Patho Ch.18

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

A 66-year-old post-surgery patient on bed rest

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

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

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 hospital. Which statement should the nurse include in their response to this expectant mother?

"Essentially, experts don't really know why so many pregnant women develop high blood pressure." The root causes of pregnancy-induced hypertension are not known. It is pathological rather than normal, however, and it can not necessarily be avoided by lifestyle modification. It can be pernicious to both the mother and the fetus.

When a 55 year old patients routine blood work returns, the nurse notes that their C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds:

"This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

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."

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

140

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 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.

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.

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.

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 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.

The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction.

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 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

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

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:

Hypertension

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

A client is concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. Which response by the nurse is most accurate? Select all that apply.

Maintain normal weight Control hypertension Control blood glucose levels

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.

A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?

Periodic severe headache and marked variability in blood pressure

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

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.

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 female client tells the health care provider that she has recently been experiencing episodes of changes occuring in the color of her fingertips especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:

Raynaud phenomenon

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 client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Which responses is best for the nurse to educate this client about? Select all that apply.

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

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

The kidneys

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

Tunica media