Chapter 18 Prep U
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation? Triglycerides C-reactive protein Lipoprotein(a) Homocysteine
C-reactive protein
Which one of the following organs are the two primary sites of lipoprotein synthesis? Small intestines and bone marrow Small intestine and liver Bone marrow and endothelium Spleen and liver
Small intestine and liver
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply. Increased intake of fats and sodium Weight reduction if overweight Dietary measures to reduce LDL levels Decreasing physical activity Smoking cessation
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
A client is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which excerpt from the educational brochure warrants correction? "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women." "High blood pressure often accompanies, or even causes, clogging of the arteries." "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease."
"Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."
During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to the hospital. Which statement should the nurse include in the response to this expectant mother? "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you." "By avoiding salt, staying active and minimizing weight gain, you can prevent this during your pregnancy." "Essentially, experts don't really know why so many pregnant women develop high blood pressure." "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy."
"Essentially, experts don't really know why so many pregnant women develop high blood pressure."
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response? "This likely won't have a huge effect on your quality of life and I'll prescribe anti-clotting drugs to prevent attacks." "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity." "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too."
"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."
A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate? "High blood pressure is largely controllable, except for those with a significant family history or black persons." "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." "It's important to minimize the amount of potassium and, especially, sodium in your diet." "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."
"Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."
A 29-year-old pregnant woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia in her second trimester. What should her care provider teach her about this change in her health status? "This is likely a result of your nervous system getting overstimulated by pregnancy." "Even though you're a healthy person, it could be that you have an underlying heart condition." "Hypertension is a common result of all the hormonal changes that happen during pregnancy." "We don't really understand why some women get high blood pressure when they're pregnant."
"We don't really understand why some women get high blood pressure when they're pregnant."
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? 119 mm Hg or lower 140 mm Hg or higher 120 to 129 mm Hg 130 to 139 mm Hg
140 mm Hg or higher
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below: 100/60 100/90 140/60 140/90
140/90
The nurse knows that mean arterial pressure is: 60% of diastolic pressure and 40% of systolic pressure Systolic pressure alone Diastolic pressure alone 50% of diastolic pressure and 50% of systolic pressure
60% of diastolic pressure and 40% of systolic pressure
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A 69-year-old woman with a diagnosis of cardiometabolic syndrome A black man who leads a sedentary lifestyle A 40-year-old smoker who eats excessive amounts of salt and saturated fats A 51-year-old male who has been diagnosed with glomerulonephritis
A 51-year-old male who has been diagnosed with glomerulonephritis
While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first? A client with a history of chronic obstructive pulmonary disease (COPD) experiencing a productive cough with green sputum. Athletic client reporting the kneecap popping in and out of socket. A client reporting painful urination and experiencing fever and chills. A client holding the abdomen and reporting a tearing and ripping feeling inside.
A client holding the abdomen and reporting a tearing and ripping feeling inside.
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 decreased pulse pressure reading A reading that is too low A reading that is too high An accurate BP assessment
A reading that is too high
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation? Homocysteine Triglycerides C-reactive protein Lipoprotein(a)
C-reactive protein
Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm? Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers) Administration of pain medication and antianxiety medication Administration of epinephrine and intravenous fluids Administration of medication to increase blood pressure
Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers)
A client who was diagnosed with hypertension is now taking a medication that decreases heart rate and cardiac output. The nurse determines that the medication is a: Calcium channel blocker Diuretic ACE inhibitor Beta adrenergic blocker
Beta adrenergic blocker
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. Chemoreceptors Neural pathways Cardiovascular centers Baroreceptors
Baroreceptors
In pregnancy, which diagnostic findings are characteristic for preeclampsia-eclampsia? Blood pressure 90/60 mm Hg and serum creatinine level of 2.1 mg/dL (160.13 µmol/L) Blood pressure 130/88 mm Hg and fasting blood glucose level of 180 mg/dL (9.99 mmol/L) Blood pressure 160/100 mm Hg and platelet count 25,000/μL (25 ×109/L) Blood pressure 140/90 mm Hg and glucose in the urine
Blood pressure 160/100 mm Hg and platelet count 25,000/μL (25 ×109/L)
A client is diagnosed with gestational hypertension. The nurse recognizes which findings are characteristics of this condition? Select all that apply. Proteinuria Development after 20th week of pregnancy Blood pressure back to normal by 12 weeks postpartum Blood pressure greater than 140/90 Always accompanied by preeclampsia
Blood pressure greater than 140/90 Development after 20th week of pregnancy Blood pressure back to normal by 12 weeks postpartum
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which blood pressure finding can be characteristic of this condition? Prominent femoral pulses Widened pulse pressure in the legs Blood pressure in arms 20 mm Hg higher than in the legs Blood pressure in legs 20 mm Hg higher than in the arms
Blood pressure in arms 20 mm Hg higher than in the legs
A critical care nurse is carefully monitoring a client's mean arterial pressure. Which combination of factors is responsible for mean arterial blood pressure? Stroke volume multiplied by cardiac output Cardiac output multiplied by systemic vascular resistance Systemic vascular resistance multiplied by heart rate Heart rate multiplied by stroke volume
Cardiac output multiplied by systemic vascular resistance
A 56-year-old male client has been diagnosed with hypercholesterolemia. Which laboratory result supports this diagnosis? Cholesterol 180 mg/dL (4.66 mmol/L) and HDL 40 mg/dL (1.04 mmol/L) Cholesterol 160 mg/dL (4.14 mmol/L) and HDL 30 mg/dL (0.78 mmol/L) Cholesterol 184 mg/dL (4.77 mmol/L) and HDL 20 mg/dL (0.52 mmol/L) Cholesterol 250 mg/dL (6.47 mmol/L) and HDL 32 mg/dL (0.83 mmol/L)
Cholesterol 250 mg/dL (6.47 mmol/L) and HDL 32 mg/dL (0.83 mmol/L)
A physical assessment of a 28-year-old female client indicates that the blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which possibility would her care provider be most likely to suspect? Coarctation of the aorta Essential hypertension Pheochromocytoma An adrenocortical disorder
Coarctation of the aorta
The nurse obtains a blood pressure reading of 150/96 mm Hg from a client at the clinic. What instructions for follow-up does the nurse anticipate giving to this client? Education about antihypertensive medications Recheck in 1 year Confirm within 2 months Recheck in 2 years
Confirm within 2 months
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply. Avoid aerobic physical activity. Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Stop smoking. Limit alcohol consumption.
Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure? Decrease renin release Decrease vascular volume Increase vasoconstriction Decrease heart rate
Decrease vascular volume
The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that the most common cause of this condition is: Arteriovenous (AV) fistulas Pressure on the abdominal veins caused by pregnancy Deep vein thrombosis (DVT) Congenital venous malformations
Deep vein thrombosis (DVT)
Select the statement that best describes Buerger disease. Disease of young, heavy cigarette smokers occurring before the age of 35. Recurring, progressive, atherosclerotic inflammation and thrombosis. Pain is not a prominent feature of the disorder. Peripheral pulse intensity is increased.
Disease of young, heavy cigarette smokers occurring before the age of 35.
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the the knowledge is understood when the client correctly matches which drug category to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion? Diuretics Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers Beta-blockers
Diuretics
The nurse practitioner is working in an overnight sleep lab assessing and diagnosing clients with sleep apnea. During this diagnostic procedure, the nurse notes that a client's blood pressure is 162/97 mm Hg. The nurse explains this connection to the client based on which pathophysiologic principle? When the client starts to snore, the epiglottis is closed over the trachea. Specialized cells are located in the back of the throat that signal when the airway is obstructed; this sends signals to the kidney to increase the pulse rate. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume. During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.
During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring? LDL IDL HDL VLDL
HDL
Which of the following facilitates the clearance of cholesterol from the periphery (including atheromatous plaques) and transports it to the liver where it may be excreted? LDL HDL Chylomicrons VLDL
HDL
All veins have internal valves to aid in the unidirectional flow of blood toward the heart. True False
False
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? Stupor and hyperreflexia Headache and confusion Restlessness and nervousness Papilledema and lethargy
Headache and confusion
Which intervention by the client will decrease overall cardiovascular risk? Activity limitations to control glucose levels Excess alcohol consumption, especially red wine Psychological counseling to deal with stress Higher levels of fitness and exercise
Higher levels of fitness and exercise
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: Being male 55 years of age Family history of heart disease Hypertension
Hypertension
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 Stimulation to form new red blood cells Increased parasympathetic stimulation of the heart and blood vessels Inhibition of renin release from the kidneys to promote fluid retention
Increased sympathetic stimulation of the heart and blood vessels
The nurse recognizes that which statements are true of the changes in blood flow through the systemic circulation? Select all that apply. Venous high pressure flow back to heart Arterial compliance (pulsatile flow) as vessels expand and contract Arteriolar resistance converts to steady flow Intermittent flow from the heart as it contracts and relaxes Pulsatile flow through capillaries
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
The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol? It has a low cholesterol content. It is associated with a low intake of saturated fats. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. It transports cholesterol away from cells to the liver for excretion.
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol? HDL VLDL LDL IDL
LDL
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: Polyarteritis nodosa Vasculitis Arterial insufficiency Pulmonary embolism
Pulmonary embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent: Loss of pulses in the limb Acute myocardial infarction Cerebrovascular accident Pulmonary embolism
Pulmonary embolism
Which of the following is the site of chylomicron synthesis? Pancreas Large intestine Stomach Small intestine
Small intestine
A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply. Stress Race Excessive alcohol consumption Family history Obesity
Race Family history
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client? Atherosclerotic occlusive disease Raynaud disease Frostbite related to hypothermia Deep vein thrombosis
Raynaud disease
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition? Coronary artery disease Diabetes Heart failure Renal artery stenosis
Renal artery stenosis
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. How will the nurse classify this client's blood pressure? Elevated Stage 2 hypertension Stage 1 hypertension Normal
Stage 1 hypertension
A nurse is administering medication to treat familial hypercholesterolemia. Which medication lowers blood levels of low-density lipoproteins (LDL)? Beta-blockers Statins Bile acid-binding resins Protease inhibitors
Statins
A nurse is administering medication to treat familial hypercholesterolemia. Which medication lowers blood levels of low-density lipoproteins (LDL)? Protease inhibitors Bile acid-binding resins Statins Beta-blockers
Statins
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure? Heart rate increased with blood loss. Stroke volume increased with blood loss. Systemic vasoconstriction maintained the diastolic pressure. Blood volume rapidly increased.
Systemic vasoconstriction maintained the diastolic pressure.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: Tearing or ripping-type pain in the chest or back Chest pain radiating to the right arm Late hypertensive crisis Tonic-clonic seizures
Tearing or ripping-type pain in the chest or back
A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head? Vertebral Ophthalmic Temporal Carotid
Temporal
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading? The client left work 1 hour ago. The client just smoked a cigarette. The client took her antihypertensive medication 2 hours ago. The client ate a hamburger 45 minutes prior to the reading.
The client just smoked a cigarette.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client? The client must protect the entire body from cold, not just the extremities. Treatment with vasoconstrictor medications may be indicated. Anxiety and stress may precipitate vasodilation in predisposed people. The client can take decongestants as needed.
The client must protect the entire body from cold, not just the extremities.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring? The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. The client's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring? Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. The client's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? Hormonal activity The kidneys Humoral influence Neural mechanisms
The kidneys
Which assessment finding of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? The man's blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells). The man is acutely short of breath and his oxygen saturation is 87%. The man's blood pressure is 178/102 and he has abnormal liver function tests. The man's temperature is 101.9°F (38.8°C) and he is diaphoretic (heavily sweating).
The man's blood pressure is 178/102 and he has abnormal liver function tests.
Which blood vessel layer is composed primarily of smooth muscle cells? Tunica media Tunica externa Tunica intima Endothelium
Tunica media
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is: Pheochromocytoma Decreased renal blood flow Unknown Hyperaldosteronism
Unknown
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels? Vascular smooth muscle cells (SMCs) Endothelial cells Extracellular matrix cells Collagen tissue
Vascular smooth muscle cells (SMCs)
Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury? Peripheral artery disease (PAD) Venous thrombosis Varicose veins Chronic venous insufficiency
Venous thrombosis
A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention? Cautious use of over-the-counter diuretics Restriction of dietary sodium Oral administration of beta-adrenergic blockers Vigilant blood pressure monitoring
Vigilant blood pressure monitoring
An older adult client arrives to the health care provider's office complaining of a "sore" that won't heal on the lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the client that the usual treatment is: hydrotherapy treatments to facilitate improvement in circulation. long-term antibiotic therapy to facilitate healing of the wound. initiation of warfarin therapy to maintain an INR of 2-3.0 above norm. compression therapy to help facilitate blood flow back to the vena cava.
compression therapy to help facilitate blood flow back to the vena cava.
