Ch 26 Patho Disorders of Blood
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 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 prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be: Ensure that the client remains on bed rest. Massage legs to maintain blood flow. Apply ice compresses to the site of the DVT hourly. Apply sequential pneumatic compression devices to lower extremities.
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.
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 heart rate Decrease renin release Increase vasoconstriction Decrease vascular volume
Decrease vascular volume Explanation: 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.
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? Ultrasound of the kidney CT of the head Echocardiogram Chest x-ray
Echocardiogram Explanation: Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fibrillation) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.
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? VLDL LDL HDL 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.
The nurse knows that which client is at greatest risk for malignant hypertension? A 60-year-old woman with newly diagnosed mild hypertension A 30-year-old woman with three children An obese 46-year-old white man A 25-year-old black man
A 25-year-old black man Explanation: Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. Persons most at risk include young black men, women with toxemia of pregnancy, and persons with renal or collagen disease.
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? Beta-blockers Calcium channel blockers Angiotensin II receptor blockers Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors Explanation: ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.
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 Blood pressure 90/60 and proteinuria in the second trimester Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Explanation: Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.
A client who is taking a diuretic asks the nurse to explain how a drug that makes her urinate more frequently can help her hypertension. The nurse will explain that diuretics exert their antihypertensive action in which ways? Select all that apply. By blocking the release of antidiuretic hormone from the posterior pituitary By decreasing vascular volume through the process of increasing sodium and water excretion By inhibiting the conversion of angiotensin I to angiotensin II. By inhibiting the movement of calcium into arterial smooth muscle cells By reducing peripheral vascular resistance
By decreasing vascular volume through the process of increasing sodium and water excretion By reducing peripheral vascular resistance Explanation: Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing sodium and water excretion) and cardiac output. Long-term diuretic administration results in a decrease in peripheral vascular resistance. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I, and calcium-channel blockers inhibit the movement of calcium into arterial smooth muscle. No antihypertensives act directly on the pituitary.
The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated? Diuretics Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers Beta-adrenergic blockers
Diuretics Explanation: Diuretics are usually the least expensive, and are usually well tolerated by most clients
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 Talking to a friend about using more saturated and less unsaturated fats when cooking Encouraging a friend to be tested for familial hypercholesterolemia Encouraging a friend to cook with transfats, as they extend the shelf life of foods
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly Explanation: The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and transfats. Testing for familial hypercholesterolemia is not a modifiable risk factor.
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? Male sex Hypercholesterolemia Increasing age Familial history of premature coronary heart disease
Hypercholesterolemia Explanation: The cause or causes of atherosclerosis have not been determined with certainty. However, epidemiologic studies have identified predisposing risk factors, which include a major risk factor of hypercholesterolemia. Other risk factors include increasing age, family history of premature coronary heart disease, and male sex.
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? Dry mouth Restlessness Constipation Hypotension
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).
When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension? Midmorning right after taking a short walk In the morning before arising from bed In the evening just before sleep Within a half-hour after the heaviest meal of the day
In the morning before arising from bed Explanation: To confirm orthostatic hypotension, blood pressure should be assessed while the client is supine and then after standing for 1 minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure, are considered orthostasis.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply. Inactive lifestyle Being female Poor performance in school High salt consumption Obesity
Obesity High salt consumption Inactive lifestyle Explanation: The prevalence of hypertension in children and adolescents is increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.
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? Rigidity of the ventricular walls Electrical impulses in the heart Release of stress hormones Peripheral vascular resistance
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.
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 Polyarteritis nodosa Vasculitis Arterial insufficiency
Pulmonary embolism Explanation: 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.
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 Family history Obesity Excessive alcohol consumption Race
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.
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 Explanation: There are two sites of lipoprotein synthesis—the small intestine and the 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. Decreasing physical activity Dietary measures to reduce LDL levels Increased intake of fats and sodium Weight reduction if overweight Smoking cessation
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight Explanation: The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes; when these are unsuccessful, pharmacologic treatment may be necessary. Therapeutic lifestyle changes include an increased emphasis on physical activity, dietary measures to reduce LDL levels, smoking cessation, and weight reduction for people who are overweight. Increased intake of fats and sodium would cause weight gain and hypertension and result in a negative consequence.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: Chest pain radiating to the right arm Tonic-clonic seizures 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.
Which blood vessel layer is composed primarily of smooth muscle cells? Endothelium Tunica intima Tunica externa 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 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. Avoid aerobic physical activity. 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.
A 35-year-old man presents to the emergency department reporting chest pain for the last 2 hours. He describes the pain as crushing, like a huge weight is on his chest. He also states that the pain goes up into his neck and down his left arm. An acute myocardial infarction (MI) is diagnosed. When taking his history, the following things are noted:● Hyperlipoproteinemia for past 7 years● Family history of early MI● Cholesterol deposits along the tendons (diagnosed 1 year ago)● Atherosclerosis (diagnosed 6 months ago)● Diabetes mellitus (type 1) diagnosed at age 16The nurse suspects which diagnosis will be made? Familial hypercholesterolemia (type 2A) Homozygotic cutaneous xanthoma Adult-onset hypercholesterolemia (type 1A) Secondary hyperlipoproteinemia
Familial hypercholesterolemia (type 2A) Explanation: Many types of primary hypercholesterolemia have a genetic basis. There may be a defective synthesis of the apoproteins, a lack of receptors, defective receptors, or defects in the handling of cholesterol in the cell that are genetically determined. For example, the LDL receptor is deficient or defective in the genetic disorder known as familial hypercholesterolemia (type 2A). This autosomal dominant type of hyperlipoproteinemia results from a mutation in the gene specifying the receptor for LDL. Although heterozygotes commonly have an elevated cholesterol level from birth, they do not develop symptoms until adult life, when they often develop xanthomas (i.e., cholesterol deposits) along the tendons and atherosclerosis appears. Myocardial infarction before 40 years of age is common. Homozygotes are much more severely affected; they have cutaneous xanthomas in childhood and may experience myocardial infarction by as early as 1 to 2 years of age. Homozygotic cutaneous xanthoma and adult-onset hypercholesterolemia (type 1A) are not known diseases. Causes of secondary hyperlipoproteinemia include obesity with high-calorie intake and diabetes mellitus. It does not have a genetic basis.
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 Papilledema and lethargy Restlessness and nervousness Headache and confusion
Headache and confusion Explanation: Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: Being male Family history of heart disease Hypertension 55 years of age
Hypertension Explanation: The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. The other options are nonmodifiable risk factors for atherosclerosis.
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. Stop smoking. Avoid aerobic physical activity. Limit alcohol consumption. Consume a diet rich in fruits, vegetables, and low-fat dairy products.
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.
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 Heart failure Renal artery stenosis Diabetes
Renal artery stenosis Explanation: ACE inhibitors are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensin-aldosterone system to maintain adequate renal perfusion. ACE inhibitors are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACE inhibitors.
A client is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension? Sustained systolic pressure of 140-159 mm Hg Sustained diastolic pressure of 81-89 mm Hg Sustained diastolic pressure of 90-99 mm Hg Sustained systolic pressure ≥160 mm Hg
Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.
The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet? Nuts Whole grains Poultry Steak
Steak Explanation: The DASH diet, emphasizing consumption of whole grains, fruits, and vegetables—and exclusion of red meats and sweets—has been shown in many studies to reduce hypertension.