alcohol consumption and hypertension are correct? Select all that apply.

• A decrease in heavy alcohol consumption may help to lower blood pressure. • Chronic excessive alcohol consumption can induce hypertension. • Moderate alcohol consumption may decrease risk for cardiovascular disease. Chronic excessive consumption of any alcoholic beverage can induce hypertension. Reducing consumption can help to lower blood pressure. The recommended safe amount of alcohol for women is one drink per day and for men is two drinks per day. While moderate consumption may decrease risk for cardiovascular disease, most authorities do not recommend alcohol consumption

The nurse knows that which of the following drugs can cause secondary hypertension? Select all that apply.

• Amphetamines • Decongestants • Oral contraceptives • Cocaine Amphetamines release norepinephrine from adrenergic nerve terminals and cocaine inhibits its reuptake; both actions cause cardiac stimulation and vasoconstriction that raise blood pressure. Decongestants often are vasoconstricting alpha adrenergic agonists. Oral contraceptives raise blood pressure via a mechanism that is not fully understood. Erythromycin is not associated with hypertension.

The nurse knows that which of the following would put a patient at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply.

• Systemic vasoconstriction • Intravascular fluid retention • Elevated renin levels Explanation: Increased blood volume and systemic vasoconstriction will increase blood pressure. Elevated renin will increase levels of angiotensin II and aldosterone resulting in vasoconstriction and sodium and water retention. Reduced heart rate will lower blood pressure. Blood viscosity is not a major factor in regulating blood pressure.

A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:

"This means your heart is not pumping as much blood out of the heart with each beat." Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.

A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke." Hypertension is a highly significant risk factor for heart disease and stroke. It would be inappropriate to promote monitoring without promoting lifestyle modifications or other interventions to lower the client's blood pressure, or teaching the client about the deleterious effects of hypertension. It is likely unproductive to simply characterize the client's hypertension as demonstrating that he does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?

140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.

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

140; 90 Hypertension is a consistent systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

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 The difference between the systolic and diastolic pressure is called the pulse pressure (approximately 40 mm Hg). The pulse pressure is calculated by deducting the diastolic pressure (82) from the systolic pressure (146). The difference is the pulse pressure.

The nurse knows that which of the following persons is at greatest risk for malignant hypertension?

A 25-year-old African-American man Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. Persons most at risk include young African-American men, women with toxemia of pregnancy, and persons with renal or collagen disease.

Which of the following patients is at greatest risk for orthostatic hypotension?

A 66-year-old post-surgery patient on bed rest Post-surgery patients who have been immobile are at greatest risk for developing othostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

An ejection fraction of 40% This ejection fraction is below normal (normal is about 55 to 75 percent) and indicates a poor prognosis. This low ejection fraction is a result of the complications of long-standing hypertension

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve The bicuspid valve, (also called the mitral) controls the flow of blood between the left atria and left ventricle. The aortic valve controls flow between the left ventricle and aorta. The tricuspid controls the flow between the right atria and ventricle. The pulmonic valve controls flow between the right ventricle and pulmonary artery

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?

Blacks and South Asians A 2006 Canadian study showed that the ethnic groups consisting of South Asians (30%) and blacks (31%) in Canada are more likely to have hypertension in comparison to the primarily Caucasian population (21%) and East Asians are the least likely to have hypertension (19%).

A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?

Continuous cardiac monitoring The American Heart Association has published practice standards for electrocardiogram monitoring in hospital settings. The rating system has three categories. Class I clients require cardiac monitoring consistently. Class II clients may need monitoring but it is not essential. Class III clients do not have monitoring indicated.

The heart controls the direction of blood flow. What is the role of the aortic valve?

Controls the direction of blood flow from the left side of the heart to the systemic circulation

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 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.

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

Diuretics Diuretics are usually the least expensive, and are usually well tolerated by most patients.

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients and wastes The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

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 Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension

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 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).

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels When the baroreceptors in the carotid arteries detected the fall in blood pressure as blood volume was depleted, reflex sympathetic activity increased the rate and force of contraction via beta-1 receptors in the heart, and increased vasoconstriction via alpha-1 receptors in blood vessels. Both of these effects serve to support blood pressure and blood flow to vital organs

Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?

It documents only current cardiac function. The resting ECG is the first approach to the clinical diagnosis of disorders of cardiac rhythm and conduction, but it is limited to events that occur during the period the ECG is being monitored. The other options are not accurate statements regarding an ECG.

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. Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent. Persons with acute coronary syndrome are at risk for developing extension of an infarcted area, ongoing myocardial ischemia, and life-threatening arrhythmias. Research has revealed that 80% to 90% of ECG-detected ischemic events are clinically silent. Thus, ECG monitoring is more sensitive than a client's report of symptoms for identifying transient ongoing myocardial ischemia. Other answers are incorrect

The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm the nurse notes the P waves all look different. Which of the following most accurately describes this rhythm?

Multifocal atrial tachycardia Multifocal atrial tachycardia (MAT) is the most accurate rhythm choice for the description. The hallmark sign of MAT is at least 3 different P wave morphologies and a rate over 100 beats/minute. Incessant and focal atrial tachycardias have P waves from the same ectopic focus and paroxysmal atrial fibrillation would have fibrillatory (f) waves. MAT is often seen in older adults with chronic obstructive pulmonary disease (COPD).

A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?

Myocardial infarction The ST-segment elevation with myocardial infarction could be caused by a decrease in blood supply to that area of cardiac muscle. However, the mechanism of ST-segment elevation is not clearly understood. The other options with this question are the opposite of other causes of ST-segment elevation

A patient's electrocardiogram rhythm shows normal sinus rhythm followed by a complex of six premature ventricular contractions with a return to normal sinus rhythm. Which of the following is the nurse's interpretation of this finding?

Nonsustained ventricular tachycardia Ventricular tachycardia can be sustained, lasting more than 30 seconds and requiring intervention, or it can be nonsustained and stop spontaneously.

An intensive care nurse is assessing a client just admitted from the emergency room status-post myocardial infarction (MI) and notes that the client's cardiac rhythm is a sinus bradycardia with a rate in the low 50s. The nurse is concerned that the client may have which of the following?

Poor prognosis Sinus bradycardia following a myocardial infarction is a sign that the infarction may have damaged the SA or AV nodes and the heart is not beating fast enough to meet the body's needs. If the bradycardia is hemodynamically significant, a temporary or permanent pacemaker may need to be inserted. The other options are incorrect because the rhythm, sinus bradycardia, was given in the question.

Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs?

Potassium-sparing diuretics Persons with hyperaldosteronism will exhibit hypokalemia as aldosterone stimulates renal sodium for potassium exchange. Potassium sparing diuretics such as spironolactone will inhibit this action of aldosterone and will increase sodium excretion and mitigate the loss of potassium. ACEI will not alter the excessive level of aldosterone, which emanates directly from an overactive adrenal gland or an adenoma. Alpha or beta antagonists will not affect the excessive sodium and water retention induced by aldosterone.

A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?

Prehypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Prehypertension is systolic 120-139 mm Hg and diastolic 80-89 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 140-159 mm Hg systolic or 90-99 mm Hg diastolic and should be confirmed within two months. Stage 2 is systolic equal to or greater than 160 mm Hg or diastolic equal to or greater than 100 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.

A patient experiencing a sinus arrest would demonstrate which of the following symptoms or findings?

Prolonged periods of asystole demonstrated on an electrocardiogram The patient with sinus arrest refers to failure of the sinoatrial node to discharge and results in an irregular pulse, prolonged periods of asystole, and predisposition to other arrthythmias. The other options do not demonstrate the symptoms demonstrated during a sinus arrest.

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 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.

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 : 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.

A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?

Renal artery stenosis ACEI are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensis system to maintain adequate renal perfusion. ACEI are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACEI.

A nurse witnesses an elderly woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?

Severe anxiety This person is most likely suffering from severe anxiety following her husband's death, which would be a normal physiologic explanation for the tachyarrhythmia that may have contributed to the syncope. Although the other options are all potential causes of tachyarrhythmias, there is nothing in the question that supports that they would be the cause.

An 80-year-old client is brought to the emergency room following a syncopal episode at home. The client has a past medical history of atrial fibrillation, type II diabetes, and coronary heart disease. The nurse notes after the cardiac monitor is attached the lack of P waves and the presence of QRS complexes at a rate of 48-54. The nurse determines the presence of which of the following?

Sinus arrest with a junctional escape rhythm Explanation: This client is suffering from sinus arrest with a junctional escape rhythm, demonstrated by the lack of P waves and QRS complexes at a rate of 48-54, which is the escape rhythm. The inherent rate in the junction is 40-60 beats per minute; if the escape rhythm were ventricular the rate would be between 15-40 beats per minute. This client has at least one risk factor for the development of this rhythm and that would be congestive heart failure.

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?

Sympathetic nervous system premature ventricular complexes can occur in healthy hearts in response to stimulation of the sympathetic nervous system. This client states nighttime studying (possibly with coffee intake) and stress over upcoming exams, both of which can stimulate the sympathetic nervous system.

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 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.

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

The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.

Preload represents the volume work of the heart and is largely determined by:

Venous blood return

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation Ventricular fibrillation represents severe derangements of cardiac rhythms that terminate fatally within minutes unless corrective measures are taken promptly. All of the other arrhythmias need to have further investigation into etiology, but are not immediately fatal.

The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which of the following therapies could be implemented to prevent tissue injury?

Wearing correctly fitted, elastic support stockings The incidence of varicose veins is more common in females between 30 and 50 years of age and among people who stand for the majority of their day due to an occupation (e.g., nurses). Treatment measures for varicose veins focus on improving venous flow and preventing tissue injury. Support stockings prevent vein distention. Sclerotherapy is used in the treatment of small varicosities. Warfarin therapy and heat application are used to treat deep vein thrombosis

An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

many people live with atrial fibrillation without even knowing they have it. Many people live with atrial arrhythmias, including atrial fibrillation, without knowing the arrhythmia exists. Atrial arrhythmias are typically less serious because they do not impact the ability of the ventricles to pump. This client is at high risk to develop atrial fibrillation due to his advanced age; the rates of atrial fibrillation begin to increase over the age of 60 and males have a greater prevalence. It is true that atrial fibrillation is a disorganized rhythm; however it is not ventricular. The client may or may not need anticoagulation; there are other considerations to be made before these medications would be considered

A patient brought to the emergency department has preeclampsia. The nurse knows that this disorder can progress to include which of the following complications? Select all that apply.

• Cerebral hemorrhage • Renal failure • Disseminated intravascular coagulation (DIC) • Hepatic failure Severe preeclampsia has risk for cerebral hemorrhage, hepatic and renal failure, and DIC. Platelet counts fall, with less than 100,000/mm2 diagnostic of serious disease.

Two months following a myocardial infarction (MI) a client visits the physician because of severe fatigue and shortness of breath. During the evaluation the client reports frequent episodes of palpitations over the past couple of weeks that cause the shortness of breath to increase. A 12-lead ECG reveals that the client has atrial fibrillation with a heart rate of 120. The practitioner should consider which of the following medications? Select all that apply.

• Anticoagulants • Antiarrhythmics Atrial fibrillation (AF) is a rhythm that involves quivering of the atrium rather than contracting rhythmically, causing pooling of blood in the atrium that can lead to the development of thrombi along with a decrease in cardiac output. Anticoagulants are used to decrease the ability of the blood pooling in the atrium to develop clots that could break off and become emboli that lodge in blood vessels elsewhere in the body causing ischemia, often to the brain causing strokes. Antiarrhythmics are used with atrial fibrillation to either convert the rhythm to normal sinus or to control the rate which gives the ventricles more time to fill.

A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply.

• Antihypertensives • Psychotropics • Diuretics Antihypertensive and psychotropic drugs and diuretics frequently cause orthostasis. The other options are not generally associated with orthostasis.

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.

• Aorta • Capillaries The systemic circulation includes the aorta and capillaries. The pulmonary circulation includes the right heart and pulmonary artery.

The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which of the following tests could the practitioner order for this condition? Select all that apply.

• Ascending venography • Duplex ultrasonography • Plasma D-dimer • White blood cell count Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an accompanying indication of inflammation. An echocardiogram is a test that evaluates heart structure and function.

Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.

• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors Baroreceptors in blood vessels and heart sense pressure changes in the circulatory system, and chemoreceptors at the carotid arteries and in the aorta detect blood levels of oxygen, carbon dioxide and hydrogen. When pressure falls or blood gases change, the autonomic nervous system can activate reflex responses to maintain adequate blood flow to vital organs. Pain, emotion and cold also can activate the autonomic nervous system control of blood pressure. Hepatic function does not directly affect autonomic control of blood pressure

The nurse recognizes which of the following as normal age-related blood pressure? Select all that apply.

• Blood pressure at age 10 days is 78 mm Hg systolic. • Blood pressure at age 25 years is ideal at 120 mm Hg systolic. • Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure of 50 mm Hg in newborn infants rises to approximately 78 mm Hg at 10 days of age. At the end of adolescence, around age 18 years, blood pressure usually has reached adult readings of 120 mm Hg. Beyond age 50 years, systolic pressure usually rises while diastolic pressure falls or remains the same.

The nurse knows that which of the following statements regarding the physiology of blood pressure are correct? Select all that apply.

• Blood pressure is very variable. • Constant elevation of blood pressure can be lethal. • A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.

The nurse is caring for a young pregnant patient. Which of the following describe cardiovascular changes during a normal pregnancy? Select all that apply.

• Blood pressure rises during the third trimester. • Blood pressure falls during the first trimester. • Levels of angiotensin-II contribute to elevated blood pressure. Blood pressure falls during the first trimester and reaches its lowest level in the second trimester. Pressure gradually rises in the third trimester. Cardiac output is increased throughout pregnancy. Plasma levels of angiotensin-II increase, inducing vasoconstriction that contributes to increased blood pressure.

A client with a history of unstable angina is admitted for a knee replacement. He questions the nurse about why continuous ECG monitoring is necessary during this hospital admission. The nurse explains to the patient that with a history of unstable angina it is important to monitor the cardiac rhythms to ensure early detection of which of the following? Select all that apply.

• Cardiac muscle ischemia • Tachyarrhythmias • Bradyarrhythmias • Irregular rhythms For persons with acute coronary syndrome (ACS), which includes conditions that cause cardiac ischemia, ECG monitoring is extremely important in preventing complications that may arise, such as early ischemia and also arrhythmias, including tachyarrhythmias, bradyarrhythmias and irregular rhythms.

In caring for clients with acute coronary syndromes (ACS) the nurse knows that without accurate assessments, including ECGs, these clients are at a much higher risk of complications, including which of the following? Select all that apply.

• Continuing myocardial ischemia • Increased area of infarction • Life-threatening arrhythmias 12-lead ECG monitoring is essential to avoid possible complications. Those complications could include; continuing myocardial ischemia, an increase in the size of the infarction along with life-threatening arrhythmias. In the presence of acute coronary syndromes ECG monitoring can detect continuing or new onset cardiac muscle ischemia more quickly and accurately than a client's report of symptoms. Other benefits of ECG monitoring are numerous and the American Heart Association has published practice guidelines to improve patient outcomes in clients with ACS

A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.

• Direct acting vasodilators • Alpha adrenergic blockers • Centrally acting adrenergic agonists There are several groups of antihypertensive medications having different mechanisms of action. Alpha adrenergic blockers inhibit adrenergic stimulation of alpha one receptors that mediates vasoconstriction. Centrally acting adrenergic agonists decrease adrenergic stimulation emanating from the central nervous system. Direct acting vasodilators, as their name implies, mediate vasodilation by direct action on vascular smooth muscle. Combinations of these drugs are used frequently, as giving lower doses of two or three drugs working by different mechanisms will often achieve good blood pressure control with minimal side effects. Angiotensin receptor agonists and beta adrenergic agonists would raise rather than lower blood pressure.

A nurse is evaluating hypertension risk factors with an African American male who works as 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. He paternal grandfather had a stroke. He drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are modifiable risk factors associated with this diagnosis? Select all that apply.

• Excessive alcohol consumption • Obesity Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.

The nurse is discussing hypertension with a group of patients. The nurse knows that which of the following statements regarding hypertension are true? Select all that apply.

• Family history of hypertension is a risk factor for hypertension. • Diabetes can lead to secondary hypertension. Primary or essential hypertension refers to hypertension with no identifiable cause. Diabetes can result in renal damage and consequent activation of the renin-angiotensin system which can elevate blood pressure. Family history is a nonmodifiable risk for hypertension. Hypertension, because it causes increased workload on the myocardium, can result in left ventricular hypertrophy. Hypertension is most often asymptomatic.

A patient has systolic hypertension. The nurse knows that systolic pressure is influenced by which of the following factors? Select all that apply.

• Heart rate • Compliance of arteries • Stroke volume • Contractile force Systolic pressure is influenced by the volume of blood forced into the systemic circulation with each heart beat (stroke volume). Faster heart rate and greater contractile force will increase systolic pressure. good arterial compliance or flexibility will result in lower systolic pressure. Venous resistance does not influence systolic pressure.

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.

• Inactive lifestyle • High salt consumption • Obesity The prevalence of hypertension in children and adolescents in increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.

The nurse recognizes that which of the following is true of the changes in blood flow through the systemic circulation? Select all that apply.

• Intermittent flow from the heart as it contracts and relaxes • Arterial compliance (pulsatile flow) as vessels expand and contract • Arteriolar resistance converts to steady flow Blood ejected with each heartbeat into the aorta and arteries forces these vessels to expand and then relax, with pulsatile flow. Arterioles provide resistance to flow, allowing for steady pressure through the capillaries. Pressure in the venous system is generally low.

A patient is diagnosed with pheochromocytoma. The nurse knows that which of the following procedures help to diagnose and manage this condition? Select all that apply.

• MRI and CT scans • Measurement of urinary catecholamines and metabolites • Radioisotope studies • Drugs to block catecholamine action Pheochromocytoma, a tumor of chromaffin cells, secretes catecholamines such as norepinephrine and epinephrine that produce an elevation in blood pressure. Measurement of urinary catecholamines and metabolites will detect excessive production of catecholamines. MRI and CT scans and radioisotopes that accumulate in chromaffin cells help to locate the aberrant tissue. If the tumor cannot be surgically removed, drugs that inhibit catecholamine secretion or action are administered. Diuretics will not address the root cause of hypertension due to pheochromocytoma

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

• Mitral • Tricuspid

A nurse is evaluating hypertension risk factors with an African American 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 pounds in the past year. Which of the following are NONmodifiable risk factors associated with this diagnosis? Select all that apply.

• Race • Family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.

Although the etiology of essential hypertension is mainly unknown, several risk factors have been identified. These risk factors fall under the categories of constitutional risk factors and lifestyle factors. What are the primary risk factors for essential hypertension? (Select all that apply.)

• Race and excessive sodium chloride intake • Type 2 diabetes and obesity • Family history and excessive alcohol consumption The constitutional risk factors include a family history of hypertension, race, and age-related increases in blood pressure. Another factor that is thought to contribute to hypertension is insulin resistance and the resultant hyperinsulinemia that occurs in metabolic abnormalities such as type 2 diabetes. Lifestyle factors can contribute to the development of hypertension by interacting with other risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided

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

• Reduce dietary sodium intake. • Limit alcohol consumption. • Stop smoking. • Consume a diet rich in fruits, vegetables, and low-fat dairy products. Explanation: Hypertension lifestyle modification included the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2) 5-20 mm Hg/10 kg weight loss. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan including consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium reduction to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg. Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day. Moderation of alcohol consumption; limiting consumption to no more than 2 drinks (1 oz or 30 mL ethanol) (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and lighter-weight persons.

The nurse knows that which of the following statements regarding sodium and hypertension are correct? Select all that apply.

• Reduction in sodium intake often produces a reduction in blood pressure. • Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. • In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated. The mechanism by which sodium contributes to hypertension is not clear. It may involve the responsiveness of the cardiovascular system to adrenergic stimulation. Reduction of salt intake will lower blood pressure. Older persons are more sensitive to the effect of salt on blood pressure. Seventy-five percent of sodium intake is from processed foods, 15 percent from cooking and table salt, and 10 percent from natural sodium content of foods

A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply.

• Renal failure • Coronary artery disease • Dementia • Loss of vision Hypertension has many severe consequences. It fosters atherosclerosis of the coronary arteries and damages retinal blood vessels resulting in loss of vision. Nephrosclerosis and renal failure are frequent sequelae of hypertension. Damage to central nervous system blood vessels can lead to dementia. While hypertension is not a causative factor for diabetes, it frequently occurs together with hypertension and elevated LDL cholesterol. Each of these disorders is a risk factor for heart disease.

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.

• The venous system collects deoxygenated blood from the tissues . • The arterial system distributes oxygenated blood to the tissues. The circulatory system consists of the heart which pumps blood, the arterial system which distributes oxygenated blood to the tissues, the venous system which collects deoxygenated blood from the tissues and returns it to the heart, and the capillaries where exchange of gases, nutrients and waste takes place.

The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.

• Thrombosis • Damage to elastic elements of blood vessel walls • Atherosclerosis • Risk for aneurysm With systolic hypertension, increased pulse pressure produces increased stretch of the arteries, resulting in damaged elastic elements and risk for aneurysm. Atherosclerosis and thrombosis as platelets begin to aggregate on rough endothelial surfaces. Systolic hypertension will cause left ventricular hypertrophy rather than right ventricular hypertrophy.