Porth's Essentials of Pathophysiology Chapter 18

The physician's order states, "Calculate the pulse pressure for the client's BP." The blood pressure reading is 146/82 mmHg. What is the pulse pressure?

64 mm Hg

Carries large amounts of triglycerides?

VLDL

Excess calorie consistently ? HDL and less consistently ? LDL levels in the blood.

lower, elevate

The ? represents the average pressure in the arterial system during ventricular contraction and relaxation.

mean arterial pressure

The measurement of tissue perfusion is called?

mean arterial pressure (MAP)

Chronic hypertension leads to ?, a common cause of chronic kidney disease.

nephrosclerosis

The use of ? pills is probably the most common cause of secondary hypertension in young women.

oral contraceptive

Any disease condition that reduces blood volume, impairs mobility, results in prolonged inactivity, or impairs autonomic nervous system function may also predispose to ?.

orthostatic hypotension

? is defined as an elevation in blood pressure and proteinuria developing after 20 weeks of gestation.

preeclampsia-eclampsia

? hypertension is the term applied to 95% of cases in which no cause for hypertension can be identified. In ? hypertension, the elevation of blood pressure results from some other disorder.

primary, secondary

The difference between the systolic and diastolic pressure (approx. 40 mmHg) is called the ?.

pulse pressure

The difference between the systolic and diastolic pressure is called?

pulse pressure

Causes of ? hyperlipoproteinemia include obesity with high-calorie intake and diabetes mellitus.

secondary

Many of the conditions causing ? hypertension can be corrected or cured by surgery or specific medical treatment.

secondary

? is closely linked with coronary heart disease and sudden death.

cigarette smoking

The ? risk factors include a family history of hypertension, race, and age-related increases in blood pressure.

constitutional

Lipoprotein measurements are particularly important in persons at high risk for development of ?.

coronary heart disease

Some of the apoproteins activate the ? enzymes that facilitate the removal of lipids from the lipoproteins.

lipolytic

The ? transport cholesterol and triglycerides to various tissues for energy utilization, lipid deposition, steroid hormone production, and bile acid formation.

lipoproteins

Correct sequence of the renin-angiotensin-aldosterone system 1. water retention 2. decrease in blood pressure 3. conversion of ANG I to ANG II by angiotensin-converting enzyme 4. conversion of angiotensinogen to ANG I 5. increased vascular resistance, release of aldosterone 6. stimulation of juxtaglomerular apparatus 7. release of renin 8. Sodium retention, stimulation of ADH release

1. Decrease in blood pressure 2. Stimulation of juxtaglomerular apparatus 3. Release of renin 4. Conversion of angiotensinogen to ANG I 5. Conversion of ANG I to ANG II by angiotensin-converting enzyme 6. Increased vascular resistance, release of aldosterone 7. Sodium retention, stimulation of ADH release 8. Water retention

What the seven signs and symptoms of acute arterial occlusion?

1. Pistol shot (acute onset) 2. Pallor 3. Polar (cold) 4. Pulselessness 5. Pain 6. Paresthesia 7. Paralysis

A diagnosis of hypertension is made if the systolic blood pressure is ? or higher and the diastolic pressure is ? or higher.

140 mmHg, 90 mmHg

The main objective for treatment of essential hypertension is to achieve and maintain arterial blood pressure below ?.

140/90 mmHg

Select the statements that most accurately describe secondary hypertension. Select all that apply. A. May be caused by oral contraceptives B. An elevation in blood pressure due to an unknown cause C. Kidney disease is one of the most common causes D. Obstructive sleep apnea is an independent risk factor E. Can be corrected or cured by surgery or specific medication F. Accounts for 5% to 10% of cases

A, C, D, E, F

Hypertension in the elderly is a common finding. This is because of the age-related rise in systolic blood pressure. Among the aging processes, what is a contributor to hypertension? A. Baroreceptor sensitivity B. Aortic softening C. Decreased peripheral vascular resistance D. Increased renal blood flow

A. Baroreceptor sensitivity

The health care provider is reviewing the results of a client's MRI. The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as: A. Berry aneurysm B. Fusiform aneurysm C. Dissecting aneurysm D. Saccular aneurysm

A. Berry aneurysm

Select the statement that best describes Buerger disease. A. Disease of young, heavy cigarette smokers occurring before the age of 35 B. Peripheral pulse intensity is increased C. Pain is not a prominent feature of the disorder D. Recurring, progressive, atherosclerotic inflammation and thrombosis

A. Disease of young, heavy cigarette smokers occurring before the age of 35

A 35-year-old man presents to the ER complaining of 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: Hyperlipoproteinenemia for the 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 16 The nurse suspects which of the following diagnoses will be made? A. Familial hypercholesterolemia (type 2A) B. Homozygotic cutaneous xanthoma C. Adult-onset hypercholesterolemia (type 1A) D. Secondary hyperlipoproteinemia

A. Familial hypercholesterolemia

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: (Select all that apply) A. It is the most common cardiovascular disorder B. The incidence increases with age C. The systolic pressure is greater than or equal to 140 mm Hg D. The diastolic pressure is equal to 80 mm Hg E. It is often associated with individuals of normal weight.

A. It is the most common cardiovascular disorder B. The incidence increases with age C. The systolic pressure is greater than or equal to 140 mm Hg

A client is very much 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. The best response would be: Select all that apply. A. Maintain normal weight B. Increase LDL levels C. Control hypertension D. Control blood glucose levels E. Decrease smoking

A. Maintain normal weight C. Control hypertension D. Control blood glucose levels

The extended, severe exposure of the walls of the blood vessels to the exaggerated pressure that occur in malignant hypertension cause injuries to the walls of the arterioles. Blood vessels in the renal system are particularly vulnerable to this type of damage. Because hypertension is a chronic disease and is associated with autoregulatory changes in the blood flow to major organs, what would be the initial treatment goal for malignant hypertension? A. Partial reduction in blood pressure to less critical values B. Reduction to normotensive levels of blood pressure C. Rapid decrease in blood pressure to less critical levels D. Slow, gradual decrease in blood pressure to normotensive blood pressures

A. Partial reduction in blood pressure to less critical values

A client has been diagnosed with DVT. The nurse is planning care and recognized that the client is most at risk for : A. Pulmonary embolism B. Vasculitis C. Polyarteritis nodosa D. Arterial insufficiency

A. Pulmonary embolism

Although the etiology of essential hypertension is mainly known, several risk factors have been identified. These risk factors fall under categories of constitutional risk factors and lifestyle factors. What are the primary risk factors for essential hypertension? (Select all that apply.) A. Race and excessive sodium chloride intake B. Type 2 diabetes and obesity C. Age and high intake of potassium D. Race and smoking E. Family history and excessive alcohol consumption

A. Race and excessive sodium chloride intake B. Type 2 diabetes and obesity E. Family history and excessive alcohol consumption

A 45-year-old woman with a diagnosis of multiple sclerosis comes to the clinic complaining of coldness and pain in her fingers. She says that her fingers turn blue, and then her fingers get red, and they throb and tingle. The nurse would expect what diagnosis and treatment for this patient? (Select all the apply.) A. Raynaud disease; protecting the digits from cold B. Arterial thrombosis; streptokinase C. Peripheral artery disease; aspirin D. Raynaud phenomenon; stop smoking

A. Raynaud disease; protecting the digits from cold D. Raynaud disease; stop smoking

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

A. Tearing or ripping-type pain in the chest or back

Where in the body is lipoprotein synthesized? (Select all the apply.) A. The small intestine B. The large intestine C. The pancreas D. The liver

A. The small intestine D. The liver

What drug blocks the formation of angiotensin II?

ACE inhibitors

What systems assist in short-term regulation of blood pressure.

Accomplished by the cardiovascular center of ANS, baroreceptors, and chemoreceptors.

A strong vasoconstrictor that reduce sodium excretion is?

Angiotensin II

LDL-related arteriosclerosis?

Atherosclerosis

Select the priority of care for the medical management of a client with a dissecting aortic aneurysm. A. administration of epinephrine and IV fluids B. Administration of sodium nitroprusside and beta blockers C. Administration of medication to increase blood pressure D. Administration of pain medication and anti-anxiety medication

B. Administration of sodium nitroprusside and beta blockers

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. As the nurse caring for this patient, what are the signs and symptoms you would assess for? A. Papilledema and lethargy B. Headache and confusion C. Restlessness and nervousness D. Stupor and hyperreflexia

B. Headache and confusion

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 here are predisposing risk factors to this disease. What is that major risk factor for developing atherosclerosis? A. Male sex B. Hypercholesterolemia C. Familial history of premature coronary heart disease D. Increasing age

B. Hypercholesterolemia

A 75-year-old man presents at the clinic for a routine physical checkup. He is found to be hypertensive. While taking his blood pressure in the sitting, standing, laying positions, the nurse notes that the brachial artery is pulseless at a high cuff pressure, but she can still feel it. What condition would the nurse suspect? A. Essential hypertension B. Pseudohypertension C. Orthostatic hypertension D. Secondary hypertension

B. Pseudohypertension

A 56-year-old woman present 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 included which of the following interventions? A. Surgical or fibrotherapy B. Sclerotherapy or surgery C. Trendelenburg therapy or sclerotherapy D. Surgery or Trendelenburg therapy

B. Sclerotherapy or surgery

Pressure-sensitive receptors that respond to changes in the stretch of the vessel wall are called?

Baroreceptors

How do baroreceptors help in short-term regulation of blood pressure?

Baroreceptors are pressure-sensitive receptors located in the walls of blood vessels and the heart. They respond to changes in the stretch of the vessel wall by sending impulses to cardiovascular centers in the brain stem to effect appropriate changes in heart rate and vascular smooth muscle tone.

A client who was diagnosed with hypertension is now taking medication that decreases heart rate and cardiac output. The medication is a?

Beta blocker

the ? blockers are effective in treating hypertension because they decrease heart rate and cardiac output, as they are cardioselective.

Beta-adrenergic

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Select all that apply. A. Decreasing physical activity B. Increased intake of fats and sodium C. Smoking cessation D. Weight reduction if overweight E. Dietary measures to reduce LDL levels

C, D, E

? is a serum marker for systemic inflammation.

C-reactive protein (CRP)

For people who suffer from hypertension and other diseases that affect blood pressure, important information about the status of their disease is gathered from measurements including systolic and diastolic pressures, pulse pressure, and mean arterial pressure. What is the mean arterial pressure estimated to be when the blood pressure is 130/85? A. 90 B. 95 C. 100 D. 105

C. 100 (MAP = diastolic pressure + pulse pressure/3) MAP = [85 + (130-85)/3]

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess. A. BP 140/90 and glucose in urine during 36th week B. BP 130/88 and hyperglycemia during 22nd week C. BP 160/100 and proteinuria during 30th week D. BP 90/60 and proteinuria in 2nd trimester

C. BP 160/100 and proteinuria during 30th week

Pregnancy-induced hypertension is a serious condition affecting between 5% to 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 preeclampsia-eclampsia classification of pregnancy-induced hypertension? A. Hepatocellular necrosis B. Thrombocytopenia C. HELLP syndrome D. Decreased renal filtration rate

C. HELLP syndrome

The renin-angiotensin-aldosterone system is a negative feedback system that plays a central role in blood pressure regulation. How does the end result of this feedback loop regulate blood pressure in the body? A. Vasodilates blood vessels to decrease blood pressure B. Vasoconstricts blood vessels to increase blood pressure C. Increases salt and water retention by the kidney D. Decreases salt and water retention by the kidney

C. Increases salt and water retention by the kidney

Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm terms abdominal aortic aneurysms? (Select all that apply.) A. Berry aneurysm B. Dissecting aneurysm C. Saccular aneurysm D. Fusiform aneurysm E. Bifurcating aneurysm

C. Saccular D. Fusiform

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall. These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is that most common of the vasculitides? A. Polyarteritis nodosa B. Raynaud disease C. Temporal arteritis D. Varicose veins

C. Temporal arteritis

A 69-year-old man is admitted to the hospital following a popliteal embolectomy. He asks the nurse why he had to have surgery on his leg. What is the best response by the nurse? A. the doctor wanted to look into your artery to make sure everything was okay. B. Didn't the doctor explain everything to you before your surgery? C. The artery the runs behind your knee was blocked by a blood clot, the doctor removed it. D. Your upper right leg was not getting enough blood so the doctor had to fix it.

C. The artery that runs behind your knee was blocked by a blood clot, and the doctor removed it

Elevated levels of what is associated with arterial disease?

CRP (C-reactive protein)

What are the physical effects of Raynaud phenomenon?

Changes in skin color (pallor to cyanosis Sensation of cold Changes in sensory perception (numbness & tingling) ***Followed by*** throbbing intense redness paresthesias

Transfer triglycerides to skeletal muscle, smaller than VLDLs?

Chylomicrons

Narrowing of the aorta is called?

Coarctation of the aorta

Describe the role of the endothelium in the arterial wall.

Controls transfer of molecules Controls platelet adhesion & blood clotting Modulates blood flow and vascular resistance Metabolism of hormones Regulates immune and inflammatory reactions Elaboration of factors that influence growth of other cells

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that the most likely cause of the varicosities is: A. Prolonged sitting B. Rapid weight loss C. Weak bone structure D. Heavy lifting

D. Heavy lifting

A 37-year-old woman is admitted to your unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms you would expect this patient to exhibit? A. Nervousness and periodic severe headache B. Variability in blood pressure and weight loss C. Excessive sweating and pallor D. Periodic severe headache and marked variability in blood pressure

D. Periodic severe headache and marked variability in blood pressure

In infants and children, secondary hypertension is the most common form of hypertension. What is the most common cause of hypertension in an infant? A. Cerebral vascular bleed B. Coarctation of the aorta C. Phenochromocytoma D. Renal artery thrombosis

D. Renal artery thrombosis

Venous thrombosis most commonly occurs in the lower extremities. Risk factors include which of the following? A. Stasis of blood, hypercoagulability, inflammation B. Hypocoagulability, vessel wall injury, increased pressure on deep veins C. Vessel wall injury, hypocoagulability, decreased venous blood flow D. Stasis of blood, hypercoagulability, vessel wall injury

D. Stasis of blood, hypercoagulability, vessel wall injury

The most common cause of secondary varicose veins is ?.

DVT

Describe the general mechanisms of drug therapy to lower serum LDL levels.

Decrease cholesterol production Decrease cholesterol absorption from the intestine Remove cholesterol from bloodstream

Diastolic pressure is over 90 mmHg is called?

Diastolic hypertension

How do skeletal muscles of the leg contribute to returning blood to the heart?

During muscle contraction, valves close to prevent backward flow of blood in the deep veins. During relaxation, valves open allowing blood to move into deep veins.

Describe the causation of secondary hyperlipoproteinemia.

High-calorie diets Excessive ingestion of cholesterol Diet high in triglycerides and saturated fats (All increase LDL levels)

? inhibits elements of the anticoagulant cascade and is associated with endothelial damage, which is thought to be an important first step in the development of atherosclerosis.

Homocysteine

A noninvasive way to obtain a BP measurement is?

Indirect auscultatory method

Main carrier of cholesterol?

LDL

LDL is removed from circulation either by ? or by ? cells.

LDL receptors, scavenger

An abnormal drop in blood pressure on assumption of the standing position is called?

Postural or orthostatic hypotension

? is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes.

Raynaud phenomenon

How do the kidneys play a major role in the development of secondary hypertension?

Reduced renal blood flow that occurs causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II. Angiotensin II act as a vasoconstrictor to increase peripheral vascular resistance and as a stimulus for increased aldosterone levels and sodium retention by the kidney

Systolic pressure over 140 mmHG is called?

Systolic hypertension

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are?

Temporal

How do chemoreceptors help in short-term regulation of blood pressure?

The arterial chemoreceptors are chemosensitive cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood.

How does the cardiovascular center of the ANS help in short-term regulation of blood pressure?

The cardiovascular center transmits parasympathetic impulses to the heart through the vagus nerve and sympathetic impulses to the heart and blood vessels through the spinal cord and peripheral sympathetic nerves

? is an inflammatory arterial disorder that causes thrombus formation.

Thromboangiitis obliterans

What increases renal water retention?

Vasopressin

? leads to tissue congestion, edema, and eventual impairment of tissue nutrition.

Venous insufficiency

Cholesterol deposits are called?

Xanthomas

An ? is an abnormal localized dilatation of a blood vessel.

aneurysm

? blood pressure reflects the rhythmic ejection of blood from the left ventricle into the aorta.

arterial

An aneurysm also may be ? with the first evidence of its presence being associated with vessel ?.

asymptomatic, rupture

? is a type of arteriosclerosis or hardening of the arteries

atherosclerosis

The uptake of LDL by macrophages in the arterial wall can result in the accumulation of insoluble cholesterol esters, the formation of foam cells, and the development of ?.

atherosclerosis

LDL, sometimes called the ?, is the main carrier of cholesterol.

bad cholesterol

Although the heart is the center of the cardiovascular system, ? transport blood throughout the body.

blood vessels

The ? drugs inhibit the movement of calcium into cardiac and vascular smooth muscle.

calcium channel blockers

The mean arterial pressure is determined mainly by the ? and the ?.

cardiac output, peripheral vascular resistance

Elevated levels of blood ? are implicated in the development of atherosclerosis with its attendant risk of heart attack or stroke.

cholesterol

Because ? and ? are insoluble in plasma, they are encapsulated by a stabilizing coat of water-soluble lipoproteins.

cholesterol, triglyceride

? transfer their triglycerides to the cells of adipose and skeletal muscle tissue.

chylomicrons

? lower blood pressure initially by decreasing vascular volume and cardiac output.

diuretics

An ? is a freely moving particle such as a blood clot that breaks loose and travels in the larger vessels of the circulation until lodging in a smaller vessel and occluding blood flow.

embolus

Endothelial cells form a continuous lining for the entire vascular system called the ?.

endothelium

The extracellular fluid volume and arterial blood pressure are regulated around an ? point, which represents the normal pressure for a given individual.

equilibrium

What disease is caused by LDL receptor deficiency, which prevents uptake of LDL?

familial hypercholesterolemia

Activated macrophages release ? that oxidize LDL.

free radicals

Many types of primary hypercholesterolemia have a ? basis.

genetic

HDL is synthesized in the liver and often is referred to as the ?.

good cholesterol

Aortic dissection involves ? into the vessel wall with longitudinal tearing of the vessel wall to form a blood-filled channel.

hemorrhage

Derived from the metabolism of dietary methionine?

homocysteine

Medical term for elevated levels of blood cholesterol?

hypercholesterolemia

The major risk factor for atherosclerosis is ?.

hypercholesterolemia

? refers to an area of ischemic necrosis in an organ produced by occlusion of its arterial blood supply or its venous drainage.

infarction

Considerable interest in the role of ? in the etiology of atherosclerosis has emerged over the last few years.

inflammation

The term ? denotes a reduction in arterial flow to a level that is insufficient to meet the oxygen demands of the tissues.

ischemia

Hypertension is a major risk factor or ? stroke and intracerebral ?.

ischemia, hemorrhage

The role that the ? play in blood pressure regulation is emphasized by the fact that many hypertension medications produce their blood pressure-lowering effects by increasing ? and ? elimination.

kidneys, sodium, water

An elevation in blood pressure increase the workload of the ? by increasing the pressure against which the heart must pump as it eject blood into the systemic circulation.

left ventricle

There are two sites of lipoprotein synthesis: the ? and the ?

small intestine, liver

Virchow described the triad that has come to be associated with venous thrombosis: ?, ?, and ?.

stasis of blood, increased blood coagulation, vessel wall injury

Elevated pressures during ? favor the development of left ventricular hypertrophy, increased myocardial oxygen demands, and eventual left heart failure.

systole

The pressure at the height of the pressure pulse is ? pressure, and the lowest pressure is the ? pressure.

systolic, diastolic

Venous ? prevent the retrograde flow of blood.

valves

Small vessel ? are sometimes associated with antineutrophil cytoplasmic antibodies.

vasculitides

Necrosis of the blood vessel wall is called?

vasculitis

Vascular smooth muscle cells, which form the predominant cellular layer in the tunica media, produce ? or ? of blood vessels.

vasoconstriction, dilation

The renin-angiotensin-aldosterone system plays a central role in blood pressure by increasing ? and ?.

vessel constriction, fluid retention