Patho 1 Exam 3

the parasympathetic nervous system is know as:

Rest & Digest/ Feed & Breed

Elevated levels of blood _______ are implicated in the development of atherosclerosis with its attendant risk of heart attack and stroke.

cholesterol

A/An ________ is a freely moving particle such as a blood clot that breaks loose and travels in the larger vessels of the circulation until lodging in a smaller vessel and occluding blood flow.

embolus

An ________ is a freely moving particle such as a blood clot that breaks loose and travels in the larger vessels of the circulation until lodging in a smaller vessel and occluding blood flow

embolus

what is the most common hypertension?

essential

Malignant hypertension:

extremely high blood pressure that develops rapidly and causes some type of organ damage

Acetylcholine =

parasympathetic

A nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:

pressure pulses

The ______ circulation consists of the right heart, the pulmonary artery, the pulmonary capillaries, and the pulmonary veins

pulmonary

The difference between the systolic and diastolic pressure is called the:

pulse pressure

_________ is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes

raynauds phenomenon

___________ is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers, and less often the toes

raynauds phenomenon

Many of the conditions causing __________ hypertension can be corrected or cured by surgery or specific medical treatment

secondary

___________ hypertension is the elevation of blood pressure that results from some other disorder:

secondary

what is the most common hypertension in children?

secondary

Cardiac Output (CO) =

stroke volume (SV) × heart rate (HR).

how are aortic aneurysms typically treated?

surgical repair

Norepinephrine, epinephrine, dopamine =

sympathetic

The neural control of the circulatory system occurs primarily through the ___________ and ________ divisions of the autonomic nervous system

sympathetic; parasympathetic

The ________ circulation consists of the left heart, the aorta and its branches, the capillaries that supply the brain and peripheral tissues, and the systemic venous system and the vena cava

systemic

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

temporal

Wall tension is inversely related to wall thickness, such that the _____ the vessel wall the lower the tension.

thicker

Which of the following is the priority complication of atherosclerosis?

thrombosis

When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension?

In the morning before arising from bed

Considering how hydrostatic forces affect the capillaries, which of the following would increase capillary hydrostatic pressure most?

Increase in venous pressure

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility

Dissection of Aorta:

Involves hemorrhage into the vessel wall with longitudinal tearing to form a blood-filled channel(Acute, life-threatening condition)

What is the role of aldosterone?

It causes the kidneys to keep sodium and water.

Which statement is correct regarding the systemic circulation?

It is a high pressure system

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange.

LDL is removed from the circulation either by __________ or by ______ cells

LDL receptors; scavenger

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar

Contractility:

(Force of contraction) How hard the myocardium must contract during a given PRELOAD

The nurse is discussing risk factors for hypertension with a client. Which factors are nonmodifiable risk factors for development of hypertension? Select all that apply.

- Advanced age - Ethnicity

what kind of factors could cause primary hypertension?

- African American - older adults - genetics - lower socioeconomic levels - High sodium intake - Excessive calorie intake - Obesity - Inactivity - Excessive alcohol consumption - Dietary fats - Sleep apnea - oral contraceptives

Which of the following is a vasoconstrictor? SATA

- Angiotensin II - Serotonin

Which are primary treatment options for a client with acute venous thrombosis? Select all that apply.

- Bed rest - Application of heat - Elastic support

As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors?

- Cardiac Contractility - Heart Rate - Preload - Afterload

A 65-year-old male client is diagnosed with systolic hypertension. The nurse educates the client about how the aging process and development of stiff, large arteries can result in which physiologic occurence? Select all that apply.

- Decreased diastolic pressure - Widened pulse pressure - Increased systolic pressure

A client is diagnosed with orthostatic hypotension. The nurse knows that which drugs can predispose the client to orthostasis? Select all that apply.

- Diuretics - Psychotropics - Antihypertensives

Which statements are true regarding the capillary system? Select all that apply.

- Flow into the system is controlled by colloidal osmotic pressure. - Albumin plays a significant role in maintaining the function of this system. - Flow out of the system is controlled by hydrostatic pressure.

s/s of Raynaud Phenomenon:

- Functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, toes. - More common in females than males - Precipitated by exposure to cold or strong emotions and is usually limited to the fingers - Seldom causes tissue necrosis

Which of the following is a vasodilator? SATA

- Histamine - Bradykinin

what conditions effect afterload?

- Hypertension - atherosclerosis - vasoconstriction: higher vascular pressure make it more difficult for the valves to open resulting in a reduced amount of ejected blood

Select the statements that most accurately describe secondary hypertension. Select all that apply.

- Kidney disease is one the most common causes - Obstructive sleep apnea is an independent risk factor for secondary hypertension - Accounts for 5-10% of hypertension cases - May be caused by oral contraceptives - Can be corrected or cured by surgery or specific medical treatment

Which of the following are characteristics for an unstable atherosclerotic plaque? SATA

- Large central lipid core - Thin fibrous cap - Vulnerable for rupture

what are some constitutional risk factors of atherosclerosis:

- Male gender - Family history - Increasing age

what disease conditions associated with vasculitis?

- Microscopic Polyangiitis - Wegener Granulomatosis - Polyarteritis nodosa - Kawasaki Disease - Thromboangiitis obliterans → Buerger Disease - Giant Cell arteritis - Takayasu arteritis

who commonly develops a dissecting aneurysm?

- Most common in 40-60 yr olds - More common in males

s/s of Thromboangitis Obliterans (Buerger Disease):

- NECROSIS - Segmental, thrombosing, acute, and chronic inflammation of the medium-sized and small arteries, principally the tibial and radial arteries but sometimes extending to the veins and nerves of the extremities--occurs almost exclusively in men who are heavy smokers - Occurs before age 35 - Pain is the predominant symptom → usually related to distal arterial ischemia

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.

- Obesity - Inactive lifestyle - High salt consumption

s/s of Atherslerotic Peripheral Vascular Disease:

- One or both legs or feet feeling cold or changing color (pale, bluish, dark reddish) - Numbness, tingling, or weakness in the legs - Burning or aching pain in the feet or toes while resting - Edema

Which of the following are characteristic signs of acute arterial embolism?

- Pallor - pulselessness - pain

what are the s/s of acute arterial occlusion?

- Pallor (sudden) - Pistol shot(acute onset) - Pulselessness - Pain - Paralysis - Paresthesia ( abnormal feelings) - numb, tingles - Polar

atherosclerosis:

- Progressive disease - Formation of fibrofatty plaques in the intima - Occurs in large and medium sized vessels

A 45 year old woman with a diagnosis of multiple sclerosis comes to the clinic complaining of coldness and pain in her fingers. She says that her fingers turn blue, and then her fingers get red, and they throb and tingle. The nurse would expect what diagnosis and treatment for this patient? SATA

- Raynaud disease; protecting the digits from cold - Raynaud phenomenon; stop smoking

Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysms termed abdominal aortic aneurysms?

- Saccular - Fusiform

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? SATA

- Size of lipid-rich core - Thickness of fibrous cap

what are modifiable risk factors of atherosclerosis?

- Smoking - Hypertension - Hypercholesterolemia - Diet (less fats) - Elevated LDL and low HDL - Obesity - Exercise (lose weight)

Virchow described the triad that has come to be associated with venous thrombosis as:

- Stasis of Blood - Increased blood coagulability - Vessel wall injury

s/s of thoracic aortic aneurysm

- Substernal back and neck pain - dyspnea - stridor, or brassy cough - hoarseness.

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 - The systolic pressure is greater than or equal to 140 mmHg - It is the most common cardiovascular disorder

What determines preload?

- Venous return - fluid volume - atrial contraction

what are some s/s of malignant hypertension?

- Vision loss - renal shutdown - headache - change in level of consciousness - visual disturbances

what are the two common causes of aortic aneurysms?

- atherosclerosis - degeneration of the vessel media

The circulatory system can be divided into two parts:

- pulmonary circulation - systemic circulation.

There are two sites of lipoprotein synthesis:

- small intestines - liver

s/s of abdominal aortic aneurysm

- typically Asymptomatic - Pulsating mass - Compress lumbar nerve roots causing lower back pain radiating to legs - Erosion of vertebrae

how tests are done to diagnose an aortic aneurysm?

- ultrasonography - echocardiography - CT scans - MRI

Which organ has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?

Liver

Mean arterial pressure for the pulmonary system is:

12mm Hg

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

140/90

The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:

64 mm Hg

Mean arterial pressure for the systemic circulation is:

90-100 mmHg

Which client is most likely to be experiencing vasodilation?

A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system

Which client is at greatest risk for orthostatic hypotension?

A 66-year-old postoperative client on bed rest

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

Apply sequential pneumatic compression devices to lower extremities

Chemoreceptors:

Cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood

The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:

A reading that is too high

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.

Which neurotransmitter is associated with the parasympathetic nervous system?

Acetylcholine

Which of the following is the postganglionic neurotransmitter for the parasympathetic neurons?

Acetylcholine

When a client experiences the Cushing reflex, what occurs with the body?

An increase in arterial pressure to levels above the intracranial pressure

What component of the RAAS (renin-angiotensin-aldosterone system) is created and found in the liver that is activated by renin?

Angiotensinogen

A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete?

Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve

why vessels aligned parallel:

Blood is not confined to a single channel but can travel through each of the several parallel channels such that resistance becomes the reciprocal of the total resistance

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

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

why vessels aligned in a series:

Blood travels sequentially from one vessel to another such that the resistance becomes additive

Cardiac output is used to measure the efficiency of the heart as a pump. What is the equation used to express CO?

CO = SV x HR

correct sequence of blood return to the heart:

Capillaries, venules, veins, right atrium

The most common cause of secondary varicose veins is __________

DVT

The most common cause of secondary varicose veins is:

DVT

While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?

Decreased heart rate as a result of parasympathetic innervation of the heart

Select the statement that best describes Buerger disease.

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

Essential(primary) hypertension:

Elevation of BP occurs without evidence of other disease

the sympathetic nervous system is known as the _________ response

Fight or Flight

"Greater the stretch = greater the force of contraction" describes which mechanism?

Frank-Starling

The nurse is caring for a client with severe aortic stenosis. What affect to cardiac afterload will the nurse note?

Greatly elevated systolic pressure when measured with hemodynamic setting

how is a direction of the aorta diagnosed?

H&P supported by CT, MRI, or vascular imaging.

Sympathetic nervous system controls:

Heart rate, Cardiac contractility and blood vessel tone

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20-40 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

Which related circulatory complication can result from surgical treatment for metastatic breast cancer?

Lymphedema in the affected arm

Function of chemoreceptors:

Maintain normal arterial gases (cardiorespiratory hemostasis)

The ________ represents the average pressure in the arterial system during ventricular contraction and relaxation

Mean Arterial Pressure

the job of the pulmonary system is too:

Move blood through the lungs and create a link with the gas exchange function of the respiratory system(oxygenate blood)

Which statement is correct regarding the pulmonary circulation?

Moves blood through the lungs and creates a link with the gas exchange function of the respiratory system

Which statement best describes vasculitis?

Necrosis of the blood vessel wall

sympathetic nervous system releases what 3 things?

Norepinephrine, epinephrine, & dopamine

Which statement correctly defines secondary hypertension?

Often results from other disorders such as kidney disease

Pulmonary artery:

Only artery that carries deoxygenated venous blood; carries blood to the lungs to collect oxygen

pulmonary veins:

Only veins that carry oxygenated arterial blood; Carries blood from the lungs to the heart (dumps into the left atrium)

Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

Preload

___________ hypertension is the term applied to 95% of cases in which no cause for hypertension can be identified.

Primary (essential)

A nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?

Pulmonary arterial pressure (PAP)

If the output of the left heart were to fall below that of the right heart, blood would accumulate in the:

Pulmonary circulation

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

Pulmonary embolism

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

Raynaud disease

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:

Raynauds

what are the most common causes of secondary hypertension in children?

Renal problems, birth defects, and endocrine disorders

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?

Repolarization of the ventricles

how can dissection of the aorta be treated?

Resection of the involved segment and replacement with a prosthetic graft. If untreated has high mortality.

A client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.

pulmonary circulation:

Right side of the heart; moves blood through the lungs and creates a link with the gas exchange function of the respiratory system

A 56 year old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?

Sclerotherapy or surgery

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

Stasis of blood, hypercoagulability, vessel wall injury

If the right heart were to pump less effectively than the left heart, blood would accumulate in the:

Systemic circulation

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

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (vasculitis). These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is the most common of the vasculitides?

Temporal arteritis

A 69 year old man is admitted to the hospital following a popliteal embolectomy. He asks the nurse why he had to have surgery on his leg. What is the best response by the nurse?

The artery that runs behind your knee was blocked by a blood clot, and the doctor removed it.

The heart and blood vessels receive both sympathetic and parasympathetic innervation from neural control. What controls the parasympathetic-mediated slowing of the heart rate?

The cardioinhibitory center

Afterload:

The load, or resistance, the left ventricle must overcome in order to eject the blood during contraction.

Preload:

The maximum amount of stretch of the cardiac muscle before it contracts(because it is work imposed on the heart BEFORE contraction)

Stroke Volume (SV):

The volume of blood pumped forward with each ventricular contraction.

two types of aortic aneurysms:

Thoracic & Abdominal

________ is an inflammatory arterial disorder that causes thrombus formation

Thromboangiitis obliterans

The renin-angiotensin-aldosterone system plays a central role in blood pressure by increasing _________ and ________

Vessel constriction; fluid retention

what is the major symptom of a dissecting aneurysm?

abrupt presence of excruciating pain, described as tearing or ripping

the parasympathetic neurotransmitter is:

acetylcholine

The _______ and _______ valves control the movement of blood out of the ventricles

aortic; pulmonic

An aneurysm also may be __________, with the first evidence of its presence being associated with vessel _________

asymptomatic ; rupture

LDL, sometimes called the _____________, is the main carrier of cholesterol

bad cholesterol

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall

baroreceptors

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.

baroreceptors

why is the arterial pressure for the pulmonary system so low?

because it allows blood to move slowly through the lungs giving it more time for gas exchange

Why is hypertension called the silent killer?

because it is typically asymptomatic

Where are central chemoreceptors located?

brain (medulla)

Which blood vessels function without the benefit of having walls comprised of three muscular layers?

capillaries

Where are peripheral chemoreceptors located?

carotid and aortic bodies

Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis?

client on bed rest

The distensibility of the blood vessel is the major factor in which of the vessel's characteristics?

compliance

what is a dissecting aneurysm caused by?

conditions that weaken or degenerate the elastic and smooth muscles layers of the aorta

The _____ risk factors include a family history of hypertension, race, and age-related increases in blood pressure

constitutional

The use of ____________ pills is probably the most common cause of secondary hypertension in young women

contraceptive

_______ is marked by ventricular relaxation and filling

diastole

The total quantity of blood that can be stored in a given portion of the circulation for each millimeter rise in pressure is termed "compliance" and reflects the ______ of the blood vessel

distensibility

The ________ mechanism allows the heart to adjust its pumping ability to accommodate various levels of venous return.

frank-starling

HDL is synthesized in the liver and is often referred to as the:

good cholesterol

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. As the nurse carding for this patient, what are the signs and symptoms you would assess for?

headache and confusion

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that the most likely cause of the varicosities is:

heavy lifting

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?

heavy lifting

Aortic dissection involves _________ into the vessel wall with longitudinal tearing of the vessel wall to form a blood-filled channel.

hemorrhage

systemic circulation is a ______ pressure system while pulmonary circulation is a _______ pressure system:

high; low

The major risk for atherosclerosis is:

hypercholesterolemia

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

hypertension

Secondary hypertension:

hypertension caused by a previously diagnosed disease/illness

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?

hypotension

Which of the following is a hallmark symptom of peripheral arterial disease?

intermittent claudication

Why is the systemic circulation a high pressure system?

it has to work against the effects of gravity

Which organ(s) is largely responsible for the long-term regulation of blood pressure?

kidneys

An elevation in blood pressure increases the workload of the _________ by increasing the pressure against which the heart must pump as it ejects blood into the systemic circulation

left ventricle

The ________ transport cholesterol and triglycerides to various tissues for energy utilization, lipid deposition, steroid hormone production, and bile acid formation

lipoproteins

what kind of hypertension is potentially fatal?

malignant

what is the difference between malignant hypertension and the other kinds?

malignant hypertension is the only hypertension that shows s/s

ejection fraction:

measurement of the volume percentage of left ventricular contents ejected with each contraction

job of the systemic circulation is too:

move blood from the heart throughout all parts of the body

The RAAS system plays a central role in blood pressure by increasing:

vessel constriction and fluid retention

The low pressure of the pulmonary circulation allows blood to move through the lungs more slowly, which is important for gas exchange Because flow is directly related to the radius, small changes in vessel radius can produce large changes in flow to an organ or tissue __ ______ is the resistance to flow caused by the friction of molecules in a fluid.

viscosity