Patho Unit 3 PrepU with Explanation Chapter 26

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 the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below: 140/90 140/60 100/60 100/90

140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.

A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring? LDL VLDL IDL HDL

HDL HDL is known as the "good" cholesterol because it transports cholesterol back to the liver for metabolism. LDL, VLDL, and IDL transport cholesterol to the tissues.

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: Pulmonary embolism Vasculitis Polyarteritis nodosa Arterial insufficiency

Pulmonary embolism Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.

A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client? Deep vein thrombosis Raynaud disease Atherosclerotic occlusive disease Frostbite related to hypothermia

Raynaud disease The symptoms of this client represent Raynaud disease. Frostbite would most likely have affected the feet and the hands. The others apply more to the lower extremities.

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.

Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels? Vascular smooth muscle cells (SMCs) Extracellular matrix cells Endothelial cells Collagen tissue

Vascular smooth muscle cells (SMCs) Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels.

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.

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.

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 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 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 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.

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.

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 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.

The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia? Elevated total cholesterol Decreased low-density lipoproteins Decreased triglycerides Normal cholesterol and triglycerides

Elevated total cholesterol Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.

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 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.

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for: Pulmonary hypertension Left ventricular hypertrophy Organ damage and hypovolemic shock Orthostatic hypotension

Organ damage and hypovolemic shock The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk.

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? Peripheral vascular resistance Electrical impulses in the heart Release of stress hormones Rigidity of the ventricular walls

Peripheral vascular resistance 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 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.

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

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.

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.

A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention? Vigilant blood pressure monitoring Oral administration of beta-adrenergic blockers Restriction of dietary sodium Cautious use of over-the-counter diuretics

Vigilant blood pressure monitoring Sodium restriction is not normally recommended during pregnancy. Most medications are contraindicated during pregnancy except in cases where the mother's life is threatened. Close monitoring is the initial focus of care.

Which is the most common site for an aortic aneurysm? Abdominal aorta Thoracic Ascending aorta Aortic arch

Abdominal aorta Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta, or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis.

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.

The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which testing procedures could the practitioner prescribe to diagnose this condition? Select all that apply. Ascending venography Duplex ultrasonography Plasma D-dimer Echocardiogram White blood cell count

Ascending venography Duplex ultrasonography Plasma D-dimer Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an indication of inflammation or infection. An echocardiogram is a test that evaluates heart structure and function.

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) Blood pressure 140/90 mm Hg and glucose in the urine Blood pressure 130/88 mm Hg and fasting blood glucose level of 180 mg/dL (9.99 mmol/L) Blood pressure 90/60 mm Hg and serum creatinine level of 2.1 mg/dL (160.13 µmol/L)

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.

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? Stasis ulcerations Arterial insufficiency Primary varicose veins Deep vein thrombosis

Deep vein thrombosis 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.

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? Elevation of triglycerides Elevation of HDL Decreased LDL Decreased VLDL

Elevation of triglycerides In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.

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.

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.

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? Dry mouth Restlessness Constipation Hypotension

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).

The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which test will the practitioner order? LDL level HDL level C-reactive protein (CRP) Serum homocysteine

LDL level Xanthomas along the tendons are seen in clients with elevated LDL levels, not HDL levels. CRP is a serum marker for systemic inflammation. Homocysteine is derived from the metabolism of dietary methionine and is associated with endothelial damage.

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.

Which statements are true concerning deep-vein thrombosis (DVT)? Select all that apply. Many individuals with DVT have no symptoms. Deep muscle tenderness is a common symptom of DVT. Sedimentation rates are a common diagnostic test for DVTs. Inflammation is the root cause of many of the symptoms of DVTs. White blood cell counts tend to decrease with the presence of a DVT.

Many individuals with DVT have no symptoms. Deep muscle tenderness is a common symptom of DVT. Sedimentation rates are a common diagnostic test for DVTs. Inflammation is the root cause of many of the symptoms of DVTs. Many people with venous thrombosis are asymptomatic; as much as 50% of people with DVT are asymptomatic. Lack of signs and symptoms is probably because the vein is not totally occluded or because of collateral circulation. When present, the most common signs and symptoms of venous thrombosis are those related to the inflammatory process, including pain, swelling, and deep muscle tenderness. Fever, general malaise, and an elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation.

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 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.