PREP U CH. 26 DISORDERS OF BLOOD FLOW

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?

"I should have my LDL monitored."

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

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?

Decreased aorta and large artery elasticity

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

The Kidneys

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 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.

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

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

140

Which type of aortic aneurysm is the most common?

Abdominal aortic

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

The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?

Elevated total cholesterol

Which of the following is the site of chylomicron synthesis?

Small Intestine

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

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

Which intervention by the client will decrease overall cardiovascular risk?

Higher levels of fitness and exercise

Disease of the arterial system affects body function by impairing blood flow. Which term refers to an area of necrosis in an organ produced by occlusion of its arterial blood supply?

Infarction

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 knows that peripheral vascular resistance is an important factor in blood pressure regulation. Which statements regarding peripheral vascular resistance are correct? Select all that apply

-Mean arterial pressure is determined by cardiac output and peripheral vascular resistance. -Peripheral resistance is influenced by blood viscosity. -Blood pressure can be maintained despite changes in cardiac output and resistance. -Peripheral resistance is influenced by arteriolar constriction.

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

140/90

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

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

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

Select the statement that best describes Buerger disease

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

The nurse knows that which group of antihypertensive drugs is usually the least expensive and are well tolerated?

Diuretics

An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?

Encouraging the client to maintain hydration throughout the day

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?

Exercise can increase blood vessel growth and help to decrease symptoms.

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

Which lipoprotein is the main carrier of cholesterol?

Low-density lipoprotein (LDL)

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition?

Renal artery stenosis

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 has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

Elevation of triglycerides

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (vasculitis). Which condition is the most common of the vasculitides?

Temporal arteritis

he nurse knows that which statements regarding the physiology of blood pressure are accurate? Select all that apply.

-Blood pressure is very variable. -Constant elevation of blood pressure can be lethal. -A decrease in blood flow can be an immediate threat to life.

A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the the knowledge is understood when the client correctly matches which drug category to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?

Diuretics

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?

Echocardiogram

Which pathogenesis is primarily responsible for Raynaud phenomenon?

Vasospasm causing excessive vasoconstriction

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 nurse is discussing hypertension with a group of clients. The nurse knows that which statements regarding hypertension are true? Select all that apply.

-Family history of hypertension is a risk factor for hypertension. -Diabetes can lead to secondary hypertension.

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state:

-It is the most common cardiovascular disorder. -The incidence increases with age. -The systolic pressure is ≥140 mm Hg.

The nurse practitioner is conducting an assessment of an older adult client who has a long-standing history of poorly controlled hypertension. Which of the nurse's assessments address potential consequences of hypertension? Select all that apply.

-Vision testing using a Snellen chart. -Review of the client's BUN and creatinine levels. -Assessment of the client's lower legs for peripheral vascular disease. -Assessment of the client's cognition using the Mini Mental Status Exam.

Which client is at greatest risk for orthostatic hypotension?

A 66-year-old postoperative client on bed rest

While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first?

A client holding the abdomen and reporting a tearing and ripping feeling inside.

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.

The practitioner's assessment of a client reveals a left leg that has no pedal pulses and is pale from the knee down. The client states that "the pain in my foot started suddenly and is severe." The practitioner suspects which condition?

Acute arterial occlusion

Besides liver, which other tissues utilize the LDL receptor-dependent pathway to obtain cholesterol needed for membrane and hormone synthesis? Select all that apply.

Adrenal glands Lymphoid cells Smooth muscle cells

A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?

Angiotensin-converting enzyme (ACE) inhibitors

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

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?

Black and South Asian people

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

The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which blood pressure finding can be characteristic of this condition?

Blood pressure in arms 20 mm Hg higher than in the legs

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

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 undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as:

Fibrous atheromatous plaque

The nurse is providing medication teaching to a client recently diagnosed with polyarteritis nodosa. The nurse explains that the client will receive three months of cytotoxic immunosuppressant agents followed by which of the following?

Glucocorticoids

The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity 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

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

Hypertension

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.

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

The student attends a health fair and has his serum cholestrol 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 postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse?

The client states his hand is numb.

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

Pallor, pulselessness, and pain

A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?

Periodic severe headache and marked variability in blood pressure

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

The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?

Promotes retention of water

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:

Pulmonary embolism

A nurse is evaluating hypertension risk factors with a black 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 lb (6.8 kg) in the past year. Which risk factors or hypertension are nonmodifiable? Select all that apply.

Race Family history

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 intervention?

Sclerotherapy or surgery

Which one of the following organs are the two primary sites of lipoprotein synthesis?

Small intestine and liver

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 Dietary measures to reduce LDL levels Weight reduction if overweight

A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. The nurse knows that the client's blood pressure would be classified as ________ according to American Heart Association guidelines?

Stage 1 hypertension

Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:

Stasis of blood, hypercoagulability, vessel wall injury

The nurse knows that which food is excluded from the Dietary Approaches to Stop Hypertension (DASH) diet?

Steak

When a person rises from a lying to a standing position, heart rate increases. What description would the nurse use to explain the physiologic basis for this response?

Stretch on baroreceptors in the heart and blood vessels

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 client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?

Temporal

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?

The client must protect the entire body from cold, not just the extremities.

Which blood vessel layer is composed primarily of smooth muscle cells?

Tunica media

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:

Unknown

Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs)