Pathophysiology Chapter 18

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?

C-reactive protein p. 409.

A nurse is planning a community education program on hypertension. Which of the following parameters should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistance

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight (p.408)

Which one of the following organs are the two primary sites of lipoprotein synthesis?

Small intestine and liver Page 405

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight

Which of the following patients is at greatest risk for orthostatic hypotension?

A 66-year-old post-surgery patient on bed rest

Which of the following types of aortic aneurysms is the most common?

Abdominal aortic p. 418.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate?

"Too much alcohol, too little exercise and too much body fat all contribute to high blood pressure."

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

A 51-year-old male who has been diagnosed with glomerulonephritis p. 427.

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." (p. 416)

A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke."

The nurse knows that mean arterial pressure is determined as which of the following?

60% of diastolic pressure and 40% of systolic pressure(p. 420)

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:

64 mm Hg

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?

A pulsating mass in the abdomen p. 418

When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate?

Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels. Page 411

A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism(p. 427.)

The nurse is providing care for a client who has a recent history of visual disturbances, facial pain and erythema in the region of the temporal artery. Which aspect of care is most appropriate?

Administration of corticosteroids as ordered

Select the priority of care for the medical management of a client with a dissecting aortic aneurysm.

Administration of sodium nitroprusside and β-adrenergic blocking medications Page 419

Which of the following patients should most likely be assessed for orthostatic hypotension?

An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:

Apply sequential pneumatic compression devices to lower extremities

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

Arterioles (P. 420)

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below?

Atherosclerotic occlusive disease necessitating thrombolytic therapy

Question 3 See full question A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below

Atherosclerotic occlusive disease necessitating thrombolytic therapy p. 415.

The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:

Berry aneurysm

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(p. 430)

A patient is diagnosed with gestational hypertension. The nurse recognizes which of the following as characteristic of this condition? Select all that apply.

Blood pressure greater than 140/90 Development after 20th week of pregnancy Blood pressure back to normal by 12 weeks postpartum (p. 431)

The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition?

Blood pressure in arms 20 mm Hg higher than in the legs(p.428)

A critical care nurse is carefully monitoring a client's mean arterial pressure. Which combination of factors is responsible for mean arterial blood pressure?

Cardiac output multiplied by systemic vascular resistance (p. 420)

A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?

Coarctation of the aorta p. 428.

The nurse obtains a blood pressure reading of 150/96 mm Hg from a patient at the clinic. What instructions for follow-up does the nurse anticipate giving to this patient?

Confirm within 2 months

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.

Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?

Decrease vascular volume

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg p. 439.

A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.

Direct acting vasodilators Alpha adrenergic blockers Centrally acting adrenergic agonists

Select the statement that best describes Buerger disease.

Disease of young, heavy cigarette smokers occurring before the age of 35.

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly matches which of the following drug categories to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?

Diuretics

The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction.

A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?

Elevation of triglycerides (p. 407)

A 35-year-old man presents to the emergency department complaining of chest pain for the last 2 hours. He describes the pain as crushing, like a huge weight is on his chest. He also states that the pain goes up into his neck and down his left arm. An acute myocardial infarction (MI) is diagnosed. When taking his history, the following things are noted: ● Hyperlipoproteinemia for past 7 years ● Family history of early MI ● Cholesterol deposits along the tendons (diagnosed 1 year ago) ● Atherosclerosis (diagnosed 6 months ago) ● Diabetes mellitus (type 1) diagnosed at age 16 The nurse suspects which of the following diagnoses will be made?

Familial hypercholesterolemia (type 2A)

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?

Fibrous atheromatous plaque (p. 410)

Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?

Fingers

The client's ultrasound shows a true aneurysm that involves the entire circumference of the vessel and has a gradual and progressive dilation of the vessel. The provider tells the client the aneurysm is which of the following form?

Fusiform (p. 417.)

The nurse is teaching a class on reduction of cardiovascular disease. Which of the following 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

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?

Headache and confusion

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms

Headache and confusion p. 430.

A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?

High-dose corticosteroid therapy and cytotoxic immunosuppressant agents (p. 414)

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?

Hypercholesterolemia(p. 408-409)

A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?

Hypertension (p. 409)

Which of the following statements regarding hypertension are correct? Select all that apply.

Hypertension is more frequent among younger men than in younger women. Hypertension is a major risk factor for cardiovascular disease. Hypertension is one of the most common health problems for adults. (p. 425)

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:

Hypertension p. 409

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels (p. 420)

The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?

Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development

The client reports a sudden onset of excruciating pain in the anterior chest and describes it as "tearing or ripping." The physician is unable to palpate a pulse in the client's right arm. Based on the client's history and physical examination, which treatment would be implemented?

Intravenous sodium nitroprusside

Which one of the following is characteristic of a thrombus?

It forms on the wall of a vessel. (p. 418)

The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion (p.405)

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.

It is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is greater than or equal to 140 mm Hg. Page 425

The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which of the following tests will the practitioner order?

LDL level

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?

LDL p. 404.

Which of the following is the site of chylomicron synthesis?

Small intestine

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.

Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL p. 406.

A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?

Prehypertension

Which goal is a priority for a nurse caring for a patient diagnosed with orthostatic hypotension?

Preventing falls p. 433

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

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 which of the following?

Pulmonary embolism

A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply.

Race Family history

A female client tells the health care provider that she has recently been experiencing episodes of changes occuring 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 (p. 416)

A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?

Raynaud's disease

A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?

Renal artery stenosis p. 427.

An older adult client has been diagnosed with orthostatic hypotension. When planning the client's subsequent care, the nurse should prioritize which diagnosis?

Risk for falls

A 16 year old adolescent who received a kidney transplant at the age of 10, has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension?

Sandimmune (Cyclosporine).

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 of the following interventions?

Sclerotherapy or surgery(p. 438)

Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include which of the following?

Stasis of blood, hypercoagulability, vessel wall injury

A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?

Statins p. 408

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?

Sustained systolic pressure equal to or greater that 160 mm Hg

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

Sympathetic

A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure?

Systemic vasoconstriction maintained the diastolic pressure.(p.420)

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 (p. 419)

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the

Temporal (p. 414)

Which of the following blood vessel cells form the predominant cellular layer in the tunica media and produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs)

The nurse knows that which of the following statements regarding the arterial chemoreceptors are correct? Select all that apply.

The chemoreceptors can induce widespread vasodilation. The main function of the chemoreceptors is in regulation of ventilation. The chemoreceptors trigger increased blood pressure in persons with sleep apnea. The chemoreceptors induce systemic hypertension in persons with chronic obstructive pulmonary disease (COPD).

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relate to these health problems?

The client is 89 years old and takes a diuretic medication for his congestive heart failure. p. 433.

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. p. 408.

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?

The client must protect the entire body from cold, not just the extremities.(p. 417)

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring?

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.(p426.)

The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?

The kidneys

Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?

The man's blood pressure is 178/102 and he has abnormal liver function tests. (p. 751)

A 28-year-old client, who is a heavy smoker, tells the practitioner that he has been experiencing pain in his feet and lower legs for several months. The practitioner notes that pulses in the feet are diminished and believes the client may have which of the following?

Thromboangiitis obliterans

The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.

Thrombosis Damage to elastic elements of blood vessel walls Atherosclerosis Risk for aneurysm (p. 426)

The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?

Unknown

Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?

Venous thrombosis

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

Will prevent the conversion of angiotensin I to angiotensin II