Chapter 26: Disorders of Blood Flow and Blood Pressure Regulation

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?

Temporal

Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs)

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."

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

"I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake."

Which health-focused educational programs will target the most common cause of renovascular disease among older adults?

"Preventive Measures to Decrease Atherosclerosis"

A client with persistent, primary hypertension remains apathetic about 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 hypertension increases your risk of heart disease and stroke."

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?

140 mm Hg or higher

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

Which type of aortic aneurysm is the most common?

Abdominal aortic

The nurse knows that the renin-angiotensin-aldosterone system (RAAS) is an important mechanism in blood pressure control. Which physiologic events will activate this system? Select all that apply.

Adrenergic (sympathetic) stimulation Decreased blood sodium Fall in blood pressure Decreased blood volume

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 nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?

Black and South Asian people

Which risk factor for the development of primary hypertension is nonmodifiable?

Black ethnicity

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

C-reactive protein

A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistance

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have on the body to consequently decrease blood pressure?

Decrease vascular volume

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

Which function is performed by arteries such as the coronary and renal arteries?

Distribution of blood to organs that are controlled by contraction and relaxation of these vessels

A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly matches which drug category to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?

Diuretics

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

Diuretics

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 has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

Elevation of triglycerides

The health care team proposes a treatment plan for a client with peripheral artery disease. Which treatment measures are likely included?

Exercise training like walking to increase collateral circulation

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

A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is:

Hypertension

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state:

It is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is ≥140 mm Hg.

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

Kawasaki disease

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

Kidneys

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

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for:

Organ damage and hypovolemic shock

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

Sclerotherapy or surgery

Which of the following is the site of chylomicron synthesis?

Small intestine

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

Small intestine and liver

The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet?

Steak

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

Sympathetic

A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure?

Systemic vasoconstriction maintained the diastolic pressure.

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

Tearing or ripping-type pain in the chest or back

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?

The client just smoked a cigarette.

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

The client must protect the entire body from cold, not just the extremities.

A 28-year-old client who is a heavy smoker tells the practitioner that he has been experiencing pain in his feet and lower legs for several months. The practitioner notes that pulses in the feet are diminished and believes the client may have:

Thromboangiitis obliterans

Which most important complication of atherosclerosis can result in occlusion of small heart vessels?

Thrombosis

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

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?

Vigilant blood pressure monitoring

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

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?

decreased elasticity of the aorta and large arteries

An adult's documented blood pressure (BP) readings over the past 2 years include: 140/82 mm Hg, 144/82 mm Hg, 150/82 mm Hg, 160/82 mm Hg, and 162/82 mm Hg. Which interpretation(s) of these BP trend will the provider discuss with this client? Select all that apply.

Client's systolic BP is hypertensive. Client has increased risk for future cardiovascular events.

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?

Confirm within 2 months

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

The client has been diagnosed with venous insufficiency after having a deep vein thrombosis (DVT). Which signs and symptoms would the nurse expect to see? Select all that apply.

Edema Brown pigmentation of the skin Stasis dermatitis

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

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

Immune-mediated inflammation

The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?

Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development

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

Intravascular fluid retention Elevated renin levels Systemic vasoconstriction

A client is diagnosed with systolic hypertension. The nurse knows that this client is at risk for:

Left ventricular hypertrophy

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

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

The nurse caring for a client with malignant hypertension knows that which possible complications can occur with malignant hypertension? Select all that apply.

Renal failure Arteriolar wall damage Cerebral edema Intravascular coagulation

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