Ch. 23- Learning: Vascular Disorders

A patient presents with dizziness, nosebleeds, and a headache. Which medical condition should the nurse suspect? A. Hypertension B. Thrombosis C. Thoracic outlet syndrome D. Chronic venous insufficiency (CVI)

A. Hypertension - A majority of the time an individual with hypertension will have no overt symptoms of the disorder. Hypertension usually goes undetected until identified by a healthcare provider, often during a routine physical exam. Symptoms such as dizziness, nosebleeds, headaches, facial flushing, and blood spots in the eyes are rare until blood pressure is extremely high. - Thrombosis manifests as swelling and pain. - Chronic venous insufficiency (CVI) is generally associated with leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. - With thoracic outlet syndrome, symptoms are related to poor blood flow or decreased nerve function. Not only will there be symptoms distal from the outlet, there will be ramifications in the neck and shoulder area.

Which body system helps develop hypertension in response to increased stress and high salt intake? A. Sympathetic nervous system (SNS) B. Renin-angiotensin-aldosterone system (RAAS) C. Enteric nervous system D. Parasympathetic nervous system

A. Sympathetic nervous system (SNS) - The sympathetic nervous system (SNS) has a role in the development of HTN. Lifestyle factors, such as increased stress and high salt intake, also contribute to higher sympathetic nervous system (SNS) activity. - The enteric nervous system controls gastrointestinal activity. - The parasympathetic nervous system is not associated with high blood pressure. - Alcohol consumption appears to activate the RAAS and cause a prolonged elevation of plasma renin and angiotensin II.

The nurse is teaching a patient diagnosed with stage I hypertension about lifestyle changes that may help lower blood pressure. Which patient statement indicates the need for further teaching? A. "I will have an alcohol beverage on the weekends." B. "I will use salt only in the preparation of food." C. "I will remove the skin from chicken before I cook it." D. "I will increase my walking to a mile daily."

B. "I will use salt only in the preparation of food." - The first step in treating chronic hypertension (HTN) is to implement therapeutic lifestyle changes, such as restricting sodium intake. The patient should be instructed to eliminate all added salt to foods and to consume foods that are low in sodium content. The therapeutic lifestyle changes are the same as those for other cardiovascular disorders. - Increasing physical activity, and decreasing consumption of saturated fat and cholesterol, and limiting alcohol intake will help decrease blood pressure.

Which ethnic group has the highest percentage of individuals with hypertension? A. Asian American B. African American C. Hispanic D. Caucasian

B. African American The fact that ethnic groups differ in their susceptibility to hypertension (HTN) also suggests a genetic component to the disease. African Americans have the highest rate of HTN among ethnic groups. Caucasians (non-Hispanic White) are less likely to have high blood pressure than are non-Hispanic Blacks. Asians are less likely to have HTN than are non-Hispanic Blacks and non-Hispanic Whites. Non-Hispanic Black men tend to have higher blood pressure than do non-Hispanic Black women.

A patient with Raynaud disease experiences numbness, tingling, and an ashy white appearance of the hands. Which medication should the nurse anticipate being prescribed as the primary pharmacologic treatment for this patient? A. Anti-inflammatory medication B. Calcium channel blocker C. Antimigraine medication D. Beta blocker

B. Calcium channel blocker - The primary pharmacologic treatment for Raynaud disease is a calcium channel blocker, such as nifedipine, which dilates arterioles that spasm. - Beta blockers will be of no benefit for treatment of Raynaud disease. - Antimigraine medications are a trigger for Raynaud disease. - Anti-inflammatory medications are used to treat secondary Raynaud disease.

Which substance is deposited on arterial walls when low-density lipoprotein (LDL) levels are elevated that promotes the development of atherosclerosis? A. Plaque B. Cholesterol C. Calcium D. Triglycerides

B. Cholesterol - Low-density lipoproteins (LDLs) are the primary carriers of cholesterol. Elevated levels of LDL promote atherosclerosis, because LDL deposits cholesterol on the arterial walls. (LDL can also be considered a mnemonic for "less desirable lipoproteins"). Plaque begins to form when white blood cells attack the LDL on the damaged endothelium. - Calcium is a component of atheroma along with macrophages, lipids, and fibrous connective tissue. - Triglycerides are transported to adipose tissue for storage by very low-density lipoproteins. - Steps in formation of atherosclerosis: The process begins when endothelial cells are damaged. When LDL cholesterol reaches the damaged endothelium, white blood cells attack the LDL, and plaque begins to form.

The nurse learns that a 28-year-old woman currently takes oral contraceptives. Which medical condition should the nurse identify that this patient is at risk of developing? A. Raynaud disease B. Deep venous thrombosis C. Coarctation of the aorta D. Thoracic outlet syndrome

B. Deep venous thrombosis - Chronic venous insufficiency (CVI) is a long-term disorder that most commonly occurs as a result of blood clots in the deep veins of the legs. Oral contraceptives increase the risk for the development of blood clots in the legs. - Cigarette smoking has a direct effect on the blood vessels, which increases the risk of Raynaud disease. - Coarctation of the aorta is normally a congenital defect of a narrow aorta. - Thoracic outlet syndrome is precipitated by heavy lifting or working as a laborer.

The nurse learns that a patient has a body mass index (BMI) of 31 and has a sedentary lifestyle. Which health problem should the nurse identify that this patient is at most risk for developing? A. Thrombosis B. Hypertension C. Thoracic outlet syndrome D. Chronic venous insufficiency (CVI)

B. Hypertension Obesity is a contributing factor for hypertension (THN). Disruption of the RAAS mechanism may contribute to the close link between HTN and obesity. Obesity leads to increased expression of angiotensin II in adipocytes, especially in visceral fat, and a reduced level of plasma adiponectin. It appears that adiponectin may be a key molecule linking obesity to HTN as well as to the metabolic syndrome. Lifestyle factors, such as a lack of physical exercise, and obesity contribute to a higher sympathetic nervous system (SNS) activity, which has a role in the development of hypertension. While obesity and/or sedentary lifestyle could be risk factors for the other conditions, the patient is at greatest risk for hypertension.

A patient presents with chest pain, dyspnea, and a blood pressure of 220/140 mmHg after using cocaine. Which medical condition is most likely associated with this patient's symptoms? A. Thoracic outlet syndrome B. Hypertensive emergency C. Chronic venous insufficiency (CVI) D. Thrombosis

B. Hypertensive emergency - A hypertensive emergency is a relatively rare condition that occurs when diastolic pressure exceeds 120 mmHg, and there is evidence of target organ damage. This can be a result of cocaine ingestion, which causes an increase in sympathetic nervous system (SNS) activity. The most common symptoms of hypertensive emergency are chest pain and dyspnea. - Thrombosis generally manifests as swelling and pain. - Chronic venous insufficiency (CVI) is generally associated with leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. - With thoracic outlet syndrome, symptoms are related to poor blood flow or decreased nerve function. Not only will there be symptoms distal from the outlet, there will also be manifestations in the neck and shoulder area.

Which characteristic is commonly seen in individuals with a family history of hypertension? A. Alcoholism B. Increases in epinephrine and norepinephrine C. African American ethnicity D. Obesity

B. Increases in epinephrine and norepinephrine - An increase in norepinephrine and epinephrine are frequently seen in individuals with a family history of hypertension (HTN). - Obesity and alcoholism are considered modifiable risk factors and do not have a genetic component. - African Americans have the highest rate of HTN among ethnic groups, but other ethnic groups are also at a higher risk of developing HTN.

Which medical condition is usually prevented by angioplasty with stent placement? A. Infection B. Infarction C. Ischemia D. Inflammation

B. Infarction If severe plaque is identified in a critical artery, such as one serving a major artery, the vessel must be reopened to prevent infarction. Angioplasty with stent placement is the minimally invasive procedure usually employed for this purpose. Angioplasty is performed in the presence of ischemia to prevent infarction. Some stents, used during angioplasty, are medically coated with anti-inflammatory medications to reduce the risk of inflammation. Angioplasty is not used to prevent infection.

A patient has a blood pressure of 110/70 mmHg. Which category of blood pressure should the nurse document? A. Stage 1 hypertension B. Normal blood pressure C. Elevated blood pressure D. Stage 2 hypertension

B. Normal blood pressure - Normal blood pressure is classified as a systolic pressure <120 mmHg and a diastolic pressure <80 mmHg. - Elevated blood pressure is classified as a systolic pressure between 121-129 mmHg and a diastolic pressure >80 mmHg. - Stage 1 hypertension is classified as a systolic pressure from 130-139 mmHg and a diastolic pressure 80-89 mmHg. - Stage 2 hypertension is classified as a systolic pressure of at least 140 mmHg and a diastolic pressure of at least 90 mmHg.

While performing a physical exam on a patient, the nurse notices that both the diastolic and systolic blood pressures are elevated at 170/110 mmHg. Which lifestyle modification should the nurse suggest to the patient that could lower both diastolic and systolic blood pressures? A. Exercise frequently B. Reduce alcohol consumption C. Decrease stress D. Lose weight

B. Reduce alcohol consumption - The sympathetic nervous system (SNS) is activated after the consumption of alcohol, causing the fight-or-flight response and elevated blood pressure. Reducing alcohol consumption can lower both systolic and diastolic pressure. Other mechanisms are likely involved in the pathogenesis of alcohol-related hypertension. - Decreasing stress, losing weight, and frequent exercise will have a positive effect on hypertension; however, they are only effective at lowering the systolic pressures.

The nurse is concerned that a patient is at risk for rupture of atherosclerotic plaque in their legs. For which health problem should the nurse plan care for this patient? A. Claudication B. Thrombosis C. Aneurysm D. Arterial dissection

B. Thrombosis - Plaque rupture is usually followed by thrombosis (blood clot) and possibly infarction, which is complete obstruction of a vessel. - Claudication occurs when blood flow in the skeletal muscle is insufficient. - Aneurysm is due to a bulging of a weak arterial wall, in which the combination of plaque and hypertension make up the primary cause. - Arterial dissection is caused by a tear in the tunica intima, in which the blood vessel splits, and blood goes between the inner and outer layers.

Atherosclerosis begins when endothelial cells are damaged. When low-density lipoprotein (LDL) cholesterol reaches the damaged endothelium, which type of cell attacks the LDL causing plaque to form? A. Stem cells B. White blood cells C. Red blood cells D. Platelets

B. White blood cells - When low-density lipoprotein (LDL) cholesterol reaches the damaged endothelium, white blood cells attack the LDL and plaque begins to form. - The region of plaque, called an atheroma, consists of calcium, macrophages, lipids, and fibrous connective tissue.

A patient has an elevated blood pressure. Which hormone should the nurse consider as a cause for this condition? A. Norepinephrine B. Cortisol C. Aldosterone D. Adrenaline

C. Aldosterone - Angiotensin II is a potent vasoconstrictor that returns blood pressure back to normal. Angiotensin II also causes the release of aldosterone from the adrenal glands. Aldosterone helps the body retain sodium, which increases blood volume and raises blood pressure. - Cortisol, adrenaline, and norepinephrine are also excreted by the adrenal glands but are not associated with the renin-angiotensin-aldosterone system (RAAS).

The nurse notes that a patient with a slightly low blood pressure has a normal pressure several hours later. Which hormone helped return this patient's blood pressure back to normal? A. Renin B. Angiotensin I C. Angiotensin II D. Adiponectin

C. Angiotensin II - Angiotensin II is a potent vasoconstrictor that returns blood pressure back to normal. - Renin converts angiotensinogen to angiotensin I. - Adiponectin is released from adipocytes and has anti-inflammatory and anti-plaque properties.

Plaque formation can occur in any of the blood vessels throughout the body. Which location affected with plaque formation can lead to stroke? A. Vessels in the extremities B. Kidneys C. Carotid arteries D. Heart

C. Carotid arteries If plaque is found in the carotid arteries, it is referred to as carotid artery disease, which can lead to stroke. Plaque found in the heart, kidneys, or vessels of the extremities will most likely lead to medical conditions other than stroke.

The nurse is caring for a patient whose leg veins are unable to return adequate blood to the heart. The nurse should recognize that the patient has which condition? A. Coarctation of the aorta B. Hypertension C. Chronic venous insufficiency (CVI) D. Thoracic outlet syndrome

C. Chronic venous insufficiency (CVI) - Chronic venous insufficiency (CVI) is a disorder in which the veins are unable to return adequate blood to the heart. It is a long-term disorder that most commonly occurs as a result of blood clots in the deep veins of the leg or deep vein thrombosis (DVT). - Hypertension occurs when atherosclerosis progressively blocks blood flow in major arteries. - Coarctation of the aorta is characterized by a narrow aorta and is usually identified at birth. - Thoracic outlet syndrome occurs by the upper body meeting resistance on a frequent basis.

The nurse prepares to assess a patient with atherosclerosis. For which reason should the nurse use a stethoscope when assessing this patient? A. Detect unequal blood flow B. Rule out cardiac involvement C. Detect the presence of a bruit D. Rule out renal involvement

C. Detect the presence of a bruit - Diagnosis of peripheral artery disease and atherosclerosis is accomplished by a thorough physical examination and several diagnostic tests. Listening with a stethoscope over specific arteries may help detect a bruit, a whooshing sound that occurs as blood tumbles over and around areas of plaque buildup. - Checking pulses in the extremities is used to detect unequal blood flow. - A treadmill test with echocardiography may be prescribed to detect cardiac involvement. - If renal involvement is suspected, kidney function tests may be prescribed.

The nurse is caring for a patient with chronic venous insufficiency (CVI). The nurse should recognize that blood often has difficulty moving in which direction? A. From the heart to the lungs B. From the heart to the brain C. From the legs to the heart D. From the heart to the upper extremities

C. From the legs to the heart The central problem in chronic venous insufficiency (CVI) begins with low pressure that is normally present in the venous system. With such low pressure, blood sometimes has difficulty moving from the legs to the heart, especially when the person is standing.

A patient with swollen veins in the lower left leg has developed a leg ulcer. Which medical condition should the nurse consider as contributing to this ulcer? A. Deep vein thrombosis B. Obesity C. Phlebitis D. Diabetes

C. Phlebitis - Phlebitis refers to swelling of a vein or veins and is a contributing risk factor for the development of leg ulcers. - Obesity and deep vein thrombosis are risk factors for leg ulcers, but are not defined as swelling of a vein or veins. - Diabetes may complicate this condition; however, this is not considered to be a direct risk factor for leg ulcers.

The nurse notes that a patient has hypertension. Which type of hypertension should the nurse recall is the most common and is caused by many factors? A. Secondary hypertension B. Malignant hypertension C. Primary hypertension D. White coat hypertension

C. Primary hypertension - Primary hypertension is thought to account for about 90% of the cases diagnosed and has been associated with a large number of factors including genetics, age, race, diet (especially sodium intake), smoking, alcohol consumption, and sedentary lifestyle. - Malignant hypertension is a relatively rare condition that occurs when diastolic pressure exceeds 120 mmHg. - If there is an identifiable cause, hypertension is classified as secondary hypertension. - White coat hypertension occurs when a patient experiences fight-or-flight symptoms around medical workers.

Which medical condition can be caused by plaque formation in the carotid arteries? A. Myocardial infarction B. Chronic kidney disease C. Stroke D. Peripheral vascular disease

C. Stroke If plaque is found in the carotid arteries, it is referred to as carotid artery disease, which can lead to stroke. Plaque found in the heart, kidneys, or vessels of the extremities will lead to medical conditions other than stroke.

The nurse notes a bruit present over a patient's carotid artery. Which medical condition should the nurse suspect this patient is experiencing? A. Thrombosis B. Aneurysm C. Hypertension D. Atherosclerosis

D. Atherosclerosis - Diagnosis of peripheral artery disease and atherosclerosis is accomplished by a thorough physical examination and several diagnostic tests. Listening with a stethoscope over certain arteries may help detect a bruit, a whooshing sound that occurs as blood tumbles over and around areas of plaque buildup. - Thrombosis is diagnosed through a d-dimer and imaging tests. - Hypertension is diagnosed through direct measurement. - Aneurysm is diagnosed through imaging procedures.

Which medical condition in childhood is likely to develop in individuals with homozygous familial hypercholesterolemia? A. Chronic renal disease B. Chronic obstructive pulmonary disease (COPD) C. Alzheimer disease D. Cardiovascular disease

D. Cardiovascular disease - The genetic nature of atherosclerosis is evidenced by individuals who inherit familial hypercholesterolemia, a condition in which the blood contains extremely high levels of cholesterol. Individuals with homozygous familial hypercholesterolemia develop severe cardiovascular disease in childhood and often die in their mid-30s. - Atherosclerosis is said to be a risk factor for Alzheimer disease and chronic renal disease, but not until later in life. - Atherosclerosis does not influence the development of chronic obstructive pulmonary disease (COPD).

A patient with hypertension has been prescribed an angiotensin-converting enzyme (ACE) inhibitor medication. Which effect does this class of medication have on the body? A. Causes vasoconstriction B. Increases the formation of angiotensin II C. Increases aldosterone secretion D. Causes more sodium to be excreted

D. Causes more sodium to be excreted Drugs blocking the renin-angiotensin-aldosterone system (RAAS) have become first-line drugs in treating both hypertension and heart failure. The primary medications in this class block angiotensin-converting enzyme (ACE). Blocking ACE reduces the formation of angiotensin II, resulting in less vasoconstriction and less sympathetic nervous system (SNS) activation, thus lowering blood pressure. The blocking of angiotensin II also lowers aldosterone secretion, which in turn allows more sodium to be excreted. The increase in sodium excretion results in decreased arterial wall pressure.

A patient is experiencing swelling of the lower leg and leg pain while standing. Which medical condition should the nurse consider this patient is experiencing? A. Raynaud disease B. Thoracic outlet syndrome C. Hypertension D. Chronic venous insufficiency (CVI)

D. Chronic venous insufficiency (CVI) General symptoms occurring with chronic venous insufficiency (CVI) include leg cramps and pain that worsens on standing, edema of the leg or ankle, thickening or discoloration of the skin on the calves, and heaviness or weakness in the legs. Three conditions closely associated with CVI are chronic leg ulcers, varicose veins, and deep vein thrombosis.

While performing an assessment, the nurse suspects a deep vein thrombosis (DVT). Which blood test should the nurse expect to be ordered? A. Complete blood count (CBC) B. Hemoglobin and hematocrit C. Prothrombin time-International Normalized Ratio (PT-INR) D. D-dimer

D. D-dimer - If a deep vein thrombosis (DVT) is suspected, a D-dimer test may be prescribed. A positive D-dimer test indicates the presence of abnormally high amounts of fibrin degradation products in the blood. This suggests that a high level of clot formation and breakdown is occurring. - A complete blood count (CBC) will not be of any use for blood clot indication. - A PT-INR is used to help diagnose the cause of unexplained bleeding and if anticoagulant medication is effective. - Hemoglobin and hematocrit measure the volume of red blood cells compared to the total blood volume.

A patient is diagnosed with arteriosclerosis. Which medical condition should the nurse identify as a nonmodifiable risk factor for this disorder? A. Diabetes B. Hypertension C. Obesity D. Hypercholesterolemia

D. Hypercholesterolemia - The genetic nature of atherosclerosis is evidenced by people who inherit familial hypercholesterolemia, a condition in which the blood contains extremely high levels of cholesterol. - Diabetes, obesity, and hypertension are all classified as modifiable risk factors for atherosclerosis.

Which type of lipid is the primary carrier of cholesterol and promotes the development of atherosclerosis when levels are elevated? A. Very low-density lipoproteins B. High-density lipoproteins C. Triglycerides D. Low-density lipoproteins

D. Low-density lipoproteins Low-density lipoproteins (LDLs) are the primary carriers of cholesterol. Elevated levels of LDLs promote atherosclerosis because LDL deposits cholesterol on the arterial walls. LDL can also be considered a mnemonic for "less desirable lipoproteins". Triglycerides are transported to adipose tissue for storage by very low-density lipoproteins. High-density lipoproteins help clear cholesterol from the arteries, transporting them to the liver for excretion. Very low-density lipoproteins are transformed into LDL molecules after triglycerides have been transported to adipose tissue. When it comes to LDLs, think, "we want low"; for HDLs, think, "we want high."

A patient has a blood pressure of 136/84 mmHg. Which advice should the nurse give to this patient? A. Increase consumption of saturated fat and cholesterol B. Decrease physical activity C. Increase fluid intake D. Restrict sodium

D. Restrict sodium - The first step in treating chronic hypertension (HTN) is to implement therapeutic lifestyle changes, such as restricting sodium intake. Minor to moderate HTN may respond to therapeutic lifestyle changes without the need for medications. The therapeutic lifestyle changes are the same as those for other cardiovascular disorders. - Increasing fluid intake, decreasing physical activity, and increasing consumption of saturated fat and cholesterol will all increase blood pressure.