PrepU Chapter 26
The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse? a. The client states his hand is numb. b. The client states his feet are cold. c. Pulses are present in the radial artery. d. The nail beds are pink.
a 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 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? a. HDL b. IDL c. LDL d. VLDL
a 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.
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? a. Have him listen to his heart for the obvious murmur that presents when smoking. b. Measure his temperature and show him how much higher it is when he is smoking. c. Measure his blood pressure and show him how much higher it is when he is smoking. d. Measure his pulse and show him how much lower it is when he is smoking.
c 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.
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? a. Electrical impulses in the heart b. Release of stress hormones c. Rigidity of the ventricular walls d. Peripheral vascular resistance
d 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.
The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet? a. Steak b. Nuts c. Poultry d. Whole grains
a The DASH diet, emphasizing consumption of whole grains, fruits, and vegetables—and exclusion of red meats and sweets—has been shown in many studies to reduce hypertension.
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. a. Baroreceptors b. Cardiovascular centers c. Chemoreceptors d. Neural pathways
a 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 knows that the primary long-term regulation of blood pressure is exerted by which body system? a. The kidneys b. Neural mechanisms c. Hormonal activity d. Humoral influence
a 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.
Which statements regarding alcohol consumption and hypertension are correct? Select all that apply. a. Chronic excessive alcohol consumption can induce hypertension. b. Hard liquor is the only alcoholic beverage associated with hypertension. c. Recommended limit for alcohol consumption for women is two drinks per day. d. A decrease in heavy alcohol consumption may help to lower blood pressure. e. Moderate alcohol consumption may decrease risk for cardiovascular disease.
a, d, e Chronic excessive consumption of any alcoholic beverage can induce hypertension. Reducing consumption can help to lower blood pressure. The recommended safe amount of alcohol for women is one drink per day and for men is two drinks per day. While moderate consumption may decrease risk for cardiovascular disease, most authorities do not recommend alcohol consumption.
Hypertension in older adults is a common finding. This is because of the age-related rise in systolic blood pressure. Among the aging processes, what is a contributor to hypertension? a. Decreased peripheral vascular resistance b. Decreased baroreceptor sensitivity c. Increased renal blood flow d. Aortic softening
b Among the aging processes that contribute to an increase in blood pressure are a stiffening of the large arteries, particularly the aorta; decreased baroreceptor sensitivity; increased peripheral vascular resistance; and decreased renal blood flow.
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia? a. Decreased low-density lipoproteins b. Elevated total cholesterol c. Decreased triglycerides d. Normal cholesterol and triglycerides
b Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.
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? a. Constipation b. Hypotension c. Restlessness d. Dry mouth
b 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).
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: a. Vasculitis b. Raynaud phenomenon c. Atherosclerosis d. Thromboangiitis obliterans
b 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.
Which of the following are characteristic signs of acute arterial embolism? a. Pain, increased blood pressure, and warmth b. Pallor, pulselessness, and pain c. Paralysis, warmth, and paranoia d. Purpura, muscle weakness, and shortness of breath
b 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.
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? a. Stasis ulcerations b. Deep vein thrombosis c. Primary varicose veins d. Arterial insufficiency
b 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 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. a. Avoid aerobic physical activity. b. Limit alcohol consumption. c. Consume a diet rich in fruits, vegetables, and low-fat dairy products. d. Reduce dietary sodium intake. e. Stop smoking.
b, c, d, e 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 lipoprotein is the main carrier of cholesterol? a. Very-low-density lipoprotein (VLDL) b. Intermediate-density lipoprotein (IDL) c. Low-density lipoprotein (LDL) d. High-density lipoprotein (HDL)
c Although all of the lipoproteins contain cholesterol and triglycerides, LDL is the main carrier of cholesterol.
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities? a. A client undergoes a stress test on a treadmill. b. A client does isotonic exercises in a wheelchair. c. A client is helped out of bed and stands up. d. A client reclines from a sitting to supine position.
c 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.
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension? a. increased elasticity of the arterial connective tissue b. decreased elasticity of the venous connective tissue c. decreased elasticity of the aorta and large arteries d. increased elasticity of the venous connective tissue
c 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.
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels? a. Collagen tissue b. Extracellular matrix cells c. Vascular smooth muscle cells (SMCs) d. Endothelial cells
c Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels.
Which would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? a. Diabetes mellitus b. Cholesterol ingestion c. Bile-binding resin d. High-calorie diet
d Obesity with high-calorie intake increases the production of VLDL, with triglyceride elevation and high conversion of VLDL to LDL. Excessive cholesterol intake reduces formation of LDL receptors. Diabetes is associated with high triglycerides and minimal elevation of LDL. Bile salt-binding resin is one treatment used to lower cholesterol levels.
The older adult client tells the health care provider about experiencing dizziness when changing from a lying to a sitting position. The provider will document which condition in the medical record? a. Decrease in peripheral vascular resistance b. Systolic hypertension c. Increased responsiveness to catecholamines d. Orthostatic hypotension
d Orthostatic hypotension, or a significant drop in systolic pressure (dizziness) on assumption of the upright position, is more common among older adults. Compensatory cardiovascular mechanisms are delayed or insufficient. The heart becomes less responsive to catecholamines. The peripheral vascular resistance rises steadily with age, increasing the blood pressure. Systolic hypertension, the increase of systolic blood pressure, occurs as a consequence of increased arterial stiffness.
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below: a. 140/60 b. 100/60 c. 100/90 d. 140/90
d 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.
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: a. Cerebrovascular accident b. Loss of pulses in the limb c. Acute myocardial infarction d. Pulmonary embolism
d 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.