Chapter 26: Disorders of Blood Flow and Blood Pressure Regulation

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states: "Capillaries permit the exchange of material between the blood and interstitial fluid." "Veins have a three-layered wall with a thick tunica media, which gives it the properties of contractility and elasticity." "Venules transport blood away from the heart and help control blood pressure." "Arteries include internal valves to aid in the unidirectional flow of blood toward the heart."

"Capillaries permit the exchange of material between the blood and interstitial fluid." Capillaries have thin walls that permit the exchange of materials between blood and interstitial fluid. Arteries have a three-layer wall with a thick tunica media. Arterioles transport blood away from the heart and help control blood pressure. Veins have internal valves.

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? "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy." "By avoiding salt, staying active and minimizing weight gain, you can prevent this during your pregnancy." "Essentially, experts don't really know why so many pregnant women develop high blood pressure." "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you."

"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 cannot necessarily be avoided by lifestyle modification. It can be pernicious to both the mother and the fetus.

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease? "I should stay in bed with my legs elevated." "I don't need to monitor my blood pressure." "Diabetes mellitus has no effect on my condition." "I should have my LDL monitored."

"I should have my LDL monitored." Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease the considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.

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? "Cholesterol sticks to the vessel wall and reduces the vessel's diameter." "HDL stimulates endothelial cell dysfunction." "Dietary fats adhere to the vessel wall and clog the artery." "LDL and VLDLs stimulate endothelial cell dysfunction."

"LDL and VLDLs stimulate endothelial cell dysfunction." 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.

An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate? "Everyone over the age of 50 tends to have their blood pressure creep up over the years." "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." "Your heart has to work harder to pump blood through your vessels as you get older." "If you slow down and rest more, your blood pressure will more than likely return to its normal level."

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." Systolic blood pressure rises almost linearly between 30 and 84 years of age, whereas diastolic pressure rises until 50 years of age and then levels off or decreases. This rise in systolic pressure is thought to be related to increased stiffness of the large arteries. With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant.

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? 140 mm Hg or higher 130 to 139 mm Hg 120 to 129 mm Hg 119 mm Hg or lower

140 mm Hg or higher 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 mean arterial pressure is: Systolic pressure alone Diastolic pressure alone 60% of diastolic pressure and 40% of systolic pressure 50% of diastolic pressure and 50% of systolic pressure

60% of diastolic pressure and 40% of systolic pressure Mean arterial pressure is not the average of systolic and diastolic pressures. It is calculated as 60 percent diastolic and 40 percent systolic pressures, since diastole has a longer duration compared to systole.

Which client is at greatest risk for orthostatic hypotension? A 66-year-old postoperative client on bed rest A 20-year-old pregnant client at 36 weeks' gestation A 42-year-old male client with history of pulmonary embolism A 70-year-old female client who has taken the same antihypertensive medication for 10 years

A 66-year-old postoperative client on bed rest Postoperative clients who have been immobile are at greatest risk for developing orthostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.

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 Syncope The pulse is unobtainable in one or both arms Hemiplegia

A pulsating mass in the abdomen 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.

When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Oxidized free radicals produce toxic metabolic waste that can kill liver cells. Activated cells roam the vascular system looking for inflammatory cells to engulf.

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor? Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism Increased sympathetic stimulation by the autonomic nervous system (ANS) Coarctation of the client's aorta

Activation of the renin-angiotensin-aldosterone mechanism Renovascular hypertension refers to hypertension caused by reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. It is the most common cause of secondary hypertension, accounting for 1% to 2% of all cases of hypertension. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II. Angiotensin II, in turn, acts as a vasoconstrictor to increase peripheral vascular resistance and as a stimulus for increased aldosterone levels and sodium retention by the kidney. One or both of the kidneys may be affected. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.

A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure? Coarctation of the aorta Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism Increased sympathetic stimulation by the autonomic nervous system

Activation of the renin-angiotensin-aldosterone mechanism The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation? Analgesics and use of a pneumatic compression device Massage followed by vascular surgery Frequent ambulation and the use of compression stockings Anticoagulation therapy and elevation of the leg

Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT. Interventions that are used to prevent DVT (ambulation; compression stockings; compression devices) may be harmful when a DVT is present. Surgery is not normally required, and massage has the potential to dislodge a DVT.

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels? Arterioles Aorta Capillaries Venules

Arterioles Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries.

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. Chemoreceptors Cardiovascular centers Baroreceptors Neural pathways

Baroreceptors 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.

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 140/90 and glucose in the urine during the 36th week of pregnancy Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy Blood pressure 90/60 and proteinuria in the second trimester

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy 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.

The nurse knows that which statements regarding the physiology of blood pressure are accurate? Select all that apply. Blood pressure is very variable. Blood pressure is poorly regulated. Blood flow is equally vital to all body organs. Constant elevation of blood pressure can be lethal. A decrease in blood flow can be an immediate threat to life.

Blood pressure is very variable. Constant elevation of blood pressure can be lethal. A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain, and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels, and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation? C-reactive protein Homocysteine Lipoprotein(a) Triglycerides

C-reactive protein C-reactive protein is a serum marker for systemic inflammation. Elevated homocysteine levels inhibit elements of the anticoagulation cascade and are associated with endothelial damage. Lipoprotein(a) is similar to LDL and can cause atherosclerosis by promoting foam cell formation and the deposition of cholesterol in atherosclerotic plaques. Triglycerides are not associated with inflammation.

A client's initial blood pressure on admission to the outpatient clinic is 190/120 mm Hg. Which action by the clinic staff is most appropriate at this time? Calling an ambulance to take the client to the emergency department Taking a more complete history to try to identify what is stressing this client Asking the client if he or she has recently changed the diet to include more high-sodium foods Performing a complete physical exam and allowing the client to calm down and rest

Calling an ambulance to take the client to the emergency department Hypertensive emergency is characterized by sudden, marked elevations of blood pressure (>180/120 mm Hg) complicated by evidence of acute or worsening target organ damage. It is critical that emergent interventions be implemented to return blood pressure to safe levels to prevent permanent organ dysfunction or death. The immediate need here is for emergent care to lower blood pressure. The history and complete physical exam can occur after the client's blood pressure has returned to a safer level. Then the client can be taught about modifiable risk factors and how to keep blood pressure under control by changing lifestyle habits.

A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure? Cardiac output and systemic vascular resistance Heart rate and peripheral resistance Blood volume and renal blood flow Myocardial contractility and arteriolar constriction

Cardiac output and systemic vascular resistance The mean arterial blood pressure is determined mainly by the cardiac output (stroke volume × heart rate) and the peripheral vascular resistance and can be expressed as the product of the two (mean arterial blood pressure = cardiac output × peripheral vascular resistance). The peripheral vascular resistance reflects changes in the radius of the arterioles as well as the viscosity or thickness of the blood.

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. Limit alcohol consumption.

Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption. 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 vascular changes can occur in older adults because of the increase in blood pressure during the aging process? Decreased elasticity in arterial connective tissue Increased elasticity in arterial connective tissue Decreased elasticity in venous connective tissue Increased elasticity in venous connective tissue

Decreased elasticity in arterial connective tissue With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and afterload. Elasticity does not increase in arterial tissue or venous tissue.

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate? The endocardium over an acute myocardial infarction Deep vein thrombophlebitis of the leg An atherosclerotic plaque in the aorta The hepatic vein in chronic passive congestion of the liver

Deep vein thrombophlebitis of the leg Deep vein thrombosis (DVT) may be a precursor to pulmonary embolism. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT.

A client with persistent primary hypertension is noncompliant with the currently prescribed antihypertensive due to adverse effects. Which antihypertensive medications might the health care provider select to use as alternatives to treat the client's hypertension? Select all that apply. Direct-acting vasodilators Angiotensin receptor agonists Alpha-adrenergic blockers Beta-adrenergic agonists Centrally acting adrenergic agonists

Direct-acting vasodilators Alpha-adrenergic blockers Centrally acting adrenergic agonists There are several groups of antihypertensive medications having different mechanisms of action. Alpha-adrenergic blockers inhibit adrenergic stimulation of alpha-1 receptors that mediate vasoconstriction. Centrally acting adrenergic agonists decrease adrenergic stimulation emanating from the central nervous system. Direct-acting vasodilators, as their name implies, mediate vasodilation by direct action on vascular smooth muscle. Combinations of these drugs are used frequently, as giving lower doses of two or three drugs working by different mechanisms will often achieve good blood pressure control with minimal side effects. Angiotensin-receptor agonists and beta-adrenergic agonists would raise rather than lower blood pressure.

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? Echocardiogram Ultrasound of the kidney CT of the head Chest x-ray

Echocardiogram 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.

An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement? Contacting the health care provider immediately Keeping the client in a supine position throughout the day Encouraging the client to maintain hydration throughout the day Administering oxygen as prescribed

Encouraging the client to maintain hydration throughout the day Significant drops in systolic blood pressure on assumption of the upright position (orthostatic hypotension) is more common in older adults due to compensatory cardiovascular mechanisms that are delayed or insufficient. Appropriate interventions by the nurse include encouraging the client to change positions slowly to decrease the risk of falls. Measures designed to help people prevent symptomatic orthostatic drops in BP include gradual ambulation to allow the circulatory system to adjust. Correcting the fluid deficit may help. Avoiding excess diuresis, diaphoresis, or loss of body fluids will help. There is no indication that the physician needs to be contacted, that the client needs to be placed in a supine position, or that oxygen needs to be administered at this time.

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise? Exercise is not recommended in this population. Clients with intermittent claudication should exercise only their arms. Aerobic exercise is not recommended but isometric exercise is. Exercise can increase blood vessel growth and help to decrease symptoms.

Exercise can increase blood vessel growth and help to decrease symptoms. 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.

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as: Fatty streak Fibrous atheromatous plaque Complicated lesion Thrombus

Fibrous atheromatous plaque The lesions associated with atherosclerosis are of three types — the fatty streak, the fibrous atheromatous plaque, and the complicated lesion. Fatty streaks are thin, flat, yellow intimal discolorations. The fibrous atheromatous plaque grows larger and proliferates into the smooth muscle. As they increase in size, they encroach on the lumen of the artery. More advanced complicated lesions contain hemorrhage, ulceration, and scar deposits and can cause thrombus formation that may occlude the vessel.

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 trans fats, 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 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 trans fats. Testing for familial hypercholesterolemia is not a modifiable risk factor.

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? Papilledema and lethargy Headache and confusion Restlessness and nervousness Stupor and hyperreflexia

Headache and confusion 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.

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 Familial history of premature coronary heart disease Increasing age

Hypercholesterolemia 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.

A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is: History of myocardial infarction Elevated HDL cholesterol Heart failure Hypertension

Hypertension Constant high blood pressure damages arterial walls and promotes formation and rupture of plaque, with subsequent stroke and myocardial infarction. Atherosclerosis can also contribute to heart failure. Elevated HDL cholesterol would mitigate the development of atherosclerosis.

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: 55 years of age Being male Family history of heart disease Hypertension

Hypertension 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 pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following? Kawasaki disease Takayasu arteritis Microscopic polyangiitis Granulomatosis with polyangiitis (formerly Wegener's granulomatosis)

Kawasaki disease Kawasaki disease involves large, medium-sized, and small arteries (frequently the coronaries) and usually occurs in small children. Takayasu arteritis, a large vessel vasculitis, is a granulomatous inflammation of the aorta, usually in people younger than 50 years of age. Microscopic polyangiitis and granulomatosis with polyangiitis, both small vessel vasculitides, involve the respiratory and renal systems.

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 HDL VLDL IDL

LDL 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.

Which lipoprotein is the main carrier of cholesterol? Intermediate-density lipoprotein (IDL) High-density lipoprotein (HDL) Low-density lipoprotein (LDL) Very-low-density lipoprotein (VLDL)

Low-density lipoprotein (LDL) Although all of the lipoproteins contain cholesterol and triglycerides, LDL is the main carrier of cholesterol.

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 temperature and show him how much higher it is when he is smoking. Measure his blood pressure and show him how much higher it is when he is smoking. Measure his pulse and show him how much lower it is when he is smoking. Have him listen to his heart for the obvious murmur that presents when smoking.

Measure his blood pressure and show him how much higher it is when he is smoking. Although a relationship between smoking and hypertension has not been established, vasoconstriction from nicotine in cigarette smoke will raise blood pressure. Elevated blood pressure and cigarette smoking are independent risk factors for heart disease.

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? Nervousness and periodic severe headache Variability in blood pressure and weight loss Excessive sweating and pallor Periodic severe headache and marked variability in blood pressure

Periodic severe headache and marked variability in blood pressure Like adrenal medullary cells, the tumor cells of a pheochromocytoma produce and secrete the catecholamines epinephrine and norepinephrine. The hypertension that develops is a result of the massive release of these catecholamines. Their release may be paroxysmal rather than continuous, causing periodic episodes of headache, excessive sweating, and palpitations. Headache is the most common symptom and can be quite severe. Nervousness, tremor, facial pallor, weakness, fatigue, and weight loss occur less frequently. Marked variability in blood pressure between episodes is typical.

Which goal is a priority for a nurse caring for a client diagnosed with orthostatic hypotension? Encouraging a low-fat diet Preventing falls Supporting an exercise program Monitoring for signs of diabetes mellitus

Preventing falls Orthostatic hypotension is an abnormal decrease in systolic and diastolic blood pressure that occurs upon standing. Dizziness and syncope are frequent consequences. Treatment includes correcting possible causes, and assisting the client to compensate for the disorder and prevent falls and injuries, and to avoid circumstances that promote vasodilation or loss of body fluids. Peripheral neuropathy of diabetes can impede autonomic reflex responses to decreases in blood pressure. Vigorous exercise in a warm environment is discouraged.

The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control? Decreases blood volume Increases osmolality of body fluids Produces prolonged increase in blood pressure Promotes retention of water

Promotes retention of water Vasopressin increases the permeability to water of the collecting ducts of the kidney, promoting renal reabsorption of water. Vasopressin is released in response to decreased blood volume or increased osmolality. Vasopressin also constricts some vascular beds. However, it cannot maintain an increase in blood pressure.

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 Acute myocardial infarction Loss of pulses in the limb Cerebrovascular accident

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 occurring 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 Thromboangiitis obliterans Vasculitis Atherosclerosis

Raynaud phenomenon Raynaud phenomenon is seen in otherwise healthy young women, and it often is precipitated by exposure to cold or by strong emotions and usually is limited to the fingers. The ischemic phase of Raynaud phenomenon is manifested by changes in skin color that progress from pallor to cyanosis and progress to hyperemia. The other conditions do not manifest these changes.

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse questions the prescription of ACE inhibitors for a client with which condition? Renal artery stenosis Coronary artery disease Diabetes Heart failure

Renal artery stenosis ACE inhibitors are contraindicated in renal artery stenosis, since blocking of efferent glomerular capillaries will interfere with normal compensation for the stenosis and cause a further frop in glomerular filtration pressure. The kidney 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.

Which adverse effect of direct-acting smooth muscle vasodilators for management of hypertension should the nurse assess for? Diarrhea Bradycardia Salt and water retention Hemorrhage

Salt and water retention Direct-acting smooth muscle vasodilators increase the capacity of the vascular compartment, causing reflex retention of salt and water as they attempt to increase blood volume. The initial fall in blood pressure induces reflex tachycardia. Diarrhea and anticoagulant action are not usually effects of the direct acting smooth muscle vasodilators.

A 56-year-old woman presents 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 includes which intervention? Surgical or fibrotherapy Sclerotherapy or surgery Trendelenburg therapy or sclerotherapy Surgery or Trendelenburg therapy Trendelenburg therapy or sclerotherapy Surgery or Trendelenburg therapy

Sclerotherapy or surgery Sclerotherapy, which often is used in the treatment of small residual varicosities, involves the injection of a sclerosing agent into the collapsed superficial veins to produce fibrosis of the vessel lumen. Surgical treatment consists of removing the varicosities and the incompetent perforating veins, but it is limited to persons with patent, deep venous channels. Sclerotherapy produces fibrosis of the vessel lumen. There is no fibrotherapy for varicose veins. There is no Trendelenburg therapy for varicose veins. There is a Trendelenburg test that is diagnostic for primary or secondary varicose veins.

Which one of the following organs are the two primary sites of lipoprotein synthesis? Spleen and liver Small intestines and bone marrow Bone marrow and endothelium Small intestine and liver

Small intestine and liver 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. Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight Decreasing physical activity Increased intake of fats and sodium

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight 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's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. How will the nurse classify this client's blood pressure? Normal Elevated Stage 1 hypertension Stage 2 hypertension

Stage 1 hypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Elevated blood pressure is systolic 120 to 129 mm Hg and diastolic less than 80 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic and should be confirmed within 2 months. Stage 2 is systolic equal to or greater than 140 mm Hg or diastolic equal to or greater than 90 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.

The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system? Sympathetic Parasympathetic Central Peripheral

Sympathetic A network of vasomotor nerves of the sympathetic component of the autonomic nervous system supplies the smooth muscle in the blood vessels. These nerves and circulating hormones are responsible for vasoconstriction of the vessel walls.

A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which reason accounts for this lack of change in the diastolic pressure? Systemic vasoconstriction maintained the diastolic pressure. Stroke volume increased with blood loss. Heart rate increased with blood loss. Blood volume rapidly increased.

Systemic vasoconstriction maintained the diastolic pressure. A decrease in blood volume with subsequent fall in blood pressure activates the sympathetic nervous system. Reflex vasoconstriction attempts to maintain blood flow to vital organs. Systolic pressure falls because a diminished blood volume exerts less force against arterial walls, but with diastole the diminished volume is sufficient to maintain pressure in a diminished vascular compartment.

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 Tonic-clonic seizures Chest pain radiating to the right arm Late hypertensive crisis

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

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head? Temporal Vertebral Ophthalmic Carotid

Temporal Giant cell (temporal) arteritis, the most common of the large vessel vasculitides, is an acute and chronic inflammation of large to small arteries. It mainly affects arteries of the head—especially the temporal arteries—but may include the vertebral and ophthalmic arteries. The most common clinical presentations are headache and tenderness over the superficial temporal artery.

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading? The client ate a hamburger 45 minutes prior to the reading. The client took her antihypertensive medication 2 hours ago. The client just smoked a cigarette. The client left work 1 hour ago.

The client just smoked a cigarette. People should be seated when blood pressure is taken, and should not have ingested caffeine or have smoked 30 minutes before the measurement.

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client? Treatment with vasoconstrictor medications may be indicated. The client must protect the entire body from cold, not just the extremities. The client can take decongestants as needed. Anxiety and stress may precipitate vasodilation in predisposed people.

The client must protect the entire body from cold, not just the extremities. Treatment measures are directed toward eliminating factors that cause vasospasm. Abstinence from smoking and protection from cold are priorities. The entire body must be protected from cold, not just the extremities. Avoidance of stress and anxiety is another important factor, as they may precipitate vascular spasm in predisposed people. Vasoconstrictor medications, such as decongestants, should be avoided. Treatment with vasodilator drugs may be indicated.

The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? Hormonal activity Humoral influence The kidneys Neural mechanisms

The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.

Which assessment finding of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? The man's blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells). The man's blood pressure is 178/102 and he has abnormal liver function tests. The man is acutely short of breath and his oxygen saturation is 87%. The man's temperature is 101.9°F (38.8°C) and he is diaphoretic (heavily sweating).

The man's blood pressure is 178/102 and he has abnormal liver function tests. Polyarteritis nodosa is associated with abnormal liver function and acute hypertension. Anemia, not elevated red cells, is a manifestation, while respiratory symptoms, diaphoresis, and fever are not noted to be accompaniments.

Which blood vessel layer is composed primarily of smooth muscle cells? Tunica externa Tunica media Tunica intima Endothelium

Tunica media 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.

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is: Pheochromocytoma Decreased renal blood flow Unknown Hyperaldosteronism

Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.

Which pathogenesis is primarily responsible for Raynaud phenomenon? Occlusion by atherosclerosis Thrombi formation blocking blood flow Vasculitides resulting from damaged vessels due to hypertension Vasospasm causing excessive vasoconstriction

Vasospasm causing excessive vasoconstriction Raynaud disease is caused by vasospasms of small distal arteries. It is caused by excessive vasoconstrictor response to stimuli that normally produce only moderate vasoconstriction.

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 Will have a direct vasoconstrictive effect on vessels of splanchnic circulation Will increase extracellular fluid and decrease venous pressure Will increase oxygen consumption of the heart

Will prevent the conversion of angiotensin I to angiotensin II 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.

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 apply ice compresses to the site of the DVT hourly ensure that the client remains on bed rest massage legs to maintain blood flow

apply sequential pneumatic compression devices to lower extremities 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.

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 decreased elasticity of the venous connective tissue increased elasticity of the arterial connective tissue increased elasticity of the venous connective tissue

decreased elasticity of the aorta and large arteries 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.

A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen? increased low-density lipoproteins increased high-density lipoproteins lowered high-density lipoproteins increased blood glucose levels

increased high-density lipoproteins 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.