Clotting and Perfusion

What is edematous?

Swollen with an excessive accumulation of fluid

Lymphangiography

X-ray exam of the vessels of the lymphatic system after injection of a substance opaque to X-rays.

Sick sinus syndrome treatment

pacemaker

What is subvolution?

A condition after childbirth where the uterus does not return to its normal size.

hypovolemic shock

A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.

neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages?

A rapid, bounding pulse A rapid, bounding pulse is observed in a client in the initial stages of septic shock. In case of hypovolemic shock, the pulse volume becomes weak and thready and circulating volume diminishes in the initial stage. In the later stages when the circulating volume has severely diminished, the pulse becomes slow and imperceptible and pulse rhythm changes from regular to irregular.

Crest syndrome (limited scleroderma)

C - calcinosis (breakthrough of calcium through skin) R - Raynaud's (spasms of blood vessels in response to hot/cold temp changes) E - Esophageal dysmotility (acid reflux / dysfunctional esophagus) S - Sclerodactyly (dino-bat fingers) T - Telangiectasia (red freckles because of dilated capillaries) ** Primary hypertension ** Doesn't have joint pain, heart/lung/kidney involvement

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?

peripheral edema, weight gain. In right-sided heart failure, blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma, which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.

The cerebral circulation receives approximately what percentage of the cardiac output?

15% The cerebral circulation receives approximately 15% of the cardiac output, or 750 mL per minute.

ALL

Acute Lymphocytic Leukemia

Contrast Phlebography (Venography)

An X-Ray exam that uses an injection of contrast material to show how blood is flowing through the veins. Used to find blood clots, identify a vein for use in a bypass procedure or dialysis access, or to assess varicose veins before surgery

A nurse is caring for a newborn that has developed a low platelet count. What could be the cause?

Decreased thrombopoietin (TPO) TPO stimulates the differentiation of platelets.

A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is:

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.

Air Plethysmography

Non-invasive exam that can quantify venous reflux and obstruction by measure volume changes in the leg used almost exclusively for medical research.

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)?

Obesity Obesity is a risk factor for DVT and PE related to venous stasis. Trauma, pacing wires, and surgery are related to endothelial damage as a risk factor for DCAT and PE.

Which of the following are characteristic signs of acute arterial embolism?

Pallor, pulselessness, and pain. The presentation of acute arterial embolism is often described as that of the seven Ps: Pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.

Lymphoscintigraphy

Special type of nuclear medicine imaging that provides special pictures of the lymphatic system, which transports fluid throughout the immune system. Often used to ID the sentinel lymph node (first node to receive the lymph drainage from a tumor).

Which factor puts a client on her first postpartum day at risk for hemorrhage?

Uterine Atony Loss of uterine tone places a client at higher risk for hemorrhage. Thrombophlebitis does not increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.

septic shock

a serious condition that occurs when an overwhelming bacterial infection affects the body

Endothelins

potent vasoconstrictors released by the endothelium of various organs

papillary muscles of the heart

string like muscles in the ventricles of the heart that control valve movement (tricuspid and mitral valve)

cardiogenic shock

Shock caused by inadequate function of the heart, or pump failure.

Disseminated Intravascular Coagulation (DIC)

Abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues.

AML

Acute Myeloid Leukemia Starts in the bone marrow (soft inner part of certain bones, where new blood cells are made), but it most often quickly moves into the blood, as well. It can sometimes spread to lymph nodes, liver, spleen, the CNS, and testicles.

Bright red bleeding following prostate surgery indicates which of the following?

Arterial Bleed Bright red bleeding with increased viscosity and numerous clots usually indicates arterial bleeding, and requires surgical intervention. Venous bleeding, which is dark red in color, may be controlled by the provider via "overinflating" the urinary catheter balloon and applying traction to the catheter so that the balloon holding the urinary catheter in place applies pressure to the prostatic fossa. It does not represent disseminated intravascular coagulation and thrombocytopenia.

A toddler with hemophilia is hospitalized with multiple injuries after falling off a sliding board. X-rays reveal no bone fractures. When caring for the child, what is the nurse's highest priority?

Assessing the child's level of consciousness (LOC) frequently. In hemophilia, one of the factors required for blood clotting is absent, significantly increasing the risk of hemorrhage after injury. Therefore, the nurse must assess the child frequently for signs and symptoms of intracranial bleeding, such as an altered LOC, slurred speech, vomiting, and headache. To manage hemophilia, the absent blood clotting factor is replaced via I.V. infusion of factor, cryoprecipitate, or fresh frozen plasma; this may be done prophylactically or after a traumatic injury. Platelet transfusions aren't necessary. Clients with hemophilia aren't at increased risk for infection. Discussing a safe play environment with the parents is important but isn't the highest priority.

The nurse notes uterine atony in the postpartum client. Which assessment is completed next?

Assessment of the perineal pad Uterine atony is the cause of postpartum hemorrhage due to the inability of the uterus to contract effectively. Assessment of the perineal pad for the characteristics and amount of bleeding is essential. It is important to monitor all postpartum women for excessive bleeding because two-thirds of the women who experience postpartum hemorrhage have no risk factors. Assessment of bowel and bladder function is routine in a postpartum assessment but not included in concerns for hemorrhage. Assessment of the lungs and any laboratory work is common but not as high of a concern.

A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instruction in her discharge teaching?

Avoid over-the-counter (OTC) salicylates. Discharge teaching should include informing the client to avoid OTC salicylates, which may potentiate the effects of anticoagulant therapy. Iron will not affect anticoagulation therapy. Restrictive clothing should be avoided to prevent the recurrence of thrombophlebitis. Shortness of breath should be reported immediately because it may be a symptom of pulmonary embolism.

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action?

Avoiding the use of products containing aspirin Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.

What is purpura?

Blood spots or skin hemorrhages that are purple-colored and recognizable on the skin when small blood vessels burst

You are caring for a client that has been admitted with a possible clotting disorder. The client is complaining of excessive bleeding and bruising without cause. You know that you should take extra care to check for signs of bruising or bleeding in what condition?

Hypocalcemia Hypocalcemia or low serum calcium levels can affect clotting. Therefore, in this condition the nurse should take extra care to check for bruising or bleeding. There is no such risk in dehydration, hypokalemia, or hypomagnesemia.

The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?

Immediate defibrillation. The classic electrocardiographic pattern of ventricular fibrillation is that of gross distortion without identifiable waveforms or intervals. When the ventricles do not contract, there is no cardiac output, and there are no palpable or audible pulses. Immediate defibrillation using a non-synchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?

Inspecting the skin for petechiae once every shift.

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up?

Irregular heart rate Irregular heart rate may indicate a potentially life-threatening cardiac dysrhythmia. Potassium, magnesium, and calcium imbalances may cause dysrhythmias. Weight loss is a good indicator of the amount of fluid lost, confusion may occur with dehydration and hyponatremia, and blood pressure is slightly lower than normal (though not life threatening); in each case, following up on potential cardiac dysrhythmias is a higher priority.

A nurse is meeting with a group of pregnant clients who are in their last trimester to teach them the signs that may indicate they are going into labor. The nurse determines the session is successful after the clients correctly choose which signs as an indication of starting labor?

Lightening, Bloody show, Backache The signs of approaching labor include lightening, bloody show, and backache. Lightening is the falling forward of the pregnant uterus due to settlement of the fetal head into the maternal pelvis. Backache associated with pelvic cramping pain, which is regular and increases in intensity, is suggestive of impending labor. Bloody show is the expulsion of the cervical mucus plug tinged with blood, and occurs due to cervical effacement and dilation (dilatation). Weight loss and diarrhea are other signs of impending labor. Weight gain and constipation are not signs of impending labor.

The nurse is conducting a postpartum examination on a client who reports pain and is unable to sit comfortably. The perineal exam reveals an episiotomy without signs of hematoma. Which action should the nurse PRIORITIZE?

Place an ice pack. The labia and perineum may be bruised and edematous after birth; the use of ice would assist in decreasing the pain and swelling. Applying a warm washcloth would bring more blood as well as fluid to the sore area, thereby increasing the edema and the soreness. Applying a witch hazel pad needs the order of the health care provider. Notifying a health care provider is not necessary at the this time as this is considered a normal finding.

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?

Pleuritic pain Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism. Pulmonary infarction often causes pleuritic pain that changes with respiration; it is more severe on inspiration and less severe on expiration. Mediastinal and tracheal shifts are not signs of a pulmonary infarction, and neither is pericardial pain.

Which treatment should take place immediately in a client experiencing autonomic dysreflexia?

Position the client in upright position, and correct the initiating stimulus. Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (e.g., full bladder, pain). The nurse should place the client in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. Intravenous fluids are not an immediate intervention for this condition.

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?

Preload Preload is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction.

A client gave birth 2 days ago and is preparing for discharge. The nurse assesses respirations to be 26 breaths/min and labored, and the client was short of breath ambulating from the bathroom the morning. Lung sounds are clear. The nurse alerts the PCP and the nurse-midwife to her concern that the client may be experiencing:

Pulmonary Embolism These symptoms suggest a pulmonary embolism. Mitral valve collapse and thrombophlebitis would not present with these symptoms; infection would have a febrile response with changes in lung sounds.

When the balloon on the distal tip of a pulmonary artery catheter is inflated and the pressure is measured, the measurement obtained is referred to as the...

Pulmonary artery wedge pressure When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary artery until it can no longer be passed. The pressure is recorded, reflecting left-atrial pressure and left-ventricular end-diastolic pressure. Central venous pressure is measured in the right atrium. Pulmonary artery pressure is measured when the balloon tip is not inflated. Cardiac output is determined through thermodilution, which involves injection of fluid into the pulmonary artery catheter.

The nurse assessing a client with scleroderma with CREST variant would include an assessment for:

Raynaud's pheomenom Raynaud's phenomenon is the characteristic symptom of CREST variant of scleroderma that is identified by the R in the CREST acronym. The other options are associated with systemic lupus erythematosus.

A biology class is discussing blood flow directions and the role of arteries and veins. The professor says, "The skin is the only place where there is a direct anastomosis between an artery and a vein." What is the purpose for this type of blood flow in the skin?

Temperature regulation The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, and close off, conserving body heat if the environmental temperature is cold. It has nothing to do with nutrient supply, elimination of toxins, or higher oxygen supply.

A nurse on the med-surge unit just received the client care assignment report. Which client should the nurse assess first?

The client with unilateral leg swelling who reports anxiety and shortness of breath. The client who reports anxiety and shortness of breath and has unilateral leg swelling should be seen first. The client is exhibiting signs and symptoms of PE which is a life-threatening condition. Crackles, fever, and pleuritic pain are signs and symptoms of pneumonia. Anorexia, weight loss, and night sweats are signs and symptoms of tuberculosis. Difficulty sleeping, daytime fatigue, and morning headache are symptoms of sleep apnea. Pneumonia, sleep apnea, and tuberculosis aren't medical emergencies. Clients with these disorders don't take priority over the client with a PE.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is most likely taking place?

The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate Alpha- and beta-adrenergic receptor activation is a central response to all types of shock. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriction, often results from adrenergic stimulation. Sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium.

The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?

The sinoatrial (SA) node initiates the impulse. The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats/minute, the SA node initiates the impulse, the impulse travels to the AV node in 0.12 to 0.2 second, the ventricles depolarize in 0.12 seconds or less, and each impulse occurs regularly.

A teenage girl, seen in the clinic, is diagnosed with nonthrombocytopenic purpura. The girl states, "You have taken a lot of blood from me. Which of my tests came back abnormal?" How should the nurse respond?

Your CBC with differential showed a normal platelet count. In persons with bleeding disorders caused by vascular defects, the platelet count and results of other tests for coagulation factors are normal. A shift to the left indicates an infectious or inflammatory process, not a clotting disorder. A lack of iron indicates iron deficiency anemia, not a clotting disorder. A normal hematocrit indicates a normal number of packed red blood cells, not a clotting disorder.

Which term describes the ability of the heart to initiate an electrical impulse?

automaticity Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.

intermittent claudication

pain and discomfort in calf muscles while walking; a condition seen in peripheral arterial disease

anaphylactic shock

A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, widespread vasodilation, circulatory shock, and sometimes sudden death.

One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for?

Consistency, shape, and location Assess the fundus for consistency, shape, and location. Remember that the uterus should be firm, in the midline, and decrease 1 cm each postpartum day.

When teaching caregiver of a client with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction?

"Try to maintain your child's usual lifestyle to promote normal development." The nurse should encourage the caregivers of a client with a congenital heart defect to treat the client normally and allow self-limited activity. Telling the caregivers to reduce the client's caloric intake isn't appropriate because doing so wouldn't necessarily reduce cardiac demand. Telling the caregivers to alter disciplinary patterns and deliberately prevent crying or interactions with other children could foster maladaptive behaviors. Contact with peers promotes normal growth and development.

Shock signs and symptoms

-Pale -Moist -Cool Skin -Shallow Irregular Breathing -Cyanosis -Dilated Pupils -Weak and rapid pulse -Dizziness or nausea -Chest Pain -Confusion -Anxiety of restlessness

Blood flow to the GI tract is approximately what percentage of the total cardiac output?

20% Blood flow to the GI tract is about 20% of the total cardiac output and increases significantly after eating.

Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?

Beta-adrenergic blockers Antiarrhythmic drugs act by modifying disordered formation and conduction of impulses that induce cardiac muscle contraction. Beta-adrenergic blocking drugs decrease sympathetic outflow to the heart. Antiadrenergic treatment with beta-blockers is the cornerstone of therapy for CPVT. The remaining options act by blocking specific electrolytes, thus altering electrical impulses affecting the heart.

A client presents to the emergency clinic not feeling well. Which report leads the health care provider to suspect the client may have acute leukemia?

Bleeding from the gums, not related to brushing the teeth Although ALL and AML are distinct disorders, they typically present with similar clinical features. Both are characterized by an abrupt onset of symptoms, including fatigue resulting from anemia; low-grade fever, night sweats, and weight loss due to the rapid proliferation and hypermetabolism of the leukemic cells; bleeding due to a decreased platelet count; and bone pain and tenderness due to bone marrow expansion. Nausea and vomiting, muscle aches, and headaches could be associated with other diagnoses like influenza.

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder?

Blood pressure varying between 120/86 and 240/130 mmHg. Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

A young woman diagnosed with prostacyclin deficiency is admitted to the hospital with recurrent deep vein thrombosis and an ovarian infarction asks the nurse why she keeps having these problems. Understanding the role of prostacyclin in hemostasis, the nurse explains that prostacyclin enables

Blood vessel vasodilation and inhibition of platelet aggregation. Prostacyclin is a prostaglandin released by the endothelial cells, which is responsible for limiting the vasoconstriction and platelet aggregation that is initiated by endothelial injury. Deficiency of this hormone increases the risk of inappropriate platelet aggregation in areas other than areas with endothelial damage, which can contribute to thrombosis in uninjured vessels.

A client is admitted with aortic regurgitation. Which medication classification is contraindicated because they can cause bradycardia and decrease ventricular contractility?

Calcium channel blockers The calcium channel blockers diltiazem and verapamil are contraindicated for clients with aortic regurgitation because they decrease ventricular contractility and may cause bradycardia.

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's PRIORITY for the client?

Check the lochia. The nurse should assess the client for prolonged bleeding time. von Willebrand disease is a congenital bleeding disorder, inherited as an autosomal dominant trait, that is characterized by a prolonged bleeding time, a deficiency of von Willebrand factor, and impairment of platelet adhesion. A fever of 100.4°F (38°C) after the first 24 hours following a birth and pain indicate infection. A client with a postpartum fundal height that is higher than expected may have subinvolution of the uterus.

A client with hemophilia type A comes to the emergency department with severe pain and swelling in the right knee. To reduce musculoskeletal damage, the nurse anticipates the administration of:

Factor VIII replacement therapy

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload?

Head of the bed elevated 45 degrees and lower arms supported by pillows Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles.

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring Because sick sinus syndrome frequently involves intermittent or alternating types of dysrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific dysrhythmias that may not be clear on a traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for dysrhythmia formation.

Adverse effects of emboli on pulmonary circulation and airways include:

Local vasoconstriction The effects of emboli on the pulmonary circulation are related to mechanical obstruction of the pulmonary circulation by the blood clot and associated reflex vasoconstriction. Obstruction of pulmonary blood flow also causes reflex bronchoconstriction in the affected area of the lung, wasted ventilation, impaired gas exchange, and loss of alveolar surfactant. Lower lob consolidation is associated with airway inflammation and infection.

A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem?

Lymphedema The lymphatic system filters fluid at the lymph nodes and removes foreign particles such as bacteria. When lymph flow is obstructed, a condition called lymphedema occurs. Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.

A nurse is explaining blood flow through the heart to a patient who has experienced a myocardial infarction. How would the nurse explain flow from the lungs to the heart?

Oxygenated blood from the lungs enters the left atrium through the pulmonary veins.

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities?

Participate in a regular walking program. Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

The nurse notes that a client has round red macules over the lower extremities. The nurse documents this finding as

Petechiae Petechiae are associated with bleeding tendencies or emboli to the skin. Spider angioma is associated with liver disease, pregnancy, and vitamin B deficiency. Ecchymosis is associated with trauma and bleeding tendencies. Telangiectasia is associated with venous pressure states.

Prostacyclin

Prostaglandin member of the eicosanoid family of lipid molecules that inhibits platelet activation and is also an effective vasodilator

juxtaglomerular apparatus

Specialized cells next to the glomerulus that help to regulate blood pressure by secreting renin and constricting the afferent arteriole (the one entering the GFR system)

What is lochia?

Tissue & fluid expelled vaginally after delivery, also known as postpartum bleeding

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient?

Ventilation exceeds perfusion. A high ventilation-perfusion rate means that ventilation exceeds perfusion, causing dead space. The alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock.

Which term describes the amount of blood ejected per heartbeat?

stroke volume Stroke volume is determined by preload, afterload, and contractility of the heart. Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate. Ejection fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42% to 50% in the normal heart. Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

vasoconstriction Endothelins are secreted by many cell types, including the endothelial lining of the circulatory system. Clients with heart failure may have increased blood levels of endothelins as the body tries to compensate for a decrease in cardiac output. However, most actions of endothelins—for example, vasoconstriction and sodium and water retention—are counterproductive in heart failure.

GFR (glomerular filtration rate)

>15 is Renal Failure 15>60 Renal Disease 60>120 Normorange

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells.

A clinician who works on a cardiac care unit of a hospital is providing care for a number of clients. Which client most likely has a genetic disorder arising from inheritance of a single gene?

A tall, thin, myopic, 28-year old woman with mitral valve prolapse The tall, thin, myopic, 28-year old woman with mitral valve prolapse exhibits several classic signs of Marfan syndrome, an autosomal dominant genetic disorder of connective tissue. The other clients show signs of heart disease most likely caused by multiple factors.

What is von Willebrand disease?

An inherited disorder and the most common clotting disease. The person is deficient to some degree in von Willebrand Factor (vWF) which is found in the blood and tissue in various forms. The client may also have low clotting factor VIII. This is distinguished by abnormal vWF lab numbers also. One example: a type of vWF is released by injured tissue and it calls platelets and binds to them and fibrinogen to promote clotting - helping to create a "platelet plug".

Which situations would the nurse associate with an increase in a client's risk for developing secondary thrombocytosis?

Inflammatory bowel disease, Cardiopulmonary bypass surgery, lung cancer, rheumatoid arthritis The diseases most likely to cause secondary thrombocytosis would be inflammatory bowel disease due to the damage to the intestinal mucosa, lung cancer due to the tissue factor molecules released by some cancer cells, surgery, and rheumatoid arthritis due to chronic inflammation.

What is thrombophlebitis?

Inflammatory process that causes a blood clot to form and block one or more veins, usually in legs. The affected vein might be near the surface (superficial) or dee within a muscle (deep).

Sick sinus syndrome

The inability of the heart's natural pacemaker (sinus node) to create a heart rate that's appropriate for the body's needs. It causes irregular heart rhythms (arrhythmias). It has multiple manifestations on electrocardiogram, including sinus bradycardia, sinus arrest, sinoatrial block, and alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome)

A client presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which diagnosis should the medical team first suspect?

Vitamin K deficiency Factors VII, IX, and X and prothrombin require the presence of vitamin K for normal activity. Vitamin K deficiency may result from impaired fat absorption caused by liver or gallbladder disease. Hemophilia B is a hereditary disorder. Half of the cases of ITP occur as an acute disorder in children; ITP in adults is a chronic disorder with insidious onset.

When describing the covering on bones to the students, the instructor asks, "Why is periosteum an important part of the bone covering?" The student responses should mention which of the following? It:

contains blood vessels that assist with providing nutrition to bone tissue. Bones are covered, except at their articular ends, by a periosteum membrane. The periosteum contains blood vessels and acts as an anchorage point for blood vessels as they enter and leave the bone. The endosteum is the membrane that is considerably thinner than the periosteum and is composed of a single layer of flattened osteoprogenitor cells and small amounts of connective tissue. Red bone marrow contains developing red blood cells and is the site of blood cell formation. Yellow bone marrow is composed largely of adipose cells. At birth, nearly all of the marrow is red and hematopoietically active.