Patho Chapter 26 Prep U

An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?

Hypotension - Particular caution should be used in people who are at risk for orthostatic hypotension (e.g., those with diabetes, autonomic nervous system dysfunction, and older adults).

In pregnancy, which diagnostic findings are characteristic for preeclampsia-eclampsia?

Blood pressure 160/100 mm Hg and platelet count 25,000/μL (25 ×109/L) - Preeclampsia and eclampsia have these characteristics: an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg); Platelet counts <100,000/µL (<100 ×109/L); elevated liver enzymes; creatinine levels >1.1 mg/dL (83.88 µmol/L); vision or cerebral disturbances, edema, and proteinuria.

The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that the most common cause of this condition is:

Deep vein thrombosis (DVT) - Secondary varicose veins result from impaired blood flow in the deep venous channels. The most common cause of secondary varicose veins is DVT. Other causes include congenital or acquired AV fistulas, congenital venous malformations, and pressure on the abdominal veins caused by pregnancy or tumors.

A client reports recent weight loss, fever, fatigue, paresthesia/pain, and weakness of the lower extremities. Assessment findings reveal reddish-blue, mottled areas of discoloration on the lower extremities. Which laboratory/diagnostic test will the health care provider prescribe for this client to correlate vasculitis with disease activity?

Antineutrophil cytoplasmic antibodies (ANCAs) - Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins with anorexia, weight loss, fever, and fatigue often accompanied by signs of organ involvement. Myalgia, arthralgia, and arthritis are common, as are peripheral neuropathies such as paresthesias, pain, and weakness. Skin lesions may also occur and are highly variable. They include reddish-blue, mottled areas of discoloration of the skin of the extremities called livedo reticularis, purpura (i.e., black-and-blue discoloration from bleeding into the skin), urticaria (i.e., hives), and ulcers. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and signs of organ involvement such as hematuria and abnormal liver function test results. Diagnosis is confirmed through biopsy specimens demonstrating vasculitis of the small and large arteries. Antineutrophil cytoplasmic antibodies (ANCAs) are antibodies directed against certain proteins in the cytoplasm of neutrophils. These autoantibodies may cause endothelial damage. Serum ANCA titers, which can correlate with disease activity, may serve as a useful quantitative diagnostic marker for this disorder.

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.

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.

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?

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 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 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.

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.

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 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.

In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up. - During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.