ch 18
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: a. Complicated lesion b. Thrombus c. Fibrous atheromatous plaque d. Fatty streak
The lesions associated with atherosclerosis are of three types — the fatty streak, the fibrous atheromatous plaque, and the complicated lesion. Fatty streaks are thin, flat, yellow intimal discolorations. The fibrous atheromatous plaque grows larger and proliferates into the smooth muscle. As they increase in size, they encroach on the lumen of the artery. More advanced complicated lesions contain hemorrhage, ulceration, and scar deposits and can cause thrombus formation that may occlude the vessel.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The client's physician would anticipate that which phenomenon is most likely occurring? a. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. b. Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. c. The client's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. d. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction.
a Angiotensin conversion in the lungs is a component of the renin-angiotensin-aldosterone system that ultimately increases blood pressure and sodium reabsorption. Juxtaglomerular cells release renin, and epinephrine (vasopressin) is responsible for neither initiating the renin-angiotensin-aldosterone system nor directly influencing chemoreceptors and baroreceptors.
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? a. Blood pressure in legs 20 mm Hg higher than in the arms b. Blood pressure in arms 20 mm Hg higher than in the legs c. Prominent femoral pulses d. Widened pulse pressure in the legs
b In coarctation of the aorta, blood flow to the lower body is reduced. Blood pressure in the arms is typically at least 20 mm Hg higher than in the legs. Pulse pressure is narrowed, and femoral pulses are weak.
The client's ultrasound shows a true aneurysm that involves the entire circumference of the vessel and has a gradual and progressive dilation of the vessel. The provider tells the client the aneurysm is which of the following forms? a. Berry b. Fusiform c. Dissecting d. Saccular
b A fusiform aneurysm is a true aneurysm that involves the entire circumference of the vessel and is characterized by a gradual and progressive dilation of the vessel. A saccular aneurysm is a true aneurysm that appears saclike berry aneurysm is a true aneurysm that consists of a small, spherical dilation of the vessel at a bifurcation. a dissecting aneurysm is a false aneurysm
Which one of the following organs are the two primary sites of lipoprotein synthesis? a. Spleen and liver b. Small intestine and liver c. Bone marrow and endothelium d. Small intestines and bone marrow
b There are two sites of lipoprotein synthesis—the small intestine and the liver.
A physician is providing care for several clients on a medical unit of a hospital. In which client situation is the physician most likely to rule out hypertension as a contributing factor? a. 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week b. 66-year-old woman with poorly controlled angina and consequent limited activity tolerance c. 61-year-old man who has endocarditis and recurrent fever d. 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
c While cardiac complications are common sequelae of hypertension, a heart infection would be less likely to be so. Stroke, kidney failure, and angina are all identified as consequences of hypertension.
After an acute myocardial infarction, the client undergoes a cardiac catheterization that reveals severe atherosclerosis. The practitioner reviews the labs and finds the client has no HDL. Which condition does the client exhibit? a. Tangier disease b. Polyarteritis nodosa c. Temporal arteritis d. Buerger disease
a Tangier disease is characterized by accelerated atherosclerosis and little or no HDL. The other conditions are types of vasculitides and do not decrease HDL levels.
The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client? a. The client can take decongestants as needed. b. Treatment with vasoconstrictor medications may be indicated. c. Anxiety and stress may precipitate vasodilation in predisposed people. d. The client must protect the entire body from cold, not just the extremities.
d Treatment measures are directed toward eliminating factors that cause vasospasm. Abstinence from smoking and protection from cold are priorities. The entire body must be protected from cold, not just the extremities. Avoidance of stress and anxiety is another important factor, as they may precipitate vascular spasm in predisposed people. Vasoconstrictor medications, such as decongestants, should be avoided. Treatment with vasodilator drugs may be indicated.
The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following? a. Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development b. Increases serum HDL levels, thereby promoting fat oxidation c. Promotes vasodilation and decreases peripheral resistance, thereby increasing cardiac workload d. Decreases serum lipid levels and increases inflammation, thereby promoting hyperlipidemia
a Endothelial damage may be worsened by cigarette smoking. Damage to the endothelium is an early marker that can later become atherosclerotic and eventually may occlude the vessel or predispose to thrombus formation. Smoking increases serum lipid levels and decreases HDL. Smoking promotes vasoconstriction.
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? a. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. b. It is associated with a low intake of saturated fats. c. It has a low cholesterol content. d. It transports cholesterol away from cells to the liver for excretion.
a Hyperlipidemia, particularly LDL, with its high cholesterol content, is also believed to play an active role in the pathogenesis of the atherosclerotic lesion. Dietary cholesterol tends to increase LDL cholesterol. HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver.
A 70-year-old male client presents to the emergency department reporting 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 medical diagnosis/possible treatment plan listed below? a. Atherosclerotic occlusive disease necessitating thrombolytic therapy b. Giant cell temporal arteritis that will be treated with corticosteroids c. Raynaud disease that will require antiplatelet medications d. Acute arterial occlusion that will be treated with angioplasty
a The client's symptoms of calf pain with intermittent claudication and diminished pulses are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are not as closely associated with acute arterial occlusion or giant cell temporal arteritis and are not related to Raynaud disease.
A 16 year old adolescent who received a kidney transplant at the age of 10, has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension? a. Sandimmune (Cyclosporine). b. Hydrochlorothiazide (Hydrodiuril). c. Furosemide (Lasix). d. Isotretinoin (Accutane).
a The nephrotoxicity of the drug cyclosporine, an immunosuppressant used in transplant therapy, may cause hypertension in children after bone marrow, heart, kidney, or liver transplantion.
A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect? a. Increased sympathetic stimulation of the heart and blood vessels b. Increased parasympathetic stimulation of the heart and blood vessels c. Stimulation to form new red blood cells d. Inhibition of renin release from the kidneys to promote fluid retention
a When the baroreceptors in the carotid arteries detected the fall in blood pressure as blood volume was depleted, reflex sympathetic activity increased the rate and force of contraction via beta-1 receptors in the heart, and increased vasoconstriction via alpha-1 receptors in blood vessels. Both of these effects serve to support blood pressure and blood flow to vital organs.
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. a. It is the most common cardiovascular disorder. b. The systolic pressure is ≥140 mm Hg. c. The incidence increases with age. d. It is often associated with individuals of normal weight. e. The diastolic pressure is equal to 80 mm Hg.
a,b,c Hypertension (systolic pressure >140 mm Hg and/or diastolic pressure >90 mm Hg) is one of the most common cardiovascular disorders. The incidence of essential hypertension increases with age; the condition is seen more frequently among black persons, it may be associated with a family history of high blood pressure, metabolic syndrome, obesity, and increased sodium
The nurse knows that which statements regarding blood pressure in the black population are correct? Select all that apply. a. Black clients often experience greater renal damage from hypertension. b. Hypertension in black clients is often treated less aggressively. c. Hypertension is more severe among black persons compared to people from other ethnic groups. d. Hypertension onset in black persons is later than in people of other ethnic groups. e.Hypertension is less prevalent among the black population compared to other ethnic group poulations.
a,b,c Hypertension is more prevalent among the black populaiton, is more severe, and occurs at an earlier age compared to other ethnic group populations. Treatment often is not sufficiently aggressive, and renal and cardiovascular damage can be greater even at lower levels of pressure.
A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which phenomenon is primarily a contributing factor to hypertension in the older adult population? Select all that apply. a. Increased peripheral vascular resistance b. Decreased baroreceptor sensitivity and renal blood flow c. Stiffening of large arteries like the aorta d. Increased sensitivity of the renin-angiotensin-aldosterone system e. increase renal perfusion
a,b,c, Increased sensitivity of the renin-angiotensin-aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.
A nurse is educating a client about modifiable risk factors of primary hypertension. Which topics will the nurse be discussing with this client? Select all that apply. a. Obesity b. Alcohol consumption c. Family history d. High blood cholesterol levels e. Cigarette smoking
a,b,d,e The major modifiable risk factors for primary hypertension that can be affected by a change in health care behaviors include high blood cholesterol levels (specifically HDL cholesterol levels), cigarette smoking, obesity and visceral fat, fitness level, alcohol consumption, insulin resistance and metabolic abnormalities, and obstructive sleep apnea. Family history, race, and gender are a nonmodifiable risk factor
Which statements regarding hypertension are correct? Select all that apply. a. Hypertension is one of the most common health problems for adults. b. Hypertension is more frequent among white persons than among black persons. c. Hypertension is more frequent among younger men than in younger women. d. Hypertension is a major risk factor for cardiovascular disease. e. hypertension is more frequent in premenopausal women compared to postmenopausal women
a,c,d Hypertension is a frequent health disorder in adults, and is a major risk factor for cardiovascular disease. It is more frequent among younger men, older adults, and black people. Postmenopausal women are at greater risk for hypertension than premenopausal women.
A client is diagnosed with gestational hypertension. The nurse recognizes which findings are characteristics of this condition? Select all that apply. a. Development after 20th week of pregnancy b. Proteinuria c. Blood pressure greater than 140/90 d. Always accompanied by preeclampsia e. Blood pressure back to normal by 12 weeks postpartum
a,c,e Gestational hypertension is blood pressure rising above 140/90 after the 20th week of pregnancy, with no proteinuria. Some signs of preeclampsia may be present. In gestational hypertension, blood pressure returns to normal readings within 12 weeks postpartum.
Which intervention is the priority for the medical management of a client with a dissecting aortic aneurysm? a. Administration of epinephrine and intravenous fluids b. Administration of sodium nitroprusside and beta-adrenergic blocking medications (beta-blockers) c. Administration of medication to increase blood pressure d.Administration of pain medication and antianxiety medication
b Administration of nitroprusside and beta-adrenergic blocking medications would be an expected treatment to lessen the force of systolic blood ejection from the heart. The client's blood pressure needs to be lowered rather than elevated with epinephrine. Though the client is likely anxious and in acute pain, pharmacologic treatment of these are not the priority.
A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which aspect of hyperlipidemia would the physician most likely take into account when teaching the client? a. Cholesterol is a metabolic waste product that the liver is responsible for clearing. b. HDL cholesterol is often characterized as being beneficial to health. c. The goal of medical treatment is to eliminate cholesterol from the vascular system. d. Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.
b Because it transports cholesterol back to the liver from the periphery, HDL is associated with increased health and lowered risk of atherosclerosis. Genetics play a role in hyperlipidemia, and it is inaccurate to characterize cholesterol as a waste product. Cholesterol is necessary for several physiologic processes and complete elimination is neither realistic nor desirable.
A client has developed atherosclerosis. The nurse knows that a major cause for this disorder is: a. History of myocardial infarction b. Hypertension c. Heart failure d. Elevated HDL cholesterol
b Constant high blood pressure damages arterial walls and promotes formation and rupture of plaque, with subsequent stroke and myocardial infarction. Atherosclerosis can also contribute to heart failure. Elevated HDL cholesterol would mitigate the development of atherosclerosis.
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? a. A 69-year-old woman with a diagnosis of cardiometabolic syndrome b. A 51-year-old male who has been diagnosed with glomerulonephritis c. A 40-year-old smoker who eats excessive amounts of salt and saturated fats d. A black man who leads a sedentary lifestyle
b Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, are associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? a. Decreased LDL b. Elevation of triglycerides c. Decreased VLDL d. Elevation of HDL
b In diabetes mellitus and the metabolic syndrome, typical dyslipidemia is seen with elevation of triglycerides, low HDL, and minimal or modest elevation of LDL. High calorie intake and diabetes mellitus increase the production of VLDL.
A 74-year-old man is being assessed by a nurse as part of a weekly basic health assessment at the long term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure? a. Blood volume, resistance, and flow b. the amount of blood that his heart ejects from the left ventricle during each beat c.The relationship between total blood volume and resting heart rate cThe cardiac reserve, or possible increase in cardiac output over normal resting level
b Pulse pressure is a reflection of the amount of blood that the heart ejects from the left ventricle during each beat combined with the distensibility of the atrial tree. Other factors such as blood flow characteristics, cardiac reserve, heart rate, and blood volume are less directly associated with pulse pressure.
The dietitian is teaching a client about cholesterol reduction strategies. Which comment by the client indicates that he understands the teaching? a. "I should increase my intake of vegetables and red meats." b. "I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods." c. "The aim of diet therapy is to reduce HDL cholesterol." d. "I should limit my daily intake of cholesterol to less than 500 mg/day."
b The aim of diet therapy is to reduce total and LDL cholesterol and to increase HDL. Transfats, which are manufactured from vegetable oils and used to enhance taste and extend shelf life, are more atherogenic than saturated fats. Dietary guidelines emphasize an increased intake of vegetables, fruits, and fish. Total daily intake of cholesterol should be limited to < 300mg/day.
Which of the following is the site of chylomicron synthesis? a. Stomach b. Small intestine c. Pancreas d. Large intestine
b There are two sites of lipoprotein synthesis—the small intestine and the liver. The chylomicrons are synthesized in the wall of the small intestine.
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include: a. Vessel wall injury, hypocoagulability, decreased venous blood flow b. Stasis of blood, hypercoagulability, vessel wall injury c. Hypocoagulability, vessel wall injury, increased pressure on deep veins d. Stasis of blood, hypercoagulability, inflammation
b in 1846, Virchow described the triad that has come to be associated with venous thrombosis: stasis of blood, increased blood coagulability, and vessel wall injury. Inflammation is a symptom of venous thrombosis, not a risk factor. Decreased venous blood flow can occur because of venous thrombosis, if the thrombus does not completely obstruct the vein; it is not a risk factor. Hypocoagulability would not cause a thrombus to form.
The client has been diagnosed with venous insufficiency after having a deep vein thrombosis (DVT). Which signs and symptoms would the nurse expect to see? Select all that apply. a. Pallor b. Stasis dermatitis c. Brown pigmentation of the skin d. Pulselessness e. edema
b,c,e In contrast to the ischemia caused by arterial insufficiency, venous insufficiency leads to tissue congestion, edema, and eventual impairment of tissue nutrition. Brown pigmentation of the skin caused by hemosiderin deposits is common. In advanced venous insufficiency, impaired tissue nutrition causes stasis dermatitis. Pallor and pulselessness are characteristics of arterial insufficiency.
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. a. Being female b. inactive lifestyle c. Obesity d. Poor performance in school e. High salt consumption
b,c,e The prevalence of hypertension in children and adolescents is increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.
A 35-year-old man presents to the emergency department reporting 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: ● Hyperlipoproteinemia for past 7 years ● Family history of early MI ● Cholesterol deposits along the tendons (diagnosed 1 year ago) ● Atherosclerosis (diagnosed 6 months ago) ● Diabetes mellitus (type 1) diagnosed at age 16 The nurse suspects which diagnosis will be made? a. Adult-onset hypercholesterolemia (type 1A) b. Familial hypercholesterolemia (type 2A) c. Homozygotic cutaneous xanthoma d. Secondary hyperlipoproteinemia
b. Many types of primary hypercholesterolemia have a genetic basis. There may be a defective synthesis of the apoproteins, a lack of receptors, defective receptors, or defects in the handling of cholesterol in the cell that are genetically determined. For example, the LDL receptor is deficient or defective in the genetic disorder known as familial hypercholesterolemia (type 2A). This autosomal dominant type of hyperlipoproteinemia results from a mutation in the gene specifying the receptor for LDL. Although heterozygotes commonly have an elevated cholesterol level from birth, they do not develop symptoms until adult life, when they often develop xanthomas (i.e., cholesterol deposits) along the tendons and atherosclerosis appears. Myocardial infarction before 40 years of age is common. Homozygotes are much more severely affected; they have cutaneous xanthomas in childhood and may experience myocardial infarction by as early as 1 to 2 years of age. Homozygotic cutaneous xanthoma and adult-onset hypercholesterolemia (type 1A) are not known diseases. Causes of secondary hyperlipoproteinemia include obesity with high-calorie intake and diabetes mellitus. It does not have a genetic basis.
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 reason accounts for this lack of change in the diastolic pressure? a. Heart rate increased with blood loss. b. Blood volume rapidly increased. c. Systemic vasoconstriction maintained the diastolic pressure. d. Stroke volume increased with blood loss.
c A decrease in blood volume with subsequent fall in blood pressure activates the sympathetic nervous system. Reflex vasoconstriction attempts to maintain blood flow to vital organs. Systolic pressure falls because a diminished blood volume exerts less force against arterial walls, but with diastole the diminished volume is sufficient to maintain pressure in a diminished vascular compartment.
Which statement is characteristic of a thrombus? a. Formation depends initially on the clotting process. b. It is a normal phenomenon associated with clotting. c. It forms on the wall of a vessel. d. It has no internal architecture.
c A thrombus is a blood clot that forms on the wall of a vessel and continues to grow until it reaches a size that obstructs blood flow. Thrombi often arise as the result of erosion or rupture of the fibrous cap of an arteriosclerotic plaque.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition? a. Coronary artery disease b. Diabetes c. Renal artery stenosis d. Heart failure
c ACE inhibitors are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensin-aldosterone system to maintain adequate renal perfusion. ACE inhibitors are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACE inhibitors.
Which type of aortic aneurysm is the most common? a. Aortic arch b. Ascending aorta c. Abdominal aortic d. Thoracic
c Aortic aneurysms may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta, or abdominal aorta. Abdominal aortic aneurysms, which are the most frequent form of aneurysm, are associated with severe atherosclerosis.
Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis? a. Dehydrated client b. Pregnant woman c. Client on bed rest d. Client in the terminal stage of cancer
c Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperactive blood coagulation that can also result in venous thrombosis.
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? a. 69-year-old woman with a diagnosis of cardiometabolic syndrome b. Black man who leads a sedentary lifestyle c. 51-year-old man who has been diagnosed with glomerulonephritis d. 40-year-old smoker who eats excessive amounts of salt and saturated fats
c Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, are associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.
Which assessment finding of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? a. The man's blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells). b. The man is acutely short of breath and his oxygen saturation is 87%. c. The man's blood pressure is 178/102 and he has abnormal liver function tests. d. The man's temperature is 101.9°F (38.8°C) and he is diaphoretic (heavily sweating).
c Polyarteritis nodosa is associated with abnormal liver function and acute hypertension. Anemia, not elevated red cells, is a manifestation, while respiratory symptoms, diaphoresis, and fever are not noted to be accompaniments.
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: a. Ensure that the client remains on bed rest. b. Massage legs to maintain blood flow. c. Apply sequential pneumatic compression devices to lower extremities. d. Apply ice compresses to the site of the DVT hourly.
c The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction. neither is massaging for fear of dissolving thrombus into circulation
Hypertension is a risk factor for atherosclerosis. The nurse knows that which of the following is the initial lesion in the pathogenesis of atherosclerosis? a. Vascular spasm b. Thrombosis c. Endothelial damage d. Inflammation
c The constant high pressure of hypertension damages the endothelium of the arteries, promoting plaque formation and eventual rupture. Thrombosis may result, as platelets begin to aggregate at sites of vascular wall damage.
The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as: a. Dissecting aneurysm b. Saccular aneurysm c. Berry aneurysm d. Fusiform aneurysm
c The description of the aneurysm describes a berry aneurysm usually found at the circle of Willis. A saccular aneurysm appears sac-like, while the fusiform aneurysm is characterized by a gradual, progressive dilatation of the vessel.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which factor has most likely resulted in the client's increased blood pressure? a. Coarctation of the aorta b. Increased levels of adrenocortical hormones c.Activation of the renin-angiotensin-aldosterone mechanism d. Increased sympathetic stimulation by the autonomic nervous system
c The largest single cause of secondary hypertension is renal disease. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II and raising blood pressure. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.
A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure? a. Myocardial contractility and arteriolar constriction b. Heart rate and peripheral resistance c. Cardiac output and systemic vascular resistance d. Blood volume and renal blood flow
c The mean arterial blood pressure is determined mainly by the cardiac output (stroke volume × heart rate) and the peripheral vascular resistance and can be expressed as the product of the two (mean arterial blood pressure = cardiac output × peripheral vascular resistance). The peripheral vascular resistance reflects changes in the radius of the arterioles as well as the viscosity or thickness of the blood.
Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury? a. Chronic venous insufficiency b. Varicose veins c. Venous thrombosis d. Peripheral artery disease (PAD)
c Venous thrombosis is associated with stasis of blood, increased blood coagulability, and vessel wall injury. Varicose veins are dilated, tortuous veins of the lower extremeties and lead to venous insufficiency. PAD is caused by atherosclerosis in arteries of the lower extremities.
The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which test will the practitioner order? a. HDL level b. Serum homocysteine c. LDL level d. C-reactive protein (CRP)
c Xanthomas along the tendons are seen in clients with elevated LDL levels, not HDL levels. CRP is a serum marker for systemic inflammation. Homocysteine is derived from the metabolism of dietary methionine and is associated with endothelial damage.
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? a. Homocysteine b. Lipoprotein(a) c. Triglycerides d. C-reactive protein
d C-reactive protein is a serum marker for systemic inflammation. Elevated homocysteine levels inhibit elements of the anticoagulation cascade and are associated with endothelial damage. Lipoprotein(a) is similar to LDL and can cause atherosclerosis by promoting foam cell formation and the deposition of cholesterol in atherosclerotic plaques. Triglycerides are not associated with inflammation.
If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in: a. release of excess fatty plaque causing numerous pulmonary emboli. b. arterial wall weakening resulting in aneurysm formation. c. overproduction of growth factors resulting in new vessel production. d. contraction of the underlying smooth muscles within the vessels.
d Endothelial dysfunction describes several types of potentially reversible changes in endothelial function that occur in response to environmental stimuli. Inducers of endothelial dysfunction include cytokines, bacterial, viral, and parasitic products that cause inflammation. They also influence the reactivity of underlying smooth muscle cells through production of both relaxing factors (nitric oxide) and contracting factors (e.g., endothelins).
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response? a. "This likely won't have a huge effect on your quality of life and I'll prescribe anti-clotting drugs to prevent attacks." b. "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too." c. "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity." d. "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."
d Ensuring total body warmth and the use of vasodilators are the normal treatment modalities for Raynaud disease.
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? a. Excessive sweating and pallor b. Variability in blood pressure and weight loss c. Nervousness and periodic severe headache d. Periodic severe headache and marked variability in blood pressure
d Like adrenal medullary cells, the tumor cells of a pheochromocytoma produce and secrete the catecholamines epinephrine and norepinephrine. The hypertension that develops is a result of the massive release of these catecholamines. Their release may be paroxysmal rather than continuous, causing periodic episodes of headache, excessive sweating, and palpitations. Headache is the most common symptom and can be quite severe. Nervousness, tremor, facial pallor, weakness, fatigue, and weight loss occur less frequently. Marked variability in blood pressure between episodes is typical.
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a client who has been admitted to the hospital following a syncopal episode and recent falls. Which fact about the client best relates to these health problems? a. The client is male and has a history of hypertension. b. The client's cardiac ejection fraction was 40% during his last echocardiogram. c. The client has a history of acute and chronic renal failure. d. The client is 89 years old and takes a diuretic medication for his congestive heart failure.
d. Old age and diuretic use are strongly associated with orthostatic hypotension, which is normally marked by falls and syncope. Gender, hypertension, stroke volume, and kidney disease are less likely to be causative factors.
