Patho- Ch.26 PrepU
Which drug(s) may cause secondary hypertension? Select all that apply.
amphetamines oral contraceptives cocaine decongestants Explanation: Amphetamines release norepinephrine from adrenergic nerve terminals and cocaine inhibits its reuptake; both actions cause cardiac stimulation and vasoconstriction that raise blood pressure. Decongestants often are vasoconstricting alpha-adrenergic agonists. Oral contraceptives raise blood pressure via a mechanism that is not fully understood. Erythromycin is not associated with hypertension.
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?
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.
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 the hospital. Which statement should the nurse include in the response to this expectant mother?
"Essentially, experts don't really know why so many pregnant women develop high blood pressure." Explanation: The root causes of pregnancy-induced hypertension are not known. It is pathological rather than normal, however, and it cannot necessarily be avoided by lifestyle modification. It can be pernicious to both the mother and the fetus.
A 55-year-old client has been diagnosed with atherosclerosis. The client understands that his or her lifestyle includes many of the risk factors for developing the disease, but the client asks the nurse, "What actually caused my disease?" What is the nurse's best scientific answer?
"LDL and VLDLs stimulate endothelial cell dysfunction." Explanation: Inducers of endothelial dysfunction include lipid products that are critical to the pathogenesis of atherosclerosis. These products, LDL and VLDL, initiate an inflammatory response in the vessel wall that will progress to an atheroma. HDL removes cholesterol from circulation. Cholesterol and fats are not found freely in circulation.
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 Explanation: HDL is known as the "good" cholesterol because it transports cholesterol back to the liver for metabolism. LDL, VLDL, and IDL transport cholesterol to the tissues.
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 Explanation: 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.
Which clients are at risk for venous thrombosis? Select all that apply.
A client on bed rest after an acute myocardial infarction A client taking oral contraceptives A client who has had total hip replacement surgery Explanation: Venous thrombosis is associated with stasis of blood, increased blood coagulability and vessel wall injury. Stasis of blood occurs with bed rest. The use of oral contraceptives appears to increase coagulability. People undergoing total hip replacement are at risk for vessel injury. Aneurysms and hypertension are not associated with venous thrombosis.
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.
Baroreceptors Explanation: Baroreceptors are pressure-sensitive receptors located in the walls of blood vessels and the heart. The arterial chemoreceptors are cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood. The cardiovascular center transmits impulses to the blood vessels. Neural control of the blood pressure is related to the integration and modulation of autonomic nervous system (ANS) response.
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 Explanation: Dizziness, blurred vision, palpitations, and syncope (i.e., fainting) are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
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. 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.
Which intervention will the nurse prioritize for the medical management of a client with a dissecting aortic aneurysm?
administration of vasodilators and beta-adrenergic blocking medications (beta-blockers) Explanation: Administration of medications to lower blood pressure such as vasodilators and and beta-adrenergic blocking medications which slow heart rate are the expected treatment. Lowering blood pressure will lessen the force of systolic blood ejection from the heart. The client's blood pressure needs to be lowered rather than elevated with epinephrine (adrenergic agonist) and IV fluids. Although the client is likely anxious and in acute pain, pharmacologic treatment of these are not the priority.
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 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.
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?
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.
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
140/90 Explanation: The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.
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?
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 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 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 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 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.
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 Explanation: There are three types of arteries: large, including the aorta; medium-sized arteries, such as the coronary and renal arteries; and small arteries and arterioles. The large arteries function in the transport of blood. The medium-sized arteries distribute blood flow to the various organs and tissues. The distribution is controlled by contraction and relaxation of the smooth muscle of these vessels. The small arteries and arterioles regulate capillary blood flow. Venules transport blood from capillary beds toward the heart.
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
Elevation of triglycerides Explanation: In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
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.
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 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.
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
Limit alcohol consumption. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. 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.
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs) Explanation: Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels.
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.
Weight reduction if overweight Smoking cessation Dietary measures to reduce LDL levels 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 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 Explanation: Among the drugs used in the treatment of hypertension are ACE inhibitors. 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, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.
A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen?
increased high-density lipoproteins Explanation: A goal in prescribing exercise and diet control in clients with hypercholesterolemia is to lower the level of low-density lipoproteins (LDL) and increase the high-density lipoproteins (HDL). Elevated blood glucose is evidence of possible diabetes mellitus.
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?
Elevated total cholesterol Explanation: Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.
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 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.
