NUR334 PrepU: Chapter 13 + 18

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.

The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5g/dL. Which type of blood product will the provider order?

Packed red blood cells.

A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?

Polycythemia vera.

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

60% of diastolic pressure and 40% of systolic pressure.

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

The kidneys.

The family of an elderly patient are wondering why his 'blood counts' are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles?

"Due stress, the red blood cells of older adults are not replaced as promptly as younger people."

The nurse is caring for of a 6-month-old infant diagnosed with iron deficiency anemia. The nurse determines further teaching is necessary when the mother states:

"I must stop breast-feeding my baby because of the anemia."

A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?

"The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

Mature red blood cells have a life span of approximately:

120 days.

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

140.

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?

140/90.

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?

A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness.

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

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

The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia.

A client who has undergone partial gastrectomy.

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.

A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop.

Blood loss.

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mg Hg and proteinuria during the 30th week of pregnancy.

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.

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

Fingers.

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.

Which of the following is the most abundant type of plasma proteins?

Albumin.

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.

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.

A nurse is participating in a health fair and is addressing many of the varied factors that can contribute to hypertension. The nurse should be cognizant of the higher incidence and prevalence of hypertension in which groups?

Blacks and South Asians.

The microbiology technician explains to the student that which of the following blood cells is the most common?

Erythrocyte.

An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?

Cerebral thrombosis.

The physician is examining a postmenopausal female and explains that which cause of iron deficiency is most common in adults?

Chronic blood loss.

An elderly client asks the nurse why so many older people develop anemia. The best response would be:

Chronic disease.

The rate at which hemoglobin is synthesized depends on availability of which substance?

Iron.

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:

Familial hypercholesterolemia (type 2A).

The provider notes that the client's hemaglobin is 8.2g/dL. Which of the following supplements will the provider recommend to the client?

Ferrous sulfate.

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.

The client has been diagnosed with impaired blood flow in the deep venous channels of her legs. The nurse explains that which of the following is the most common cause of this condition?

Deep vein thrombosis (DVT).

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

An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding?

Elevated RBC, hemoglobin, and hematocrit.

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

Elevation of triglycerides.

Which of the following blood vessel layers is composed primarily of smooth muscle cells?

Tunica media.

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).

A client is pregnant for the first time and is considered to be at high risk for preeclampsia. The care team should prioritize which intervention?

Vigilant blood pressure monitoring.

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.

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate?

"The increase in bilirubin which causes the jaundice, is related to the increased red blood cell breakdown."

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:

"They are looking for the presence of antibody or complement on the surface of the RBC."

A nurse is teaching parents expecting their first child about the benefits of umbilical cord blood donation. The nurse determines teaching was effective based on which statement?

"Umbilical cord blood can provide stem cells for transplantation."

The nurse knows that which statements regarding blood pressure in the African-American population are correct? Select all that apply.

-African Americans often experience greater renal damage from hypertension. -Hypertension is more severe among African Americans compared to other ethnic groups. -Hypertension in African Americans is often treated less aggressively.

The nurse is assessing a female patient with a hemoglobin of 6.8g/dL. Which of the following symptoms would the nurse expect to find? Select all that apply.

-Headache. -Faintness. -Dyspnea.

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.

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

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 client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. Which responses is best for the nurse to educate this client about? Select all that apply.

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

A nurse is preparing a presentation for a community prenatal group about umbilical cord blood banking and donation. Which of the following statements should be included in the presentation? Select all that apply.

-Sources of the stem cells include bone marrow and umbilical cord blood. -People with immunodeficiencies and malignancies can receive donated stem cell transplants to replenish stem cells after chemotherapy. -Stem cells must be from a histocompatible matched donor to prevent graft-versus-host disease.

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.

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

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.

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

Hypertension.

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 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?

HDL.

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 nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin?

Hypoxia.

The client presents with a reduction in red blood cells, white blood cells and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have?

Idiopathic aplastic.

A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing?

Impaired function of the electron transport chain.

The rennin-angiotensin-aldosterone system is a negative feedback system that plays a central role in blood pressure regulation. How does the end result of this feedback loop regulate blood pressure in the body?

Increases salt and water retention by the kidney.

The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as:

Insufficient hemoglobin.

A pediatric nurse is treating a 2-day-old infant for jaundice. The treatment involves exposing the infant's skin to fluorescent light at 420 nm to 470 nm wavelengths. What does the light do to the bilirubin?

It converts the bilirubin into a soluble form that is easily excreted in the stool and urine.

The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid.

Kale.

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which of the following lab results?

Low platelets.

The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?

Polycythemia vera.

A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?

Polycythemia.

The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?

Posterior iliac crest.

Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?

Posterior iliac crest.

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 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.

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.

Which of the following would be tested by a complete blood count (CBC)?

Red blood cells and platelets.

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. The primary goal of his treatment will be to:

Reduce the viscosity of his blood.

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.

The anemic client is receiving erythopoietin. If there is a marked increase in red blood cell production, which lab result would increase?

Reticulocytes.

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:

Rh immune globulin.

A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool which has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?

She will have iron-deficiency anemia due to depletion of iron stores.

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs?

Spleen.

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 blood pressure.

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.

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.

When it is determined that a patient's red blood cells (RBCs) have a biconcave shape, which of the following will be the nurse's reaction?

The nurse will be pleased, as that shape allows for increased oxygen diffusion.

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?

Thrombosis in the right leg.