Chapter 26: Disorders of Blood Flow and Blood Pressure Regulation
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Tearing or ripping-type pain in the chest or back
A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?
Temporal
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?
The client just smoked a cigarette
A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?
Vigilant blood pressure monitoring
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?
Peripheral vascular resistance
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?
The kidneys
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. The nurse knows that the client's blood pressure would be classified as ________ according to American Heart Association guidelines?
stage 1 hypertension
The dietitian is teaching a client about cholesterol reduction strategies. Which comment by the client indicates that he understands the teaching?
"I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods."
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."
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate?
"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
140/90
Which client is at greatest risk for orthostatic hypotension?
A 66-year-old postoperative client on bed rest
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure?
Activation of the renin-angiotensin-aldosterone mechanism
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)
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
Angiotensin-converting enzyme (ACE) inhibitors
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
Hypertension
A client reports recent weight loss, fever, fatigue, paresthesia/pain, and weakness of the lower extremities. Assessment findings reveal reddish-blue, mottled areas of discoloration on the lower extremities. Which laboratory/diagnostic test will the health care provider prescribe for this client to correlate vasculitis with disease activity?
Antineutrophil cytoplasmic antibodies (ANCAs)
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:
Apply sequential pneumatic compression devices to lower extremities.
A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?
Black and South Asian people
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?
Decreased aorta and large artery elasticity
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process?
Decreased elasticity in arterial connective tissue
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
Deep vein thrombophlebitis of the leg
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?
Deep vein thrombosis
A client has a narrowed pulse pressure with a BP of 89/68. The nurse knows that which major factors influence pulse pressure? Select all that apply.
Distensibility of the arteries Stroke volume
The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated?
Diuretics
A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?
Echocardiogram
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
Elevation of triglycerides
An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?
Encouraging the client to maintain hydration throughout the day
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?
Exercise can increase blood vessel growth and help to decrease symptoms
The client has symptoms of a focal inflammatory condition of medium-sized and large arteries which includes diplopia. Which condition does the client have?
Giant cell temporal arteritis
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?
HDL
Which intervention by the client will decrease overall cardiovascular risk?
Higher levels of fitness and exercise
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
Hypercholesterolemia
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client?
Hypertension is a frequent modifiable contributor to aneurysms.
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
Hypotension
The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol?
LDL
The nurse is assessing a client with arteriosclerosis obliterans. Which assessment sign would the nurse expect to see?
Limb color blanches with elevation of the leg
Which of the following are characteristic signs of acute arterial embolism?
Pallor, pulselessness, and pain
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
Pulmonary embolism
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:
Pulmonary embolism
A nurse is evaluating hypertension risk factors with a black male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.
Race Family history
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?
Raynaud disease
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition?
Renal artery stenosis
The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet?
Steak
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
Which blood vessel layer is composed primarily of smooth muscle cells?
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:
Unknown
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
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.
* Consume a diet rich in fruits, vegetables, and low-fat dairy products. * Reduce dietary sodium intake. * Stop smoking. * Limit alcohol consumption.
The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse?
The client states his hand is numb
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
While examining a client, a physician finds reddish-blue, mottled areas of discoloration on the skin of the extremities (livedo reticularis). The client states she has had anorexia, weight loss, fatigue, and fever. Which diagnostic test will confirm a diagnosis?
Biopsy specimens
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
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)