NUR 4135 PrepU Chapter 26

A client with persistent primary hypertension remains apathetic about having high blood pressure, stating, "I do not feel sick, and it does not seem to be causing me any problems that I can tell." How would the nurse best respond to this client's statement? "You are right, but it is still worthwhile to monitor it in case you do develop problems." "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." "That is true, but it is an indicator that you are not taking very good care of yourself." "You may not sense any problems, but it really increases your risk of heart disease and stroke." SUBMIT ANSWER

"You may not sense any problems, but it really increases your risk of heart disease and stroke." Explanation: 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 the client does not "take care" of himself. Hypertension is not a risk factor for the development of diabetes mellitus.

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? 130 to 139 mm Hg 140 mm Hg or higher 119 mm Hg or lower 120 to 129 mm Hg

140 mm Hg or higher Explanation: Classification of blood pressure in adults defines a systolic pressure of 140 mm Hg or higher as stage 2 hypertension. Stage 1 hypertension has a systolic pressure between 130 and 139 mm Hg. Systolic blood pressure between 120 and 129 mm Hg is classified as elevated and 119 mm Hg or lower is classified as normal.

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities? A client undergoes a stress test on a treadmill. A client does isotonic exercises in a wheelchair. A client is helped out of bed and stands up. A client reclines from a sitting to supine position.

A client is helped out of bed and stands up. Explanation: 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.

When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? Activated cells roam the vascular system looking for inflammatory cells to engulf. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Oxidized free radicals produce toxic metabolic waste that can kill liver cells.

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Explanation: Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

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 Decreased elasticity in venous connective tissue Increased elasticity in venous connective tissue Increased elasticity in arterial connective tissue

Decreased elasticity in arterial connective tissue Explanation: With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and afterload. Elasticity does not increase in arterial tissue or venous tissue.

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate? Deep vein thrombophlebitis of the leg The hepatic vein in chronic passive congestion of the liver An atherosclerotic plaque in the aorta The endocardium over an acute myocardial infarction

Deep vein thrombophlebitis of the leg Explanation: Deep vein thrombosis (DVT) may be a precursor to pulmonary embolism. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT.

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? Arterial insufficiency Deep vein thrombosis Stasis ulcerations Primary varicose veins

Deep vein thrombosis Explanation: Venous insufficiency with deep vein thrombus formation is characterized by pain, swelling [edema], and deep muscle tenderness. Fever, general malaise, and elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. Swelling may vary from minimal to maximal. 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 with deep vein thrombosis.

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? Hepatocellular necrosis Thrombocytopenia Decreased renal filtration rate HELLP syndrome

HELLP syndrome Explanation: 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.

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 Dry mouth Constipation Restlessness

Hypotension Explanation: Particular caution should be used in people who are at risk for orthostatic hypotension (e.g., those with diabetes, autonomic nervous system dysfunction, and older adults).

A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor? Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Inhibits the movement of calcium into cardiac and vascular smooth muscle Decreases the heart rate, which will cause a decrease in cardiac output Decreases vascular volume by suppressing renal reabsorption of sodium

Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Explanation: 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.

Which statement is characteristic of a thrombus? It forms on the wall of a vessel. It has no internal architecture. It is a normal phenomenon associated with clotting. Formation depends initially on the clotting process.

It forms on the wall of a vessel. Explanation: A thrombus is a blood clot that forms on the wall of a vessel and continues to grow until it reaches a size that obstructs blood flow. Thrombi often arise as the result of erosion or rupture of the fibrous cap of an arteriosclerotic plaque.

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 LDL VLDL IDL

LDL Explanation: 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.

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: Orthostatic hypotension Left ventricular hypertrophy Organ damage and hypovolemic shock Pulmonary hypertension

Organ damage and hypovolemic shock Explanation: The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. 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.

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 Deep vein thrombosis Frostbite related to hypothermia Atherosclerotic occlusive disease

Raynaud disease Explanation: The symptoms of this client represent Raynaud disease. Frostbite would most likely have affected the feet and the hands. The others apply more to the lower extremities.

A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: Tonic-clonic seizures Chest pain radiating to the right arm Late hypertensive crisis Tearing or ripping-type pain in the chest or back

Tearing or ripping-type pain in the chest or back Explanation: 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 client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client? The client must protect the entire body from cold, not just the extremities. The client can take decongestants as needed. Treatment with vasoconstrictor medications may be indicated. Anxiety and stress may precipitate vasodilation in predisposed people.

The client must protect the entire body from cold, not just the extremities. Explanation: Treatment measures are directed toward eliminating factors that cause vasospasm. Abstinence from smoking and protection from cold are priorities. The entire body must be protected from cold, not just the extremities. Avoidance of stress and anxiety is another important factor, as they may precipitate vascular spasm in predisposed people. Vasoconstrictor medications, such as decongestants, should be avoided. Treatment with vasodilator drugs may be indicated.

Which blood vessel layer is composed primarily of smooth muscle cells? Tunica externa Endothelium Tunica intima Tunica media

Tunica media Explanation: 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.

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 Oral administration of beta-adrenergic blockers Vigilant blood pressure monitoring Restriction of dietary sodium

Vigilant blood pressure monitoring Explanation: Sodium restriction is not normally recommended during pregnancy. Most medications are contraindicated during pregnancy except in cases where the mother's life is threatened. Close monitoring is the initial focus of care.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement? massage legs to maintain blood flow apply sequential pneumatic compression devices to lower extremities apply ice compresses to the site of the DVT hourly ensure that the client remains on bed rest

apply sequential pneumatic compression devices to lower extremities Explanation: The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension? increased elasticity of the venous connective tissue decreased elasticity of the aorta and large arteries increased elasticity of the arterial connective tissue decreased elasticity of the venous connective tissue

decreased elasticity of the aorta and large arteries Explanation: In aging adults, there is a decrease in the elasticity of the aorta and large arteries making them more rigid, thereby increasing systolic blood pressure. This can lead to increased cardiac afterload and hypertension.

A nurse is evaluating hypertension risk factors with a client. Of the risk factors in the client's history noted, which risk factor(s) for hypertension is nonmodifiable? Select all that apply. family history obesity excessive alcohol consumption race stress

race family history Explanation: Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors that 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.

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 reporting painful urination and experiencing fever and chills. A client with a history of chronic obstructive pulmonary disease (COPD) experiencing a productive cough with green sputum. A client holding the abdomen and reporting a tearing and ripping feeling inside. Athletic client reporting the kneecap popping in and out of socket.

A client holding the abdomen and reporting a tearing and ripping feeling inside. Explanation: A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. The location of the pain may point to the site of dissection. Because aortic dissection is a life-threatening emergency, a client with a probable diagnosis is stabilized medically even before the diagnosis is confirmed. Painful urination with fever is usually associated with a urinary tract infection and is not an imminent threat. A dislocated kneecap is extremely painful, but again not an imminent threat. The respiratory client with productive cough with green sputum likely has an infection like pneumonia and needs treatment but is not the priority when the priority client may be experiencing a dissecting aortic aneurysm.

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition? Syncope A pulsating mass in the abdomen Hemiplegia The pulse is unobtainable in one or both arms

A pulsating mass in the abdomen Explanation: 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.

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 Coarctation of the aorta Increased sympathetic stimulation by the autonomic nervous system Increased levels of adrenocortical hormones

Activation of the renin-angiotensin-aldosterone mechanism Explanation: 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.

Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm? Administration of pain medication and antianxiety medication Administration of medication to increase blood pressure Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers) Administration of epinephrine and intravenous fluids

Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers) Explanation: Administration of nitroprusside and beta-adrenergic blocking medications would be an expected treatment to lessen the force of systolic blood ejection from the heart. The client's blood pressure needs to be lowered rather than elevated with epinephrine. Though the client is likely anxious and in acute pain, pharmacologic treatment of these are not the priority.

A client is receiving home care for the treatment of a wound on the inside of the lower leg described as 3 cm in diameter with a yellow wound bed draining clear exudate. Assessment of the client's legs reveals edema and a irregularly darkened pigmentation on the ankles and shins of both legs. How would the home care nurse document these findings? Varicose veins Chronic venous insufficiency Peripheral arterial disease Deep vein thrombosis

Chronic venous insufficiency Explanation: In contrast to the ischemia caused by arterial insufficiency, venous insufficiency leads to tissue congestion, edema, and eventual impairment of tissue nutrition (development of a venous ulcer). The edema is exacerbated by long periods of standing. Necrosis of subcutaneous fat deposits occurs, followed by skin atrophy. Brown pigmentation of the skin caused by hemosiderin deposits resulting from the breakdown of red blood cells is common. Deep vein thrombosis, varicose veins, and peripheral artery disease do not have this symptomatology. Varicose veins are dilated, tortuous veins in the lower extremities. Deep vein thrombosis signs/symptoms include pain, swelling, and deep muscle tenderness. Peripheral arterial disease affects blood vessels outside the heart and thorax. They include Raynaud disease caused by vessel spasm and Buerger disease characterized by an inflammation process.

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. Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Avoid aerobic physical activity. Limit alcohol consumption. Stop smoking.

Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption. Explanation: Hypertension lifestyle modification includes the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2). Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan includes 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 should be reduced to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride). Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day). Alcohol consumption should be moderate, with consumption of no more than 2 drinks (1 oz [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 persons of lighter weight.

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? Contacting the health care provider immediately Encouraging the client to maintain hydration throughout the day Administering oxygen as prescribed Keeping the client in a supine position throughout the day

Encouraging the client to maintain hydration throughout the day Explanation: Significant drops in systolic blood pressure on assumption of the upright position (orthostatic hypotension) is more common in older adults due to compensatory cardiovascular mechanisms that are delayed or insufficient. Appropriate interventions by the nurse include encouraging the client to change positions slowly to decrease the risk of falls. Measures designed to help people prevent symptomatic orthostatic drops in BP include gradual ambulation to allow the circulatory system to adjust. Correcting the fluid deficit may help. Avoiding excess diuresis, diaphoresis, or loss of body fluids will help. There is no indication that the physician needs to be contacted, that the client needs to be placed in a supine position, or that oxygen needs to be administered at this time.

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise? Clients with intermittent claudication should exercise only their arms. Exercise can increase blood vessel growth and help to decrease symptoms. Exercise is not recommended in this population. Aerobic exercise is not recommended but isometric exercise is.

Exercise can increase blood vessel growth and help to decrease symptoms. Explanation: Adaptation to exercise induces angiogenesis with an increased growth of vessels to support blood flow to the exercising muscle. Exercise may help to decrease pain in clients with peripheral vascular disease.

Raynaud disease or phenomenon is a functional disorder caused by intense vasospasm of the arteries and arterioles in the: Lungs Heart Fingers Brain

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

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. Reduced heart rate Reduced blood viscosity Elevated renin levels Systemic vasoconstriction Intravascular fluid retention

Intravascular fluid retention Elevated renin levels Systemic vasoconstriction 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.

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? Electrical impulses in the heart Peripheral vascular resistance Rigidity of the ventricular walls Release of stress hormones

Peripheral vascular resistance Explanation: 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 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 feet are cold. The nail beds are pink. Pulses are present in the radial artery. The client states his hand is numb.

The client states his hand is numb. Explanation: 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.

The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? Neural mechanisms The kidneys Hormonal activity Humoral influence

The kidneys Explanation: 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.