Chapter 16: altered perfusion
Vascular stiffness
An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased: Response to beta-adrenergic stimulation Cardiac tone and compliance Vascular stiffness Myocardial metabolism
Hypercholesterolemia
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? Increasing age Hypercholesterolemia Familial history of premature coronary heart disease Male sex
Atherosclerosis and unstable angina
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function? Dilated cardiomyopathies Pericardial effusion and cardiac tamponade Aortic valve regurgitation and aortic stenosis Atherosclerosis and unstable angina
urine output less than 20 mL/hour.
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: blood pressure staying in the 98/72 range for the past hour. urine output less than 20 mL/hour. warm legs with peripheral vasodilation. sleepiness and difficulty to arouse without using painful stimuli.
Right-sided Right-sided heart failure occurs when the right ventricle fails to contract effectively. The primary cause is from left-sided heart failure in which the increase in pulmonary congestion eventually results in chronic pulmonary hypertension (increased right ventricular afterload) leading to right-sided hypertrophy and heart failure.
In which of the following Types of Heart Failure is peripheral edema most likely to be seen?
Left-sided Left-sided heart failure results from left ventricle dysfunction and can eventually progress to right-sided heart failure. The two types of left-sided heart failure include systolic dysfunction (the left ventricle loses its ability to contract with enough force, resulting in less oxygen-rich blood being pumped into circulation) and diastolic dysfunction (the left ventricle loses its ability to relax properly or has become stiff, resulting in less blood entering the heart during normal filling).
In which of the following Types of Heart Failure is pulmonary congestion most likely to be seen?
Action decreases metabolic demands of the heart.
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. Action increases autonomic nervous system activity. Action relieves pain and gives sense of depression. Action increases anxiety, in turn increasing metabolic demands of the heart.
Baroreceptors
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. Baroreceptors Neural pathways Cardiovascular centers Chemoreceptors
Hypertension
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: Hypertension Being male 55 years of age Family history of heart disease
elevated C-reactive protein (CRP)
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) decreased low-density lipoprotein (LDL) diminished homocysteine level raised troponin-C level
compensatory mechanisms
The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. compensatory mechanisms parasympathetic system electrical conductivity aortic hypertrophy
Low-density lipoprotein (LDL)
Which lipoprotein is the main carrier of cholesterol? Very-low-density lipoprotein (VLDL) Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Intermediate-density lipoprotein (IDL)
Peripheral vascular resistance The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.
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? Release of stress hormones Peripheral vascular resistance Rigidity of the ventricular walls Electrical impulses in the heart
Activate the emergency response system. Calling an ambulance so the neighbor can be taken to the hospital for emergency care is the priority for a client having a stroke. Giving aspirin and nitroglycerin is appropriate for the client having chest pain and possible myocardial infarction but not for a client having a stroke. The client may already be on a blood thinner and additional aspirin could cause more bleeding into the brain. Nitroglycerin is a vasodilator and not appropriate for this scenario. There is no mention of seizure activity; therefore, turning the lights out and keeping the room quiet is not a priority action.
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? Administer aspirin. Give sublingual nitroglycerin. Turn light out and keep room quiet. Activate the emergency response system.
HDL
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? VLDL HDL LDL IDL
"I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake."
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've starting going to the gym before work three times a week." "I'm going to eat organic foods from now on but I'm glad I don't have to watch my fat intake." "I'm planning to lose 15 lb (7 kg) before the end of this year." "I'm trying to cut back on the amount of salt that I cook with and add to my food."
Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight
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. Weight reduction if overweight Increased intake of fats and sodium Dietary measures to reduce LDL levels Decreasing physical activity Smoking cessation
hypovolemic shock due to acute intravascular volume loss.
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:
Maintain normal weight Control hypertension Control blood glucose levels The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. Cigarette smoking must be stopped, not decreased.
A client is concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. Which responses by the nurse are most accurate? Select all that apply. Increase LDL levels Control hypertension Control blood glucose levels Decrease smoking Maintain normal weight
Decrease in antidiuretic hormone
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 Reduction in glomerular filtration rate Excessive secretion of aldosterone Activation of the angiotensin system
Deep vein thrombosis Venous insufficiency with deep vein thrombus formation is characterized by pain, swelling [edema], and deep muscle tenderness. Fever, general malaise, and elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation. Swelling may vary from minimal to maximal. Immobility raises the risk for thrombus formation. The skin is intact, so venous stasis ulcerations are not present. Distended torturous veins (varicosity manifestations) are not present with deep vein thrombosis.
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? Arterial insufficiency Stasis ulcerations Deep vein thrombosis Primary varicose veins
Epinephrine
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? Epinephrine Dexamethasone Diphenhydramine Normal saline infusion
Will prevent the conversion of angiotensin I to angiotensin II
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 have a direct vasoconstrictive effect on vessels of splanchnic circulation Will increase oxygen consumption of the heart Will prevent the conversion of angiotensin I to angiotensin II Will increase extracellular fluid and decrease venous pressure
myocardial infarction.
A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate: benign late repolarization. decreased intracranial pressure. advanced hypokalemia. myocardial infarction.
heart rate 150 beats/min
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 blood pressure 80/50 mm Hg warm, dry skin urine output greater than 100 ml/hr
Increase heart rate
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? impaired venous return increased heart rate venous injury increased blood viscosity
Consume a diet rich in fruits, vegetables, and low-fat dairy products. Reduce dietary sodium intake. Stop smoking. Limit alcohol consumption.
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. Stop smoking. Avoid aerobic physical activity. Limit alcohol consumption. Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low-fat dairy products.
Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction
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? Decreases the heart rate, which will cause a decrease in cardiac output Decreases vascular volume by suppressing renal reabsorption of sodium Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction Inhibits the movement of calcium into cardiac and vascular smooth muscle
Raising the head of the bed to a high Fowler's position Treatment measures include close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion; and the administration of oxygen, antihistamine drugs, and corticosteroids. The person should be placed in a supine position. This is extremely important because venous return can be severely compromised in the sitting position. This in turn produces a pulseless mechanical contraction of the heart and predisposes to arrhythmias. In several cases, death has occurred immediately after assuming the sitting position.
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? Administration of 2L of oxygen by nasal cannula Raising the head of the bed to a high Fowler's position Placing a pulse oximeter on the client to monitor oxygenation status Inserting an IV to begin a normal saline infusion
pulmonary congestion Left ventricular dysfunction prevents normal, forward blood flow from occurring and thus, the blood backs up into the left atrium and pulmonary veins. This increase in pulmonary pressure results in fluid leakage from the pulmonary capillary bed into the interstitium and alveoli causing pulmonary congestion.
During your assessment of a patient with left-sided heart failure, which of the following is most likely to be seen?
peripheral edema Peripheral edema is a classic sign of right-sided heart failure as a result of the backup of blood into the right atrium and venous circulation. Other manifestations include jugular vein distention, hepatosplenomegaly, and vascular congestion of the GI tract.
During your assessment of a patient with right-sided heart failure, which of the following is most likely to be seen?
Backflow from the left ventricle to left atrium
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? Inhibition of the SA node's normal action potential Backflow from the left ventricle to left atrium Backflow from the right ventricle to the right atrium during systole Backup of blood from the right atrium into the superior vena cava
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion. 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.
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 has a low cholesterol content. It is associated with a low intake of saturated fats. It transports cholesterol away from cells to the liver for excretion. It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
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 roam the vascular system looking for inflammatory cells to engulf. The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Oxidized free radicals produce toxic metabolic waste that can kill liver cells. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension? A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in the ankles An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom A 78-year-old client who has begun reporting frequent headaches unrelieved by over-the-counter analgesics A 42-year-old client who has a history of poorly controlled type 1 diabetes
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) Diagnosis of hyperlipidemia depends on a person's complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after an overnight fast. One person may have a favorable lipid profile with a HDL of 110 mg/dL, a triglyceride level of 175 mg/dL, and an LDL of 130 mg/dL, whereas another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease.
Which lipid results on four clients will the nurse recognize as having the greatest risk for cardiovascular disease? LDL cholesterol 180 mg/dL (4.66 mmol/L), HDL 50 mg/dL (1.29 mmol/L), and triglyceride level 100 mg/dL (1.13 mmol/L) LDL cholesterol 160 mg/dL (4.14 mmol/L), HDL 30 mg/dL (0.78 mmol/L), and triglyceride level 120 mg/dL (1.36 mmol/L) LDL cholesterol 184 mg/dL (4.77 mmol/L), HDL 60 mg/dL (1.55 mmol/L), and triglyceride level 70 mg/dL (0.79 mmol/L) 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)
High Output High output heart failure occurs when the body's need for blood is unusually high in a normally functioning heart. So although the heart may be working well otherwise, it cannot pump out enough blood to keep up with the extra demands.
Which of the following Types of Heart Failure occurs when the heart cannot supply enough blood to meet the body's metabolic needs?
Unable to meet metabolic needs A variety of conditions can significantly increase the body's need for blood and oxygen, resulting in high output heart failure, but the end result is the heart being unable to meet the body's metabolic needs. Such conditions include severe anemia, hyperthyroidism, sepsis, arteriovenous fistula, beriberi (thiamine or Vitamin B1 deficiency), and Paget's disease.
Which of the following best describes the pathophysiology of high output heart failure?
Vascular smooth muscle cells (SMCs)
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels? Endothelial cells Collagen tissue Extracellular matrix cells Vascular smooth muscle cells (SMCs)
