Pathophysiology Unit 6 chapter 16
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
Deep vein thrombophlebitis of the leg
While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:
recording weight every day at the same time with same type of clothing.
A client arrives and the nurse assesses a blood pressure of 210/150 mm Hg. Which assessment finding is priority for the nurse to report to the primary health care provider?
reduced level of consciousness
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:
see the doctor for evaluation immediately.
The nurse cares for a newborn with a large right-to-left shunt in the heart. For which expected complication will the nurse assess the newborn?
severe hypoxemia
Which most important complication of atherosclerosis can result in occlusion of small heart vessels?
thrombosis
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. Due to ischemia, which initial peripheral symptom is associated with this disease?
Calf Pain
When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share?
"A 10-pound loss of weight can produce a decrease in blood pressure."
A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. -Wheezing sound on inspiration -Swelling around the lips and eyes -Severe bronchospasm -Hives over entire body -Incontinent of urine
-Severe bronchospasm -Wheezing sound on inspiration -Hives over entire body -Swelling around the lips and eyes
Which assessment finding would be considered a clinical manifestation of acute pericarditis? Select all that apply. -Pericardial friction rub -Narrowed pulse pressure -Sharp, abrupt onset of chest pain that radiates to the neck -Muffled heart sounds -Abnormal ECG results
-Sharp, abrupt onset of chest pain that radiates to the neck -Pericardial friction rub -Abnormal ECG results
A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by the health care provider. Which client statement indicates a need for further health promotion teaching?
"I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake."
A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which explanation is most appropriate to share?
"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate?
"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."
The nurse working in cardiac rehab stresses the importance of which interventions to her clients who have suffered a myocardial infarction to improve their overall health? Select all that apply. -Adequate exercise -Proper nutrition -Smoking cessation -Religious preferences -Psychosocial management -Education related to medications
-Adequate exercise -Proper nutrition -Smoking cessation -Psychosocial management -Education related to medications
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply. -Smoking cessation -Decreasing physical activity -Weight reduction if overweight -Increased intake of fats and sodium -Dietary measures to reduce LDL levels
-Smoking cessation -Dietary measures to reduce LDL levels -Weight reduction if overweight
Which assessment value(s) indicates the client is experiencing ineffective perfusion? Select all that apply. -cardiac output 6.5 L/min -signs of a stroke in the medulla of the brain -oxygen saturation 98% -hemoglobin 14.0 g/dl (140 g/L) -heart rate 130 beats/min, regular rhythm
-heart rate 130 beats/min, regular rhythm -signs of a stroke in the medulla of the brain
Upon arrival to the emergency department, which sign(s) and/or symptom(s) leads the nurse to suspect the client is experiencing a stroke? Select all that apply. -weakness on one side of the body -inability to empty bladder -incontinent of stool -throbbing headache -difficulty speaking -blood pressure 130/86 mm Hg
-weakness on one side of the body -difficulty speaking -throbbing headache
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?
140 mm Hg or higher
Which client on a geriatric medical unit is most likely to require slow-release potassium supplements on a regular basis?
81-year-old male who takes a thiazide diuretic to control hypertension.
In which situation is blood most likely to be rapidly relocated from central circulation to the lower extremities?
A client is helped out of bed and stands up.
Which individual is likely experiencing the manifestation of acute coronary syndrome (ACS)?
A client who occasionally experiences persistent and severe chest pain when at rest
While looking in on a neighbor who lives alone, the nurse notes left-sided paralysis, drooping face, and aphasia. What action should the nurse perform first?
Activate the emergency response system.
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate?
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?
Activation of the renin-angiotensin-aldosterone mechanism
A client experienced the onset of chest pain and collapses and dies suddenly. The family asks, "What caused him to die so suddenly?" Which response by the health care provider is most appropriate?
Acute ventricular dysrhythmia
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are prescribed by the health care provider. Which intervention should the nurse complete first?
Administer epinephrine (adrenaline).
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock?
Anaphylactic
A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which has lead to a diagnosis of deep vein thrombosis (DVT). What treatment option will be of greatest benefit to prevent further thrombus formation?
Anticoagulation therapy and elevation of the leg
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?
Atherosclerosis and unstable angina
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?
Backflow from the left ventricle to left atrium
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.
Baroreceptors
Which lipoprotein is the main carrier of cholesterol?
Low-density lipoprotein (LDL)
The nurse is caring for a client who has just experienced an acute myocardial infarction. Which type of shock is this client likely to experience?
Cardiogenic
A 56-year-old male client has been diagnosed with hypercholesterolemia. Which laboratory result supports this diagnosis?
Cholesterol 250 mg/dL (6.47 mmol/L) and HDL 32 mg/dL (0.83 mmol/L)
The nurse anticipates that which client would be considered a good candidate for coronary artery bypass grafting (CABG)?
Client who failed a percutaneous coronary intervention (PCI) and has a history of myocardial infarction (MI) experiencing new-onset pain and ST elevation
A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.
Diastolic dysfunction
Which function is performed by arteries such as the coronary and renal arteries?
Distribution of blood to organs that are controlled by contraction and relaxation of these vessels
A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure?
Diuretic, ACE inhibitor, beta-blocker
The client requires diagnostic testing to look at the directions of blood flow within their heart. For which test will the nurse provide client education?
Doppler color flow ultrasound
Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:
Fixed coronary obstruction
In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which clinical manifestation would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow?
Gastric bleeding
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- high density lipoprotein
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
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:
History of cigarette smoking and elevated blood pressure
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
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client?
Hypertension is a frequent modifiable contributor to aneurysms.
The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which lipoprotein is the main carrier of cholesterol?
LDL
Which lipid results on four clients will the nurse recognize as having the greatest risk for cardiovascular disease?
LDL cholesterol 205 mg/dL (5.31 mmol/L), HDL 40 mg/dL (1.04 mmol/L), and triglyceride level 150 mg/dL (1.69 mmol/L)
Which health problem is associated with heart failure as a result of diastolic dysfunction?
Myocardial hypertrophy
A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?
Norepinephrine
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?
Peripheral vascular resistance
A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?
Raising the head of the bed to a high Fowler's position
Which medication will likely be prescribed for a client with elevated LDL and triglyceride levels?
Simvastatin, an HMG-CoA reductase inhibitor or 'statin'
What is the primary cause of heart failure in infants and children?
Structural heart defects
When lecturing to a group of students about the pathophysiologic principles behind heart failure, the instructor defines cardiac output as which example?
The amount of blood the heart pumps each minute
Select the client who may be at risk for developing an increased resistance to blood flow.
The client in hypovolemic shock experiencing extreme dehydration
What physiologic process occurs when a gram-negative microbe enters the vascular system through a wound?
The microbe contains an endotoxin that can produce an inflammatory response, which ultimately results in injury to cells and vascular collapse.
A client is scheduled for cardiac catheterization. What is the likely purpose for the procedure?
To look for defects in heart structures or function by injecting contrast dye
Which serum biomarker is highly specific for myocardial tissue?
Troponin
A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?
Troponin Assays
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?
Troponin Level
A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:
Valvular regurgitation
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)
An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased:
Vascular stiffness
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?
anaphylactic shock
A client's atrioventricular (AV) node does not let all the impulses through and results in an obstruction of cardiac conduction. How does the nurse document this situation in the medical record?
atrioventricular (AV) heart block
Which risk factor for the development of primary hypertension is nonmodifiable?
black ethnicity
The physician has prescribed a thiazide diuretic for a client. The nurse anticipates that the medication will:
block the tubular reabsorption of sodium.
An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:
blocking the conversion of angiotensin I to angiotensin II.
Persistent cyanosis has lead an infant's care team to suspect a congenital heart defect. Which assessment finding coarctation of the infants aorta?
blood pressure in the child's legs is lower than in his arms
A client with anxiety disorder overstimulates their sympathetic nervous system (SNS). Which manifestation is a direct result of this SNS stimulation?
heart rate 150 beats/min
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
compensatory mechanisms
The nurse educates a client about myocardial infarction (heart attack). Which laboratory result does the nurse identify as a marker of inflammation?
elevated C-reactive protein (CRP)
A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:
hypovolemic shock due to acute intravascular volume loss.
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
improving quality of life by relieving symptoms.
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply. -Avoid aerobic physical activity. -Limit alcohol consumption. -Consume a diet rich in fruits, vegetables, and low-fat dairy products. -Stop smoking. -Reduce dietary sodium intake.
-Consume a diet rich in fruits, vegetables, and low-fat dairy products. -Reduce dietary sodium intake. -Stop smoking. -Limit alcohol consumption.
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
Action decreases metabolic demands of the heart.
Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease?
C-reactive protein
A client's initial blood pressure on admission to the outpatient clinic is 190/120 mm Hg. Which action by the clinic staff is most appropriate at this time?
Calling an ambulance to take the client to the emergency department
The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:
Decreased cardiac output
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?
Deep vein thrombosis
Clients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) are classified as low or high risk for acute myocardial infarction and sudden death based on the severity of which characteristic?
ECG changes
All of the following interventions are ordered STAT for a client stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?
Epinephrine
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this client has developed which type of shock?
Hypovolemic
A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?
Increase the IV fluid infusion per protocol.
A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?
Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction
A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience which physiologic response?
Relaxation of the bronchioles
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?
Septic
The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which diagnosis?
Stable angina
Which client response is an example of a chemoreceptor response to decreased oxygen levels in the blood?
increase in vasoconstriction to keep vital organs oxygenated
A health care provider is providing care for a client who developed deep vein thrombosis (DVT) and a pulmonary embolism following a period of bed rest. Which factor will the nurse determine did not contribute to the formation of a DVT?
increased heart rate
A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?
low blood pressure
The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?
morphine
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:
onset of STEMI
A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:
percutaneous transluminal angioplasty and stent placement.
The nurse is assessing a client involved in a motor vehicle collision who has bruising across the sternum from seat belt pressure. The nurse notes muffled heart sounds, and the client's blood pressure is 100/85 mm Hg. The nurse notifies the health care provider to present these findings as evidence of which condition?
pericardial effusion
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
unknown
In an ICU setting, one assessment that would lead the nurse to suspect that shock has led to decreased blood flow to vital organs is:
urine output less than 20 mL/hour.
For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve?
Compensatory mechanisms
A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which complication?
Crackles in bilateral lung bases caused by left-sided heart failure
A client is experiencing an increase in urinary output. Which physiologic response by the body is responsible for how the kidney concentrates urine?
Decrease in antidiuretic hormone
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. How will the nurse classify this client's blood pressure?
Stage 1 hypertension
A client is receiving home care for the treatment of a wound on the inside of the lower leg described as 3 cm in diameter with a yellow wound bed draining clear exudate. Assessment of the client's legs reveals edema and a irregularly darkened pigmentation on the ankles and shins of both legs. How would the home care nurse document these findings?
Chronic venous insufficiency
A nurse is caring for a client who was brought by ambulance to the emergency department. The caregiver states that an hour ago, the client had difficulty talking and was not able to use their right arm or leg. Which condition in the medical history may have contributed to the symptoms?
smokes 1 pack per day for 20 years