Iggy Ch 33 Vascular problems
Which statement describes a true aneurysm? 1 Blood accumulates in the wall of an artery. Correct 2 The arterial wall is weakened by congenital or acquired problems. 3 There is vessel injury or trauma to all three layers of the arterial wall. 4 Diffuse dilation affects the entire circumference of the artery
Aneurysms can be described as true or false. In true aneurysms, the arterial wall is weakened by congenital or acquired problems. When there is a diffuse dilation affecting the entire circumference of the artery, this is fusiform. If there is vessel injury or trauma to all three layers of the arterial wall, this is a false aneurysm. When blood accumulates in the wall of an artery, this describes a dissecting aneurysm.
Which instruction would the nurse give to a patient receiving anticoagulant therapy? Select all that apply. One, some, or all responses may be correct. 1 "Limit sodium in your diet." 2 "Avoid consumption of grapefruit." Correct 3 "Avoid abruptly stopping drug therapy." Correct 4 "Use only an electric razor for shaving." Correct 5 "Avoid using tools like hammers and saws."
Anticoagulants can increase prothrombin time in the patient and increase the risk for bleeding. The patient should not stop drug therapy abruptly as it may increase the risk for bleeding in the patient. Because the patient has higher risk for bleeding during anticoagulant therapy, the patient should use an electric razor for shaving. The patient should avoid using tools such as hammers and saws as an accidental injury can result in excessive bleeding. Limiting sodium intake and eliminating grapefruit from the diet are not necessary precautions while undergoing anticoagulant therapy.
Which alternative medication is used in patients who have heparin-induced thrombocytopenia (HIT)? 1 Warfarin Correct2 Bivalirudin 3 Dalteparin 4 Enoxaparin
Bivalirudin is a selective direct thrombin inhibitor, which is used as an alternative in case of heparin-induced thrombocytopenia (HIT). Warfarin is an oral anticoagulant, which is an alternative to unfractionated heparin. Dalteparin and enoxaparin are low-molecular-weight heparins, and therefore, are not used as alternatives in HIT.
Which instruction would the nurse give to the patient who has a history of venous thromboembolism? Select all that apply. One, some, or all responses may be correct. Correct 1 "Drink adequate fluid." 2 "Limit potassium intake." Correct 3 "Avoid oral contraceptives." 4 "Avoid consumption of grapefruit." Correct 5 "Perform leg exercises during long periods of sitting."
Drinking adequate fluid helps maintain hydration. Oral contraceptives increase the risk for clotting and venous thromboembolism. Leg exercises during long periods of sitting improve blood circulation and reduce the risk for thrombus formation. The patient who is receiving spironolactone should limit potassium intake to prevent hyperkalemia. The patient who is receiving verapamil treatment should avoid eating grapefruit.
Which action is associated with niacin? 1 An increase in triglycerides (TGs) level 2 An increase in low-density lipoprotein cholesterol (LDL-C) level 3 A decrease in high-density lipoprotein cholesterol (HDL-C) level Correct 4 A decrease in very low-density lipoprotein cholesterol (VLDL-C) level
Niacin partially inhibits free fatty acids released from adipose tissue and increased lipoprotein lipase activity. Therefore it decreases the level of VLDL-C. The level of TGs is also decreased by niacin. It may also reduce LDL-C by its effect on lipoprotein lipase activity. However, it increases the HDL-C level. This cholesterol is beneficial in patients with atherosclerosis. Ch. 33: pg. 709 (bottom)
Which adverse effect is associated with nifedipine? 1 Cough 2 Diarrhea 3 Hyperkalemia Correct 4 Facial flushing
Nifedipine is used as vasodilating drug that can cause facial flushing as a side effect. An adverse effect of lisinopril is cough. A side effect of cilostazol is diarrhea. An adverse effect of alsartan is hyperkalemia.
Which sign or symptom would cause the nurse to suspect that a patient has a deep vein thrombosis (DVT)? 1 Headache 2 Back spasms Correct 3 Calf or groin pain 4 Appendage discoloration
The classic symptom of DVT is calf or groin pain or tenderness. Appendage discoloration, back spasms, and headache are not classic symptoms of DVT.
Which condition is believed to cause atherosclerosis? 1 Ischemia 2 Hypertension 3 Ruptured plaques Correct 4 Blood vessel damage
The exact pathophysiology of atherosclerosis is not known, but the condition is thought to occur from blood vessel damage that causes inflammation, which alters immunity. Ischemia is decreased oxygenation blood flow to body tissue. Hypertension, or high blood pressure, occurs when pressure inside arteries rises to unhealthy levels. Ruptured plaques are not considered to be part of the pathophysiology of atherosclerosis.
The registered nurse is teaching a student nurse how to prepare a patient with venous insufficiency for self-management. Which statements of the student nurse indicate ineffective learning? Select all that apply. 1 "You should wear compression stockings." Correct 2 "You can push stockings down for comfort." Correct 3 "You should wear stockings even while sleeping." 4 "You should elevate your legs above the level of your heart." Correct 5 "You should not cross your legs, but crossing at the ankles is allowed."
Venous insufficiency occurs due to prolonged venous hypertension that stretches the veins and damages the valves. The patient is not advised to push stockings down, as it may act as tourniquet and further impair venous return. Stockings should be worn after awakening and before getting out of bed. Crossing of the legs should be avoided, but the ankles can be crossed for short durations. The patient should wear compression stockings, as they help in decreasing the venous pressure and relieve pain in the legs. Venous insufficiency may cause leg swelling due to edema, and therefore, the patient should be advised to elevate the legs above heart level.
What is Virchow's triad? 1 The distended, protruding veins with darkened and tortuous appearance 2 The prolonged hypertension in veins that stretches the veins and damages the valves 3 The permanent localized dilation of an artery, which enlarges it to at least 2 times its normal diameter Correct4 The thrombus formation in the veins due to stasis of blood flow, endothelial injury, and hypercoagulability
Virchow's triad is the thrombus formation in veins due to stasis of blood flow, endothelial injury, and hypercoagulability. Distended, protruding veins with darkened and tortuous appearance are known as varicose veins. The prolonged hypertension in veins that stretch the veins and damage the valves is called as venous insufficiency. The permanent localized dilation of an artery, which enlarges it to at least 2 times its normal diameter, is the aneurysm.
Which drug is used as an antidote for warfarin? 1 Lepirudin Correct 2 Vitamin K 3 Bivalirudin 4 Argatroban
Vitamin K reverses the anticoagulant action of warfarin, so it can be used as an antidote for warfarin. Lepirudin, bivalirudin, and argatroban are highly selective direct thrombin inhibitors used as alternatives to heparin.
Which type of vitamin is nicotinic acid? 1 Vitamin A Correct 2 Vitamin B 3 Vitamin C 4 Vitamin D
Nicotinic acid is a common form of B vitamin. It alters lipid profiles by partially inhibiting free fatty acids release from adipose tissue. Therefore it is used in the treatment of patients at high risk for atherosclerosis. Niacin is not a form of vitamins A, C, or D.
Which drug is approved by the Food and Drug Administration (FDA) as a dietary adjunct to reduce triglyceride levels greater than 500 mg/dL? 1 Ezetimibe 2 Amlodipine 3 Nicotinic acid 4 correct Omega-3 ethyl esters
Omega-3 ethyl esters is a drug used as an adjunct to diet to reduce triglyceride levels greater than 500 mg/dL. Ezetimibe is used in combination with simvastatin to reduce low-density lipoprotein levels. Amlodipine is a drug used to reduce the blood pressure in hypertensive patients. Nicotinic acid, or niacin, is used in combination with statins to reduce cholesterol levels.
Which class of medication can cause secondary hypertension? 1 Diuretics 2 Renin inhibitors Correct 3 Glucocorticoids 4 Calcium channel blockers
One side effect of glucocorticoids is fluid retention that can lead to secondary hypertension. Diuretics, renin inhibitors, and calcium channel blockers are used to treat hypertension.
Which drug is usually administered to a patient after orthopedic surgery to prevent deep vein thrombosis? 1. Cilostazol Correct 2. Enoxaparin 3. Pravastatin 4. Amlodipine
The patient who has undergone orthopedic surgery is at high risk of developing deep vein thrombosis. Enoxaparin is a low-molecular-weight heparin that prevents blood clot formation and reduces the risk of deep vein thrombosis. Cilostazol treats peripheral arterial disease. Pravastatin lowers low-density lipoprotein. Amlodipine is used primarily to treat hypertension.
Which term describes a loud-pitched, turbulent, swishing sound over the left carotid artery upon auscultation? 1 Thrill Correct 2 Bruit 3 Gallop 4 Murmur
A bruit is a turbulent, swishing sound, which can be soft or loud in pitch, and it occurs when blood is trying to pass through a narrowed artery. A murmur that is palpable is called thrill. A murmur is an unusual sound between heart beats. Gallop is an extra heart sound referred to as an S3 or S4. **Bruits often occur in carotid, aortic, femoral, & popliteal arteries.
A patient with aortic dissection complains of a sharp stabbing pain in the chest, diaphoresis, and apprehension. The patient's blood pressure is 140/100 mm Hg, and the heart rate is 105 beats/min. Which medication would the nurse expect to be prescribed for this patient? Correct 1 Esmolol 2 Nicardipine 3 Propranolol 4 Amlodipine
A patient with aortic dissection whose blood pressure is 130/100 mm Hg and heart rate is 105 beats/min should initially receive an IV beta blocker such as esmolol. Esmolol is a cardioselective beta blocker, which lowers heart rate and blood pressure. If esmolol is not effective in this patient, nicardipine can be used. Beta blockers such as propranolol and calcium channel blockers such as amlodipine are prescribed for blood pressure maintenance after the patient is stabilized.
Which patient category is most likely to be affected by premature atherosclerosis? 1 A patient with metabolic syndrome 2 A patient with cardiovascular disease Correct3 A patient with severe diabetes mellitus 4 A patient with gastrointestinal bleeding
A patient with severe diabetes mellitus may have premature atherosclerosis due to microvascular damage. This occurs because diabetes promotes an increase in LDL-C and triglycerides (lipids) in plasma. The risk of metabolic syndrome may be aggravated by hypertriglyceridemia. Cardiovascular disease may be a contributing factor for atherosclerosis. However, premature atherosclerosis is mainly caused by diabetes mellitus. Bleeding in the gastrointestinal tract may occur as an adverse effect of statins. However, it is not associated with the risk of atherosclerosis.
Which syndrome may be associated with a sudden tear in the aortic intima? Correct1 Marfan syndrome 2 Ehlers-Danlos syndrome 3 Compartment syndrome 4 Thoracic outlet syndrome
A sudden tear in the aortic intima may cause an aortic dissection, which may open the way for blood to enter the aortic wall. This may result in the degeneration of the aortic media and hypertension in the patient. This condition is associated with Marfan syndrome. Ehlers-Danlos syndrome is a rare inherited connective tissue disorder that is not associated with a tear in the aortic intima. Compartment syndrome is related to the elevation of tissue pressure within a confined body space that restricts blood flow. Thoracic outlet syndrome involves the compression of the subclavian artery by rib or muscle, and is not associated with a sudden tear in the aortic intima.
The nurse is caring for a patient who is scheduled for a thrombectomy. Which information would the nurse provide to the patient? 1 "A stent will be implanted into the artery." Correct 2 "The surgery is intended to remove the clot." 3 "The procedure will prevent future clot formation in the blood." 4 "The surgeon will inject a dye into the blood that dissolves the clot."
A thrombectomy is the surgical procedure for removing clots. It does not prevent clot formation, use dye to dissolve the clot, or use stents.
Which term is used for a thrombus without inflammation? 1 Thrombus Correct 2 Phlebothrombosis 3 Thrombophlebitis 4 Deep vein thrombosis (DVT)
A thrombus without inflammation is known as phlebothrombosis. A thrombus is any blood clot that results from an endothelial injury, venous stasis, or hypercoagulability. Thrombophlebitis is a thrombus that is associated with inflammation. DVT is the most common type of thrombophlebitis.
Which medication is used to treat acute peripheral arterial graft occlusions? Correct 1 Abciximab 2 Bivalirudin 3 Pravastatin 4 Amlodipine
Abciximab is an infusion of a platelet inhibitor used to treat acute graft occlusions. Bivalirudin is a highly selective direct thrombin inhibitor used for patients with heparin-induced thrombocytopenia. Pravastatin is used to lower triglycerides and cholesterol, and amlodipine is a calcium channel blocker used to treat hypertension.
Which substance causes the collecting tubules in the kidneys to reabsorb sodium as part of a blood pressure (BP) control system? 1 Renin 2 Sodium Correct 3 Aldosterone 4
Aldosterone works on the collecting tubules in the kidneys to reabsorb sodium. The kidney produces renin, which acts on angiotensinogen to split off angiotensin I as part of a BP control system. Sodium is not an enzyme; sodium retention inhibits fluid loss, thus increasing blood volume and subsequent BP. Angiotensin-converting enzyme converts angiotensin I to angiotensin II.
Which treatment regimen is preferred to reduce blood pressure and keep the lipid profile within normal limits in a patient with atherosclerosis? 1 Niacin + Lovastatin 2 Aspirin + Provastatin 3 Ezitemibe + Simvastatin Correct4 Amlodipine + Atorvastatin
Amlodipine and atorvastatin when taken in combination are used to reduce blood pressure and to decrease triglycerides, increase high-density lipoproteins (HDL), and lower the low-density lipoproteins (LDL). A combination of niacin and lovastatin is used to improve lipid levels. A combination of aspirin and provastatin is used to reduce the risk of stroke. A combination of ezitemibe and simvastatin inhibits the absorption of cholesterol through the small intestine.
Which clinical term describes a piece of a clot that travels from a deep leg vein and lodges in the pulmonary vein? Correct 1 Embolus 2 Thrombus 3 Thrombophlebitis 4 Peripheral vascular disease
An embolus is a piece of a clot that is carried in the bloodstream from one area to lodge in a vessel of another area. A thrombus is a blood clot formed in situ within the vascular system of the body and impeding blood flow. Peripheral vascular disease is a circulatory disorder that causes the blood vessels outside of the heart and brain to narrow, block, or spasm. Thrombophlebitis is an inflammatory process that may cause a blood clot to form and block one or more veins.
What instructions should the nurse give to a patient receiving anticoagulant therapy? Select all that apply. 1 Limit sodium in the diet. 2 Avoid consumption of grapefruit. Correct 3 Avoid abruptly stopping drug therapy. Correct 4 Use only an electric razor for shaving. Correct 5 Avoid using tools like hammers and saws.
Anticoagulants can increase prothrombin time in the patient and increase the risk of bleeding. The patient should not stop drug therapy abruptly as it may increase the risk of bleeding in the patient. Because the patient has higher risk of bleeding during anticoagulant therapy, the patient should use an electric razor for shaving. The patient should avoid using tools such as hammers and saws as an accidental injury can result in excessive bleeding. Limiting sodium intake and eliminating grapefruit from the diet are not necessary precautions while undergoing anticoagulant therapy.
Which alternative medication is used in patients who have heparin-induced thrombocytopenia (HIT)? 1. Warfarin Correct 2. Bivalirudin 3. Dalteparin 4. Enoxaparin
Bivalirudin is a selective direct thrombin inhibitor, which is used as an alternative in case of heparin-induced thrombocytopenia (HIT). Warfarin is an oral anticoagulant, which is an alternative to unfractionated heparin. Dalteparin and enoxaparin are low-molecular-weight heparins, and therefore, are not used as alternatives in HIT.
A patient diagnosed with Buerger disease is prescribed nifedipine. Which food would the nurse instruct the patient to avoid? 1 Kale 2 Spinach 3 Broccoli Correct 4 Grapefruit
Buerger disease is associated with claudication in the feet and lower extremities, which may worsen during the night. The patient prescribed nifedipine is instructed not to eat or drink grapefruit and grapefruit juice as both may cause severe adverse effects. The other foods such as broccoli, spinach, and kale are rich in vitamin K and do not interact with nifedipine.
Which medication does a health care provider prescribe to a patient diagnosed with Buerger's disease? 1. Warfarin 2. Lepirudin Correct 3. Nifedipine 4. Protamine sulfate
Buerger's disease is manifested with appearance of feet claudication, ischemia, and fibrosis of vessels in the feet with occurrence of ulcerations on the digits. Therefore, a vasodilator such as nifedipine is prescribed for the treatment. The other drugs such as warfarin, lepirudin, and protamine sulfate may not be effective for treating this condition. Warfarin may be administered to patients with deep vein thrombosis (DVT). Lepirudin is a highly selective direct thrombin inhibitor that may be used as an alternative to heparin. Protamine sulfate may be used as an antidote for heparin toxicity.
A patient hospitalized with carotid aorta dissection is suddenly diagnosed with rapid hypotension and decreased peripheral pulses. Further assessment reveals a musical murmur along the right sternal border. Which complication does the nurse suspect in this patient? 1 Arterial occlusion Correct2 Cardiac tamponade 3 Rupture of aneurysm 4 Thoracic outlet syndrome
Cardiac tamponade is an acute type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium. This condition results in slow or rapid compression of the heart. Therefore, the patient is diagnosed with rapid hypotension, decreased peripheral pulses, and a musical murmur along the right sternal. Patients with arterial occlusion may have severe pain below the level of occlusion that occurs even at rest. The rupture of an aneurysm may not be indicated by a musical murmur. In thoracic outlet syndrome, a musical murmur is not heard and hypotension is not too severe.
What instructions does the nurse give to a patient with a history of deep vein thrombosis (DVT)? Select all that apply. 1 "You should avoid tea/coffee." Correct 2 "You should drink adequate fluids." Correct 3 "You should avoid oral contraceptives." 4 "You should avoid green leafy vegetables." Correct 5 "You should exercise your legs during long periods of bedrest or while sitting."
Deep vein thrombosis (DVT) refers to the blood clot formation in the veins deep in the body. Patients with such conditions are instructed to drink plenty of fluids and oral contraceptives should be avoided. These patients must do leg exercises during long periods of bedrest or sitting. The intake of tea/coffee and green leafy vegetables may not cause harm to the patient with DVT.
The nurse finds that a patient has a history of venous thromboembolism. Which instructions should the nurse give to the patient to prevent further complications? Select all that apply. Correct 1 Drink adequate fluid. Incorrect 2 Limit potassium intake. Correct 3 Avoid oral contraceptives. Incorrect 4 Avoid consumption of grapefruit. Correct 5 Perform leg exercises during long periods of sitting.
Drinking adequate fluid helps maintain hydration. Oral contraceptives increase the risk of clotting and venous thromboembolism. Leg exercises during long periods of sitting improve blood circulation and reduce the risk of thrombus formation. The patient who is receiving spironolactone should limit potassium intake to prevent hyperkalemia. The patient who is receiving verapamil treatment should avoid eating grapefruit.
The nurse finds that a patient has a history of venous thromboembolism. Which instructions should the nurse give to the patient to prevent further complications? Select all that apply. Correct 1 Drink adequate fluid. 2 . Limit potassium intake. Correct 3 Avoid oral contraceptives. 4. Avoid consumption of grapefruit. Correct 5 Perform leg exercises during long periods of sitting.
Drinking adequate fluid helps maintain hydration. Oral contraceptives increase the risk of clotting and venous thromboembolism. Leg exercises during long periods of sitting improve blood circulation and reduce the risk of thrombus formation. The patient who is receiving spironolactone should limit potassium intake to prevent hyperkalemia. The patient who is receiving verapamil treatment should avoid eating grapefruit.
A patient suspected of having varicose veins is undergoing duplex ultrasonography. Which reflux time signifies abnormality? Correct1 Greater than 0.5 second 2 Greater than 0.1 second 3 Greater than 0.4 second 4 Greater than 0.3 sec
Duplex ultrasonography procedure in a patient is used to diagnose any abnormalities such as varicose veins and reflux. The reflux time greater than 0.5 second in the saphenous vein is considered abnormal. The other result values such as reflux time greater than 0.1, 0.4, and 0.3 seconds are not abnormal values.
Which treatment is included in the three "E"s for a patient with varicose veins? Select all that apply. One, some, or all responses may be correct. 1 Elastic 2 Estrogen 3 External 4 Exercise 5 Elevation
Elastic, Exercise, Elevation The three E's of treating varicose veins are elastic (compression stocking), exercise, and elevation. Estrogen and external are not included.
Which type of hypertension is the most common? Correct 1 Essential 2 Malignant 3 Secondary 4 Gestational
Essential hypertension is the most common type of hypertension and is not caused by an existing health problem. Malignant hypertension is a severe type of elevated blood pressure (BP) that rapidly progresses; it is not as common. Specific disease states and drugs can increase a person's susceptibility to hypertension. A person with this type of elevation in BP has secondary hypertension. Pregnancy is a secondary cause of hypertension.
Which food would the nurse teach the patient to avoid while being treated with a potassium-sparing diuretic? Select all that apply. One, some, or all responses may be correct. 1 Apples Correct 2 Bananas Correct 3 Potatoes Correct 4 Oranges 5 Strawberries
Foods high in potassium include bananas, oranges, and potatoes. Apples and strawberries are considered to be low in potassium.
Which part of the eye exhibits vascular changes that provide a reliable index of the severity of hypertension? 1 Iris 2 Pupil 3 Sclera Correct 4 Retina
Funduscopic examination of the eyes to observe vascular changes in the retina is done by a skilled health care practitioner. The appearance of the retina can be a reliable index of the severity and prognosis of hypertension. These changes are not observed in the iris, pupil, or sclera.
The primary health care provider prescribes nifedipine to a patient with Buerger's disease. What instruction should the nurse give to the patient to ensure safety? Incorrect1 Rise slowly from the bed. 2 Decrease intake of potassium rich food. 3 Avoid taking the drug with ketoconazole. Correct4 Avoid taking the drug with grapefruit juice.
Grapefruit and grapefruit juice interact with nifedipine, and can produce severe adverse effects in the patient, even death. Therefore, the patient should avoid grapefruit and grapefruit juice while receiving nifedipine treatment. Hydrochlorothiazide causes diuresis, which results in orthostatic hypotension. Therefore, the patient should rise slowly from the bed to reduce the risk of falling. Spironolactone causes potassium retention in the body and increases the risk of hyperkalemia. Therefore, the nurse should instruct the patient to decrease intake of potassium-rich foods. The patient should avoid taking eplerenone with ketoconazole because ketoconazole enhances the action of eplerenone.
Which process is directly affected by the interaction between furanocoumarins and lovastatin? 1 Lovastatin excretion 2 Lovastatin absorption 3 Lovastatin distribution Correct4 Lovastatin metabolism
Grapefruit contains a group of chemicals called furanocoumarins that bind with the enzyme CYP3A4 and inactivate it. This enzyme is important for drug metabolism, and its inactivation may lead to high levels of the statin drug in the bloodstream. The excretion, absorption, and distribution of lovastatin are not directly affected by this interaction.
Which is considered "good" cholesterol? 1 Lipids 2 Triglycerides 3 Low-density lipoprotein cholesterol (LDL-C) Correct 4 High-density lipoprotein cholesterol (HDL-C)
HDL-C is considered good cholesterol. LDL-C is considered "bad" cholesterol. Triglycerides are a type of fat in the blood. Lipids include fatty acids, oils, waxes, sterols, and triglycerides.
The nurse finds hematuria, occult blood in the stool, ecchymosis, petechiae, and pain in a patient receiving anticoagulant therapy. What is the nursing action for this situation? 1 Administering cilostazol 2 Administering nitroprusside 3 Performing plethysmography Correct4 Discontinuing anticoagulant therapy
Hematuria, occult blood in the stool, ecchymosis, petechiae, and pain indicate a risk of bleeding in the patient. Therefore, the nurse should immediately discontinue anticoagulant therapy to prevent further complications. Cilostazol is used to treat peripheral arterial disease. Nitroprusside is administered to a patient with a hypertensive condition. Plethysmography is used to evaluate arterial flow in the lower extremities.
A patient with deep vein thrombosis (DVT) is on heparin. Which drug does the primary health care provider further prescribe if the patient is experiencing excessive bleeding? 1 Lepirudin 2 Bivalirudin 3 Argatroban Correct4 Protamine sulfate
Heparin administration to a patient with deep vein thrombosis (DVT) may cause severe bleeding. Therefore, the antidote of heparin, which is protamine sulfate, is prescribed to manage the patient's condition. Other drugs such as lepirudin, bivalirudin, and argatroban are highly selective direct thrombin inhibitors. These drugs are utilized as an alternative to heparin in patients with heparin-induced thrombocytopenia (HIT).
Which recommendation is beneficial for secondary prevention of atherosclerotic cardiovascular disease in adults? 1 A 40- to 75-year-old adult with diabetes mellitus should be treated with high-intensity statin therapy. 2 A patient with LDL-C greater or equal to 190 mg/dL should be evaluated for secondary causes of hyperlipidemia. Correct3 High-intensity statin therapy should be initiated or continued as first-line treatment in adults 75 years old or younger who are at risk. 4 A 40- to 75-year-old adult with LDL-C of 70 to 189 mg/dL without diabetes should be treated with moderate- to high-intensity statin therapy.
High-intensity statin therapy should be initiated, or continued as first-line treatment, in adults 75 years of age or younger, who have symptoms of atherosclerotic cardiovascular disease, as a measure for secondary prevention. Primary prevention includes treatment with high-intensity statin therapy in adults 40 to 75 years old with diabetes mellitus. Another recommendation for primary prevention includes evaluating patients with LDL-C greater than 190 mg/dL for secondary causes. As a part of primary prevention, adults 40 to 75 years old with LDL-C 70 to 189 mg/dL should receive treatment with moderate- to high-intensity statin therapy.
Which drug prescribed to treat a patient's hypertension may exacerbate gout? 1 Torsemide 2 Furosemide 3 Triamterene Correct 4 Hydrochlorothiazide
Hydrochlorothiazide may cause retention of uric acid, which could further aggravate the patient's gout. The other diuretics, such as torsemide and furosemide, are loop diuretics associated with inhibition of sodium reabsorption and potassium excretion. Triamterene is a potassium-sparing diuretic that helps retain sodium and is used in combination with another diuretic.
A patient has increased sensitivity to cold, ulceration on the digits, and claudication in the feet that worsens at night. Which condition would the nurse suspect? 1 Venous ulcer 2 Aortic dissection Correct 3 Buerger disease 4 Raynaud phenomenon
Increased sensitivity to cold, ulceration of the digits, and claudication in the feet that worsens at night are the symptoms of Buerger disease. Ankle swelling, brown pigmentation, a pink ulcer bed with uneven edges, and the presence of granulation tissue are symptoms of a venous ulcer. Diaphoresis, pain in the anterior chest, vomiting, and faintness are symptoms of aortic dissection. Painful vasospasms of the arteries and red-white-blue skin color changes on exposure to cold are symptoms of Raynaud phenomenon.
The nurse finds that a patient has increased sensitivity to cold, ulceration on the digits, and claudication in the feet that worsens at night. Which complication does the nurse suspect in the patient? 1 Venous ulcer 2 Aortic dissection Correct3 Buerger's disease 4 Raynaud's phenomenon
Increased sensitivity to cold, ulceration of the digits, and claudication in the feet that worsens at night are the symptoms of Buerger's disease. Ankle swelling, brown pigmentation, a pink ulcer bed with uneven edges, and the presence of granulation tissue are symptoms of a venous ulcer. Diaphoresis, pain in the anterior chest, vomiting, and faintness are symptoms of aortic dissection. Painful vasospasms of the arteries and red-white-blue skin color changes on exposure to cold are symptoms of Raynaud's phenomenon.
How often would a low-risk patient over 20 years old in the United States have his or her total serum cholesterol level evaluated? 1 Annually 2 Not until age 65 3 Once every 2 years Correct 4 Once every 5 years
Low-risk people over age 20 in the United States should have their total serum cholesterol levels evaluated every 4-6 years. Atherosclerosis progresses for years before clinical manifestations occur. Cholesterol screening and history intake are good ways to identify atherosclerosis early. More frequent measurements are suggested for people with multiple risk factors and those older than 40 years of age; patients who meet these criteria may be screened annually or every 2 years. Waiting until age 65 is too late.
Which consequence has little relation to the interaction between furanocoumarins and statins? 1 GI bleeding 2 Heart failure 3 Kidney failure Correct4 Muscle myopathy
Muscle myopathy is the general adverse effect associated with statins. It is not caused due to the interaction of the furoanocoumarins in grapefruit and the statin. Grapefruit contains furanocoumarins that bind with the enzyme CYP3A4 and inactivate it. This enzyme hinders the drug's metabolism and leads to a high level of statin in the bloodstream. This interaction may cause GI bleeding, heart failure, and kidney failure.
Which factor is a direct cause of peripheral arterial disease (PAD)? 1 Diuretic use 2 Thromboembolism 3 Intermittent claudication Correct 4 Systemic atherosclerosis
PAD is a result of systemic atherosclerosis. It is a chronic condition in which partial or total arterial occlusion (blockage) decreases perfusion to the extremities. The tissues below the narrowed or obstructed arteries cannot live without an adequate oxygen and nutrient supply. Diuretics are used to treat hypertension. Thromboembolism may result from PAD. Intermittent claudication is a clinical symptom of PAD.
A female swimmer complains of neck, arm, and shoulder pain with numbness. Which condition does the nurse anticipate if the patient has developed subclavian artery compression by the rib? 1 Subclavian steal 2 Buerger's disease 3 Raynaud's disease Correct4 Thoracic outlet syndrome
Patients who keep moving their arms above their heads, such as female swimmers, may be commonly affected with thoracic outlet syndrome. In this condition, the patient complains of neck, arm, and shoulder pain with numbness due to development of subclavian artery compression by the rib. Subclavian steal is associated with ischemia, blood pressure difference in the arm, and pain. Buerger's disease causes claudication in the feet and lower extremities. Raynaud's disease is manifested as painful vasospasms of the arteries and arterioles in the extremities.
Which condition may result from systemic atherosclerosis? 1 Peripheral paralysis 2 Peripheral neuropathy Correct 3 Peripheral arterial disease 4 Peripheral vascular resistance
Peripheral arterial disease is a result of systemic atherosclerosis. It is a chronic condition in which partial or total arterial occlusion decreases perfusion to the extremities. Peripheral neuropathy is a result of damage to the peripheral nervous system commonly associated with diabetes mellitus, not systemic atherosclerosis. Peripheral paralysis is complete loss of strength in an affected limb or muscle group. This condition is not associated with systemic atherosclerosis. Peripheral vascular resistance impedes the flow of blood in the peripheral arterial vessels that is typically a function of the internal vessel diameter, vessel length, and blood viscosity. It is not associated with systemic atherosclerosis. Ch. 33: pg. 709
Which chemical in the urine may indicate pheochromocytoma in a patient with hypertension? 1 Estrogen 2 Corticoids 3 17-ketosteroids Correct 4 Catecholamines
Pheochromocytoma is a tumor of the adrenal medulla, which results in the presence of catecholamines in the patient's urine. The presence of estrogens in urine is diagnostic of liver disease. The presence of chemicals such as 17-ketosteroids and corticoids in the urine are used to diagnose Cushing syndrome.
The nurse recently taught safety measures to a patient who was prescribed warfarin. During the follow-up visit, the nurse anticipates the risk of bleeding in the patient. Which action of the patient is responsible for this finding? 1 Increasing fluid intake Correct2 Including asparagus in the diet 3 Avoiding consumption of cauliflower 4 Avoiding taking a nonsteroidal anti-inflammatory drug
Potassium and warfarin interact and increase the risk of bleeding. Asparagus is rich in potassium and patients should avoid a sudden increase in the diet of potassium-rich foods. Increasing fluid intake will help keep the body hydrated. Avoiding the consumption of cauliflower during warfarin use will reduce the risk of bleeding. Avoiding taking a nonsteroidal anti-inflammatory drug during warfarin treatment will reduce the risk of bleeding.
Which dietary instructions should the nurse give to a patient with a venous stasis ulcer? Select all that apply. 1. "Limit sodium intake." 2. "Reduce potassium intake." Correct 3 "Consume protein rich foods." Correct 4 "Eat foods rich in vitamins A and C." Correct 5 "Consume adequate amounts of zinc."
Protein-rich foods, vitamins A and C, and zinc promote wound healing. Sodium intake should be limited in the patient with hypertension. Potassium intake should be reduced in the patient receiving spironolactone treatment.
A patient informs the nurse, "My skin becomes red-white-blue after exposure to cold." What disorder does the nurse anticipate is related to this finding? 1 Subclavian steal 2 Buerger's disease Correct3 Raynaud's phenomenon 4 Thoracic outlet syndrome
Raynaud's phenomenon causes painful vasospasms of arteries and arterioles in the extremities. Due to poor blood circulation, the skin becomes red-white-blue after exposure to cold. Subclavian steal causes ischemia in the arm, paresthesias, dizziness, and blood pressure differences in the arms. Ulceration on the digits and claudication in feet, which worsens at night, are symptoms of Buerger's disease. Numbness, cyanosis, and compression of the subclavian artery by the ribs are symptoms of thoracic outlet syndrome.
A patient with deep vein thrombosis (DVT) asks about ambulation. Which information would the nurse provide to this patient? 1 "You should not ambulate because doing so can dislodge the clot." 2 "You must limit ambulation to just going to and from the bathroom." 3 "We will provide you with a wheelchair that you can use for getting around." Correct 4 "Walking around will not increase the risk for dislodging the clot."
Research has shown that ambulation does not increase the risk for pulmonary embolus from DVT, so it is appropriate for the nurse to tell the patient to walk around. It is not true that ambulating can dislodge the clot, that ambulation should be limited, or that a wheelchair is necessary.
Which factor increases the risk for primary hypertension? Select all that apply. One, some, or all responses may be correct. Correct 1 Smoking 2 Pregnancy 3 Kidney disease Correct 4 Hyperlipidemia 5 Oral contraceptive use
Risk factors for primary hypertension include smoking and hyperlipidemia. Risk factors for secondary hypertension include pregnancy, kidney disease, and oral contraceptive use. Primary & Secondary Risk Factors: Table 33.2
Which patient is in the demographic with the highest prevalence of hypertension? 1 50-year-old man 2 70-year-old man 3 45-year-old woman Correct 4 65-year-old woman
The 65-year-old woman has the highest risk for hypertension. Men are at a higher risk until age 45, so the 50- and 70-year-old men are at a lower risk than the 65-year-old woman. From ages 45 to 64, women and men have a similar risk for hypertension. After age 64, women have a higher risk than men, so the 65-year-old woman is therefore at a higher risk than the 45-year-old woman.
Which explanation would the nurse provide when a patient states, "The doctor says I have hyperlipidemia. What does that mean?" 1 "Hyperlipidemia means you have atherosclerosis." 2 "Hyperlipidemia means you have arteriosclerosis." Correct 3 "Hyperlipidemia is an elevation of serum lipid levels." 4 "Hyperlipidemia describes a diet high in fat and cholesterol."
The best explanation of hyperlipidemia is that it is an elevation of serum lipid levels. Hyperlipidemia is a risk factor for the development of atherosclerosis. A diet high in fat and cholesterol may contribute to the development of hyperlipidemia. Hyperlipidemia puts the patient at risk for arteriosclerosis.
Which definition of atherosclerosis is most accurate? 1 Coronary artery blockage 2 The development of renal stenosis 3 A blood clot that blocks perfusion to the heart Correct 4 A type of arteriosclerosis involving plaque formation
The most accurate definition of atherosclerosis is that it is a type of arteriosclerosis involving plaque formation. A blood clot blocking perfusion is called a thrombus or embolus. Atherosclerosis may block coronary artery perfusion, but atherosclerosis is not limited to the coronary arteries and may occur in any large vessel. Renal stenosis is narrowing of the renal arteries that may occur as a result of atherosclerosis or fibromuscular dysplasia, but atherosclerosis is not limited to the renal arteries.
Which description of arteriosclerosis is most accurate? 1 Cholesterol lining the arterial wall 2 Fat deposits along the arterial vessels Correct 3 Thickening or hardening of the arterial wall 4 Enlargement of the diameter of blood vessels
The most accurate description of arteriosclerosis is thickening or hardening of the arterial wall, often associated with aging. A diet high in cholesterol increases the risk for coronary artery disease; however, the exact pathophysiology of arteriosclerosis is not known. Plaques forming along vessel walls are thought to become inflamed followed by a fatty streak appearing on the intima of the artery. Fat deposits along arteries, also called fat embolisms, are associated with long-bone fractures and not the development of plaque. Enlargement of the diameter of blood vessels is termed dilation. With arteriosclerosis, the diameter of the vessel narrows.
Which drug does the primary health care provider prescribe for relieving sharp pain in the chest of a patient hospitalized and in the intensive care unit (ICU) with carotid aorta dissection? 1 Esmolol 2 Amlodipine 3 Propranolol Correct4 Morphine sulfate
The most commonly associated symptom with aorta dissection is sharp pain in the chest. The primary health care provider prescribes morphine sulfate to the patient because it is a narcotic analgesic and an opioid. The other drugs such as esmolol, amlodipine, and propranolol may be prescribed to treat hypertension associated with the condition. Therefore, these drugs may not be prescribed for relieving the pain in the chest.
Which drug would the nurse expect to administer for relieving the sharp chest pain of a patient in the ICU with aortic dissection? 1 Esmolol 2 Amlodipine 3 Propranolol Correct 4 Morphine
The most commonly associated symptom with aortic dissection is sharp pain in the chest. The primary health care provider prescribes morphine sulfate to the patient because it is a narcotic analgesic and an opioid. Other drugs such as esmolol, amlodipine, and propranolol may be prescribed to treat hypertension associated with the condition. Therefore these drugs would not be prescribed for relieving the pain in the chest.
Which assessment of measure is related to venous thromboembolism (VTE) core measure set VTE-3? 1 The number of patients who received venous thromboembolism (VTE) prophylaxis 2 The number of patients who developed venous thromboembolism (VTE) on intensive care unit (ICU) admission 3 The number of patients who received venous thromboembolism (VTE) prophylaxis on intensive care unit (ICU) admission Correct4 The number of venous thromboembolism (VTE) confirmed patients who received overlap of parenteral anticoagulant and warfarin
The number of venous thromboembolism (VTE) confirmed patients who have received overlap of parenteral anticoagulant and warfarin is included under the VTE core measure set VTE-3. The measurement of the number of patients who have received VTE prophylaxis falls under VTE core measure set VTE-1. In the core measure set VTE-6, the number of patients who have developed VTE while hospitalized is measured. The VTE core measure set VTE-2 requires measuring the number of patients who have received VTE prophylaxis on intensive care unit (ICU) admission.
A patient with atherosclerosis has a decreased intensity in his or her pedal pulse. What should be the immediate nursing actions? Select all that apply. 1 Administer electrolytes 2 Perform a physical examination 3 Perform an electrocardiogram Correct 4 Notify the primary health care provider Correct 5 Document for emergency management
The nurse should immediately report this finding to a primary health care provider for interventions and document for emergency management in the patient's medical record. The administration of electrolytes should be performed after knowing the cause of the decrease in intensity of the pulse. A physical exam and electrocardiogram can be performed if the primary health care provider advises it.
A patient hospitalized with aortic dissection is further diagnosed with cardiac tamponade. Which is the first observation that helps the nurse identify this condition? 1 Vomiting 2 Flank pain 3 Diaphoresis Correct4 Hypotension
The occurrence of cardiac tamponade complication in a patient with abdominal aorta dissection makes the patient rapidly hypotensive. Vomiting may even appear in the absence of cardiac tamponade in patients with aorta dissection. Flank pain is seen in patients with aneurysms of the central arteries. Diaphoresis may appear even if the complication of cardiac tamponade is absent.
Which characteristic applies to acute arterial occlusion? 1 It progresses slowly. Correct 2 It has a sudden and dramatic onset. 3 It mainly affects the upper extremities. 4 It is most often caused by emboli originating in the lungs.
The onset of acute arterial occlusions is sudden and dramatic. Chronic peripheral arterial disease progresses slowly. Occlusions mainly affect the lower extremities, though they can still affect the upper extremities. Emboli originating from the heart, not the lungs, are the most common cause of acute arterial occlusions.
Which blood pressure control system is controlled by enzymes produced in the kidneys and lungs? 1 Vascular autoregulation 2 Body fluid volume regulation 3 Arterial baroreceptor system Correct 4 Renin-angiotensin-aldosterone system
The renin-angiotensin-aldosterone system is controlled by enzymes produced in the kidneys and lungs. The exact mechanism of how vascular autoregulation works is unknown. Body fluid volume regulation is largely controlled by the kidneys. Arterial baroreceptors are found primarily in the carotid sinus, aorta, and wall of the left ventricle.
A patient with deep vein thrombosis (DVT) is undergoing IV infusion therapy with unfractional heparin (UFH). The nurse finds that the patient's level of consciousness is altered and occult blood appears in the stool. Which should be the most appropriate intervention by the nurse, if activated partial thromboplastin time (APTT) value was found to be 73 seconds? Correct1 Discontinue the heparin therapy. 2 Replace heparin therapy with diltiazem. 3 Consider it normal and continue further. 4 Replace heparin therapy with bivalirudin.
The treatment choice for a patient with deep vein thrombosis (DVT) is unfractional heparin, which inhibits fibrin formation. This therapy should be discontinued with the appearance of occult blood in the stool, altered level of consciousness, and pain due to the risk for bleeding. Diltiazem is a calcium channel blocker that helps reduce hypertension in the patients. Therefore, replacement of unfractionated heparin with diltiazem would not be beneficial in this patient. An activated partial thromboplastin time (APTT) value of more than 70 seconds should not be considered normal in a patient who is on heparin therapy. Although bivalirudin is used as alternative to heparin, it may also increase the risk of bleeding. Therefore, replacing unfractional heparin (UFH) with bivalirudin would not be appropriate.
Which process occurs through cellular proliferation in atherosclerosis? 1 Inflammation of the vessel 2 Calcification of the fibrous plaque Correct3 Migration of collagen over the fatty streak 4 Protrusion of fibrous plaque into the vessel lumen
Through the cellular proliferation process, collagen migrates over the fatty streak, resulting in the formation of a fibrous plaque. Blood vessel damage may cause inflammation of the vessel. The final stage of atherosclerosis is characterized by calcification of the fibrous plaque. Protrusion of fibrous plaque into the lumen of vessel leads to obstruction of the blood flow.
A patient develops a venous stasis ulcer and is being prescribed a topical agent to chemically debride the ulcer. Which effect would the nurse expect the patient to report? 1 Excessive thirst 2 GI upset 3 Swelling in the affected limb Correct 4 Burning sensation on the ulcer
Topical agents may be prescribed to patients who have venous stasis ulcers. These are used to chemically debride the ulcer, eliminating necrotic tissue, and promoting healing. Therefore the patient may feel a temporary burning sensation when the agent is applied. The patient is unlikely to report GI upset, swelling, or excessive thirst.
A patient is prescribed IV unfractionated heparin followed by oral anticoagulation with warfarin. Which information would the nurse provide to the patient? 1 "Your blood will be able to clot faster now." Correct 2 "These drugs will increase the risk for bleeding." 3 "You should not experience any side effects." 4 "We will need to check your blood again in a month."
Unfractionated heparin by IV and oral anticoagulation warfarin increase the risk for bleeding. There are several side effects and complications with unfractionated heparin, which is why low-molecular-weight heparin is used more commonly today. With unfractionated heparin, the patient's blood will need to be checked regularly and before a month has passed, so hospitalization may be required. These drugs cause the patient's blood to become thin, not clot faster.
Which factor causes the greatest amount of complications for patients with atherosclerosis? 1 Hypertension 2 Inflammation 3 High-density lipoprotein (HDL) levels Correct 4 Unstable plaque
Unstable plaque can rupture, leading to more acute damage. The unstable plaque can break off and cause a thrombus, leading to vessel occlusion such as a myocardial infarction. Hypertension can weaken the blood vessel walls, but unstable plaque can cause ischemic damage. Inflammation is the first step in the formation of atherosclerosis. An increased HDL level is a normal finding and not a risk factor.
Which term in the health record describes a patient's platelet count reduction to 147,000/mm3 after receiving heparin therapy? 1 Induration 2 Poikilothermy Correct 3 White clot syndrome 4 Deep vein thrombosis
White clot syndrome, also known as heparin-induced thrombocytopenia, occurs when the patient's platelet count is below 150,000/mm3. Deep vein thrombosis is the most common type of thrombophlebitis. Induration is hardening, which can occur along the blood vessel. Poikilothermy is coolness.
Which finding would the nurse expect in the affected extremity of a patient with acute arterial occlusion? Select all that apply. One, some, or all responses may be correct. 1 Warm Correct 2 Mottled Correct 3 Pulseless 4 Unchanged color Correct 5 Reported as painful
With acute arterial occlusion, the affected extremity is pulseless and mottled. The patient will also report pain below the level of the occlusion. The affected extremity is cold or cool, not warm. Small areas on the toes may be blackened or gangrenous and do not stay the same color.
