PrepU ch. 18 practice quiz

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. 1. Baroreceptors 2. Neural pathways 3. Cardiovascular centers 4. Chemoreceptors

1 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.

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease. 1. Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL 2. Patient with LDL cholesterol 160 mg/dL, HDL 30 mg/dL, and triglyceride level 120 mg/dL 3. Patient with LDL cholesterol 184 mg/dL, HDL 60 mg/dL, and triglyceride level 70 mg/dL 4. Patient with LDL cholesterol 180 mg/dL, HDL 50 mg/dL, and triglyceride level 100 mg/dL

1 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. 406

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer thus resulting in decrease vessel lumen radius? 1. Norepinephrine. 2. Adrenal glands. 3. Nitric Oxide. 4. Fibroblast growth factor.

1 Nerve cells and circulating hormones are responsible for vasoconstriction of the vessel walls. Because they do not enter the tunica media of the blood vessel, the nerves do not synapse directly on the smooth muscle cells. Instead, they release the neurotransmitter, norepinephrine, which diffuses into the media and acts on the nearby smooth muscle cells....resulting in contraction of the entire muscle cell layer and thus reducing the radius of the vessel lumen. This increases the systemic circulation. 403

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician be most likely to rule out hypertension as a contributing factor? 1. A 61-year-old man who has a heart valve infection and recurrent fever 2. A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week 3. An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness 4. A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

1 While cardiac complications are common sequelae of hypertension, a heart infection would be less likely to be so. Stroke, kidney failure, and angina are all identified as consequences of hypertension. 426

The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.

140. 130-139 is considered prehypertension

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? 1. Papilledema and lethargy 2. Headache and confusion 3. Stupor and hyperreflexia 4. Restlessness and nervousness

2 Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.

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? 1. Hemiplegia 2. A pulsating mass in the abdomen 3. The pulse is unobtainable in one or both arms 4. Syncope

2 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.

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? 1. Specialized cells are located in the back of the throat what signals when the airway is obstructed which sends signals to the kidney to increase pulse rate. 2. During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction. 3. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume. 4. When the patient starts to snore, their epiglottis is closed over the trachea.

2 People with sleep apnea also may experience an increase in BP because of the hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are located in carotid bodies and aortic bodies of aorta. Retention of fluid is not the cause of increased BP during sleep apnea episodes. 423

The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following? 1. Hormonal activity 2. The kidneys 3. Neural mechanisms 4. Humoral influence

2 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. 424

A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply. 1. Being female 2. Obesity 3. Poor performance in school 4. High salt consumption 5. Inactive lifestyle

2, 4, 5 The prevalence of hypertension in children and adolescents in increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance. 426

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? 1. High-dose antibiotic therapy 2. Allopurinol and sulfonamides 3. High-dose corticosteroid therapy and cytotoxic immunosuppressant agents 4. Antiviral agents

3 Clinical signs and symptoms may vary due to the widely varied vascular involvement. It usually begins complaints of 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 necrotizing vasculitis of the small and large arteries. Treatment involves use of high-dose corticosteroid therapy and often-cytotoxic immunosuppressant agents (e.g., azathioprine, cyclophosphamide) 414

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? 1. Thrombus 2. Fatty streak 3. Fibrous atheromatous plaque 4. Complicated lesion

3 The lesions associated with atherosclerosis are of three types - the fatty streak, the fibrous atheromatous plaque, and the complicated lesion. Fatty streaks are thin, flat, yellow intimal discolorations. The fibrous atheromatous plaque grows larger and proliferates into the smooth muscle. As they increase in size, they encroach on the lumen of the artery. More advanced complicated lesions contain hemorrhage, ulceration, and scar deposits and can cause thrombus formation which may occlude the vessel.

When a 55 year old patients routine blood work returns, the nurse notes that their C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds: 1. "This means you have high levels of HDL to balance the LDL found in animal proteins." 2. "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein." 3. "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels." 4. "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

4 CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for development of premature coronary heart disease. 409

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? 1. Pheochromocytoma 2. Hyperaldosteronism 3. Decreased renal blood flow 4. Unknown

4 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. 426