Patho: Chapter 15: Altered Perfusion
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? 140 mm Hg or higher 119 mm Hg or lower 120 to 129 mm Hg 130 to 139 mm Hg
140 mm Hg or higher Explanation: Classification of blood pressure in adults defines a systolic pressure of 140 mm Hg or higher as stage 2 hypertension. Stage 1 hypertension has a systolic pressure between 130 and 139 mm Hg. Systolic blood pressure between 120 and 129 mm Hg is classified as elevated and 119 mm Hg or lower is classified as normal.
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be: 228 mm Hg 41mm Hg 73 mm Hg 64 mm Hg
64 mm Hg Explanation: The difference between the systolic and diastolic pressure is called the pulse pressure (approximately 40 mm Hg). The pulse pressure is calculated by deducting the diastolic pressure (82) from the systolic pressure (146). The difference is the pulse pressure.
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock? Cardiogenic Septic Anaphylactic Neurogenic
Anaphylactic Explanation: Signs and symptoms associated with impending anaphylactic shock include abdominal cramps; apprehension; warm or burning sensation of the skin; itching; urticaria (i.e., hives); coughing; choking; wheezing; chest tightness; and difficulty in breathing. The other types of shock do not have these clinical manifestations.
Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis? Dehydrated client Pregnant woman Client in the terminal stage of cancer Client on bed rest
Client on bed rest Explanation: Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperreactive blood coagulation that can also result in venous thrombosis.
Implantation of a pacemaker is most likely to benefit a client with which cardiomyopathy? Primary restrictive cardiomyopathy Takotsubo cardiomyopathy Dilated cardiomyopathy (DCM) Myocarditis
Dilated cardiomyopathy (DCM) Explanation: Arrhythmias and dysrhythmias are characteristic of DCM, often requiring the use of an implanted pacemaker or an implantable cardioverter-defibrillator. Implanted pacemakers are not noted to be among the common treatments for myocarditis, Takotsubo cardiomyopathy, or primary restrictive cardiomyopathy.
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: Advanced age and low serum total and low-density lipoprotein cholesterol History of cigarette smoking and elevated blood pressure High serum high-density lipoprotein and diabetes Physical inactivity and high serum high-density lipoprotein cholesterol
History of cigarette smoking and elevated blood pressure Explanation: The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical
The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain? Demerol Morphine Fentanyl Codeine
Morphine Explanation: Although a number of analgesic agents have been used to treat pain of myocardial infarction, morphine is the drug of choice and is usually indicated if chest pain is unrelieved with oxygen and nitrates.
Which serum biomarker is highly specific for myocardial tissue? C-reactive protein White blood cells Troponin Creatine kinase
Troponin Explanation: The troponin assays have high specificity for myocardial tissue and have become the primary biomarker tests for the diagnosis of myocardial infarction. Creatine kinase is specific for muscle injury but is not as focused as is troponin. White blood cells and C-reactive protein are associated with inflammation.
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client? septic shock anaphylactic shock neurogenic shock cardiogenic shock
anaphylactic shock Explanation: Anaphylactic shock is initiated through an immunologically mediated reaction to an irritant. Neurogenic shock is caused by decreased sympathetic control of blood vessel tone due to a defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels. Cardiogenic shock occurs when the heart fails to pump blood sufficiently to meet the body's demands. Septic shock, which is the most common type of distributive shock, is associated with the systemic immune response to severe infection.
A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate: decreased intracranial pressure. advanced hypokalemia. myocardial infarction. benign late repolarization.
myocardial infarction. Explanation: The ST-segment elevation with myocardial infarction could be caused by a decrease in blood supply to that area of cardiac muscle. Hypokalemia results in flattening or inversion of T waves.
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI? Action relieves pain and gives sense of depression. Action increases anxiety, in turn increasing metabolic demands of the heart. Action increases autonomic nervous system activity. Action decreases metabolic demands of the heart.
Action decreases metabolic demands of the heart. Explanation: Although a number of analgesic agents have been used to treat the pain of STEMI, morphine is usually the drug of choice. It usually is indicated if chest pain is unrelieved with oxygen and nitrates. The reduction in anxiety that accompanies the administration of morphine contributes to a decrease in restlessness and autonomic nervous system activity, with a subsequent decrease in the metabolic demands of the heart. Morphine does not cause a feeling of depression to the client.
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? 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 Asking the client if he or she has recently changed the diet to include more high-sodium foods Taking a more complete history to try to identify what is stressing this client
Calling an ambulance to take the client to the emergency department Explanation: 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.
The nurse is caring for a client who has just experienced an acute myocardial infarction. Which type of shock is this client likely to experience? Cardiogenic Septic Hypovolemic Neurogenic
Cardiogenic Explanation: Cardiogenic shock occurs when the heart fails to pump blood sufficiently to meet the body's demands. Clinically, it is defined as decreased cardiac output, hypotension, hypoperfusion, and indications of tissue hypoxia despite an adequate intravascular volume. Cardiogenic shock most commonly occurs from an acute myocardial infarction.
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor? Inhibits the movement of calcium into cardiac and vascular smooth muscle Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Decreases the heart rate, which will cause a decrease in cardiac output Decreases vascular volume by suppressing renal reabsorption of sodium
Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Explanation: 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.
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction? 67-year-old woman whose pain started at 2 AM while she was asleep and that responded to nitrates; the ECG showed dysrhythmias and ST-segment elevation; cardiac markers remained stable 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened 80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose 33-year-old man whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable
80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose Explanation: The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other clients have angina of varying severity.
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? Activated cells roam the vascular system looking for inflammatory cells to engulf. 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 that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Explanation: 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.
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension? A 78-year-old client who has begun reporting frequent headaches unrelieved by over-the-counter analgesics A 42-year-old client who has a history of poorly controlled type 1 diabetes An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in the ankles
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom Explanation: Dizziness, blurred vision, palpitations, and syncope (i.e., fainting) are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences? Backflow from the right ventricle to the right atrium during systole Backup of blood from the right atrium into the superior vena cava Inhibition of the SA node's normal action potential Backflow from the left ventricle to left atrium
Backflow from the left ventricle to left atrium Explanation: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol? It is associated with a low intake of saturated fats. It has a low cholesterol content. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. It transports cholesterol away from cells to the liver for excretion.
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. Explanation: Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver.
Which lipid results on four clients will the nurse recognize as having the greatest risk for cardiovascular disease? LDL cholesterol 184 mg/dL (4.77 mmol/L), HDL 60 mg/dL (1.55 mmol/L), and triglyceride level 70 mg/dL (0.79 mmol/L) LDL cholesterol 160 mg/dL (4.14 mmol/L), HDL 30 mg/dL (0.78 mmol/L), and triglyceride level 120 mg/dL (1.36 mmol/L) LDL cholesterol 180 mg/dL (4.66 mmol/L), HDL 50 mg/dL (1.29 mmol/L), and triglyceride level 100 mg/dL (1.13 mmol/L) LDL cholesterol 205 mg/dL (5.31 mmol/L), HDL 40 mg/dL (1.04 mmol/L), and triglyceride level 150 mg/dL (1.69 mmol/L)
LDL cholesterol 205 mg/dL (5.31 mmol/L), HDL 40 mg/dL (1.04 mmol/L), and triglyceride level 150 mg/dL (1.69 mmol/L) Explanation: Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease.
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process? Release of stress hormones Electrical impulses in the heart Rigidity of the ventricular walls Peripheral vascular resistance
Peripheral vascular resistance Explanation: The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.
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 Explanation: 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.
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences? Backup of blood from the right atrium into the superior vena cava Backflow from the right ventricle to the right atrium during systole Backflow from the left ventricle to left atrium Inhibition of the SA node's normal action potential
Backflow from the left ventricle to left atrium Explanation: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility.
An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by: blocking the conversion of angiotensin I to angiotensin II. promoting cardiac output through a reduction in afterload. enhancing inotropy by maximizing calcium channel function. selectively blocking the synthesis of renin in the kidneys.
blocking the conversion of angiotensin I to angiotensin II. Explanation: ACE inhibitors block the conversion of angiotensin I to angiotensin II. They do not directly affect renin synthesis, calcium channel function, or afterload.
A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD? "Has a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." "Measures the pressures inside your heart continuously to asses pumping ability of your left ventricle." "Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body." "Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure." Explanation: Although the response is technical in nature, it is the most accurate. The nurse will use the most accurate terms and then follows up with an explanation of these terms based on the client's level of understanding of the terminology. Decompensated, refractory heart failure reflects deterioration in cardiac function that is unresponsive to medical or surgical interventions. Ventricular assist devices (VADs) are mechanical pumps used to support ventricular function. VADs are used to decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure. This decreases the workload on the ventricle and allows it to rest and recover. The rest of the distractors relate to the monitoring in an ICU of cardiac functioning. Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. With the balloon inflated, the catheter monitors pulmonary capillary pressures (i.e., pulmonary capillary wedge pressure or pulmonary artery occlusion pressure), which reflect pressures from the left ventricle. The pulmonary capillary pressures provide a means of assessing the pumping ability of the left ventricle. One type of pulmonary artery catheter is equipped with a thermistor probe to obtain thermodilution measurements of cardiac output.
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this client has developed which type of shock? Obstructive Hypovolemic Distributive Cardiogenic
Hypovolemic Explanation: Hypovolemic shock occurs when there has been extensive blood or body fluid loss. Cardiogenic shock occurs when the heart loses its ability to pump sufficient blood to meet oxygenation needs of body tissues. Distributive shock is loss of blood vessel tone, resulting in expansion of the vascular compartment. Obstructive shock is an inability of the heart to fill or empty properly.
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education? Placing a pulse oximeter on the client to monitor oxygenation status Raising the head of the bed to a high Fowler's position Inserting an IV to begin a normal saline infusion Administration of 2L of oxygen by nasal cannula
Raising the head of the bed to a high Fowler's position Explanation: Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock? Neurogenic Septic Anaphylactic Cardiogenic
Septic Explanation: Septic shock can result with the body's response to a severe infection. Neurogenic shock is a loss of sympathetic (adrenergic) control of systemic blood vessel tone. Cardiogenic shock is a loss of cardiac efficiency, and anaphylactic shock is a severe allergic reaction.
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is: Decreased renal blood flow Unknown Pheochromocytoma Hyperaldosteronism
Unknown Explanation: 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.
The nurse is assessing a client who has long-standing, poorly controlled primary hypertension whose current blood pressure is 150/95 mm Hg. For which condition should the nurse advocate the client be tested? type 1 diabetes mellitus hypertensive emergency chronic venous insufficiency chronic kidney disease
chronic kidney disease Explanation: The nurse should advocate the client be screened for evidence of chronic kidney disease because chronic hypertension leads to nephrosclerosis, a common cause of chronic kidney disease. While hypertension may contribute to peripheral artery disease, it is not a direct risk factor for venous insufficiency. While type 2 diabetes is considered a risk factor for developing hypertension, and hypertension is also linked to an increased risk for this type of diabetes, hypertension is not a risk factor for type 1 diabetes. Hypertensive emergency is a severely elevated blood pressure (>180/120 mm Hg) which places the client at risk for acute target organ damage. The client's current blood pressure does not meet this criteria.
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? Neural mechanisms The kidneys Humoral influence Hormonal activity
The kidneys Explanation: 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.
For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve? Compensatory mechanisms Parasympathetic system Electrical conductivity Aortic hypertrophy
Compensatory mechanisms Explanation: The pathophysiology of heart failure involves a decrease in pumping ability of the heart with a consequent decrease in the cardiac output, and activation of compensatory mechanisms that attempt to maintain cardiac output but also contribute to the progression of heart failure. Stimulation of the sympathetic nervous system plays an important role in the compensatory mechanisms and the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings? Deep vein thrombosis Stasis ulcerations Arterial insufficiency Primary varicose veins
Deep vein thrombosis Explanation: Venous insufficiency with deep vein thrombus formation is characterized by pain, swelling [edema], and deep muscle tenderness. Fever, general malaise, and elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. Swelling may vary from minimal to maximal. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present with deep vein thrombosis.
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death? Takotsubo cardiomyopathy Hypertrophic cardiomyopathy (HCM) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) Dilated cardiomyopathy (DCM)
Hypertrophic cardiomyopathy (HCM) Explanation: The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular dysrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.
Which diagnostic/assessment findings would be seen in a client with worsening mitral valve stenosis? Select all that apply. Severe elevation in left ventricular end-diastolic pressure Left ventricle increases its stroke volume Low-pitched diastolic murmur that is increasing in duration Sharp elevation in left atrial pressure Decreased cardiac output
Low-pitched diastolic murmur that is increasing in duration Sharp elevation in left atrial pressure Decreased cardiac output Explanation: The increased left atrial pressure eventually is transmitted to the pulmonary venous system, causing pulmonary congestion. A characteristic auscultatory finding in mitral stenosis is an opening snap following the second heart sound, which is caused by the stiff mitral valve. As the stenosis worsens, there is a localized, low-pitched diastolic murmur that increases in duration with the severity of the stenosis. Manifestations are related to the elevation in left atrial pressure and pulmonary congestion such as dyspnea with exertion, decreased cardiac output owing to impaired left ventricular filling, and left atrial enlargement with the development of atrial dysrhythmias and mural thrombi. Severe elevation in left ventricular end-diastolic pressure and left ventricle increases its stroke volume occur with aortic regurgitation.
A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. Hives over entire body Severe bronchospasm Wheezing sound on inspiration Swelling around the lips and eyes Incontinent of urine
Severe bronchospasm Wheezing sound on inspiration Hives over entire body Swelling around the lips and eyes Explanation: Anaphylactic shock results from an immunologically mediated reaction in which vasodilator substances such as histamine are released into the blood. These substances cause vasodilation of arterioles and venules along with a marked increase in capillary permeability. The vascular response in anaphylaxis is often accompanied by life-threatening laryngeal edema and bronchospasm, circulatory collapse, contraction of gastrointestinal and uterine smooth muscle, and urticaria (hives) or angioedema. The onset and severity of anaphylaxis depend on the sensitivity of the person and the rate and quantity of antigen exposure. Signs and symptoms associated with impending anaphylactic shock include abdominal cramps; apprehension; warm or burning sensation of the skin, itching, and urticaria (i.e., hives); and respiratory distress such as coughing, choking, wheezing, chest tightness, and difficulty in breathing.
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply. Limit alcohol consumption. Avoid aerobic physical activity. Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Stop smoking.
Stop smoking. Limit alcohol consumption. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Explanation: Hypertension lifestyle modification includes the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2). Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan includes consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium should be reduced to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride). Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day). Alcohol consumption should be moderate, with consumption of no more than 2 drinks (1 oz [30 mL] ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and persons of lighter weight.
Which children may be considered high risk for developing hypertension? Select all that apply. Has a history of epilepsy with weekly seizures Takes cyclosporine daily since a kidney transplant Has a history of frequent sinus infections treated with antibiotics Diagnosed with coarctation of the aorta as an infant Recent scan showing a pheochromocytoma
Takes cyclosporine daily since a kidney transplant Diagnosed with coarctation of the aorta as an infant Recent scan showing a pheochromocytoma Explanation: Approximately 75% to 80% of secondary hypertension in children is caused by kidney abnormalities. Coarctation of the aorta is another cause of hypertension in children and adolescents. Endocrine causes of hypertension, such as pheochromocytoma and adrenal cortical disorders, are rare. The nephrotoxicity of the drug cyclosporine, an immunosuppressant used in transplant therapy, may cause hypertension in children after kidney transplantation. Epilepsy and sinus infections do not cause hypertension.
The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse? The nail beds are pink. The client states his feet are cold. The client states his hand is numb. Pulses are present in the radial artery.
The client states his hand is numb. Explanation: Arterial spasm caused by arterial cannulation can be a cause of acute arterial occlusion. Occlusion in an extremity causes sudden onset of acute pain, numbness, tingling, weakness, pallor, and coldness of the affected limb. Pulses are absent below the level of the occlusion.
A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order? Phosphorous Troponin assays Creatine kinase Potassium
Troponin assays Explanation: The troponin assays have high specificity for myocardial tissue and have become the primary biomarker for the diagnosis of myocardial infarction. Creatine kinase is an intracellular enzyme found in muscle cells. The troponin level identifies necrosis in cardiac muscles earlier than creatine kinase. The others are not necessarily used when suspecting a myocardial infarction.
