Chapter 26
The dietitian is teaching a client about cholesterol reduction strategies. Which comment by the client indicates that he understands the teaching? "I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods."
"I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods." The aim of diet therapy is to reduce total and LDL cholesterol and to increase HDL. Trans fats, 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 health-focused educational programs will target the most common cause of renovascular disease among older adults? "Preventive Measures to Decrease Atherosclerosis" "Living with Arthritis" "Cooking for the Diabetic" "Heart-Healthy Sodium Intake Recommendations"
"Preventive Measures to Decrease Atherosclerosis" Hypertension is believed to affect 56% of the older adult population. Two major types of renovascular disease have been described: atherosclerosis of the proximal renal artery and fibromuscular dysplasia, a noninflammatory vascular disease that affects the renal arteries and branch vessels. Atherosclerotic stenosis of the renal artery is seen most often in older adults. Arthritis (50%), diabetes (19%), and heart disease (32%) are diagnosed less frequently.
The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion? 140 mm Hg or higher 130 to 139 mm Hg 120 to 129 mm Hg 119 mm Hg or lower
140 mm Hg or higher Classification of blood pressure in adults defines a systolic pressure of 140 mm Hg or higher as stage 2 hypertension. Stage 1 hypertension has a systolic pressure between 130 and 139 mm Hg. Systolic blood pressure between 120 and 129 mm Hg is classified as elevated and 119 mm Hg or lower is classified as normal.
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below: 140/90 140/60 100/60 100/90
140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.
The nurse knows that mean arterial pressure is: Systolic pressure alone Diastolic pressure alone 60% of diastolic pressure and 40% of systolic pressure 50% of diastolic pressure and 50% of systolic pressure
60% of diastolic pressure and 40% of systolic pressure Mean arterial pressure is not the average of systolic and diastolic pressures. It is calculated as 60 percent diastolic and 40 percent systolic pressures, since diastole has a longer duration compared to systole.
The nurse knows that which client is at greatest risk for malignant hypertension? A 60-year-old woman with newly diagnosed mild hypertension A 25-year-old black man A 30-year-old woman with three children An obese 46-year-old white man
A 25-year-old black man Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. Persons most at risk include young black men, women with toxemia of pregnancy, and persons with renal or collagen disease.
Which client is at greatest risk for orthostatic hypotension? A 66-year-old postoperative client on bed rest A 20-year-old pregnant client at 36 weeks' gestation A 42-year-old male client with history of pulmonary embolism A 70-year-old female client who has taken the same antihypertensive medication for 10 years
A 66-year-old postoperative client on bed rest Postoperative clients who have been immobile are at greatest risk for developing orthostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications
The practitioner is reviewing the medication list of a client with Raynaud disease. Which medication would the practitioner expect the client to be receiving? A calcium channel-blocker A nonsteroidal anti-inflammatory agent An antiviral agent An anticoagulant
A calcium channel-blocker. Raynaud disease is a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers, and less often the toes. Treatment with vasodilator drugs may be indicated. The calcium channel-blocking drugs decrease the severity and frequency of attacks. The other options are not vasodilators.
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 reporting painful urination and experiencing fever and chills. A client holding the abdomen and reporting a tearing and ripping feeling inside. Athletic client reporting the kneecap popping in and out of socket. A client with a history of chronic obstructive pulmonary disease (COPD) experiencing a productive cough with green sputum.
A client holding the abdomen and reporting a tearing and ripping feeling inside. A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. The location of the pain may point to the site of dissection. Because aortic dissection is a life-threatening emergency, a client with a probable diagnosis is stabilized medically even before the diagnosis is confirmed. Painful urination with fever is usually associated with a urinary tract infection and is not an imminent threat. A dislocated kneecap is extremely painful, but again not an imminent threat. The respiratory client with productive cough with green sputum likely has an infection like pneumonia and needs treatment but is not the priority when the priority client may be experiencing a dissecting aortic aneurysm.
The physician understands that which client is at risk for developing primary hyperlipoproteinemia? A client with familial hypercholesterolemia A client with hypothyroidism A client receiving beta-blockers A client with obstructive liver disease
A client with familial hypercholesterolemia Many types of primary hyperlipoproteinemia have a genetic basis. The LDL receptor is deficient or defective in the genetic disorder known as familial hypercholesterolemia. The other options cause secondary hyperlipoproteinemia.
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition? A pulsating mass in the abdomen Syncope The pulse is unobtainable in one or both arms Hemiplegia
A pulsating mass in the abdomen Most abdominal aortic aneurysms are asymptomatic. Because an aneurysm is of arterial origin, a pulsating mass in the abdomen may provide the first evidence of the disorder. The other options are signs and symptoms of aortic dissection.
Which is the most common site for an aortic aneurysm? Abdominal aorta Thoracic Ascending aorta Aortic arch
Abdominal aorta 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.
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? The end result of oxidation is rupture of the plaque, resulting in hemorrhage. Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Oxidized free radicals produce toxic metabolic waste that can kill liver cells. Activated cells roam the vascular system looking for inflammatory cells to engulf.
Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.
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? Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism Increased sympathetic stimulation by the autonomic nervous system (ANS) Coarctation of the client's aorta
Activation of the renin-angiotensin-aldosterone mechanism Renovascular hypertension refers to hypertension caused by reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. It is the most common cause of secondary hypertension, accounting for 1% to 2% of all cases of hypertension. 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. Angiotensin II, in turn, acts as a vasoconstrictor to increase peripheral vascular resistance and as a stimulus for increased aldosterone levels and sodium retention by the kidney. One or both of the kidneys may be affected. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.
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? Coarctation of the aorta Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism Increased sympathetic stimulation by the autonomic nervous system
Activation of the renin-angiotensin-aldosterone mechanism 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.
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension? A 78-year-old client who has begun reporting frequent headaches unrelieved by over-the-counter analgesics 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 42-year-old client who has a history of poorly controlled type 1 diabetes
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom Dizziness, blurred vision, palpitations, and syncope (i.e., fainting) are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
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 Beta-blockers Angiotensin II receptor blockers Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors inhibit bradykinin degradation in the lungs, which can cause a common side effect of a dry, nonproductive cough.
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? Analgesics and use of a pneumatic compression device Massage followed by vascular surgery Frequent ambulation and the use of compression stockings Anticoagulation therapy and elevation of the leg
Anticoagulation therapy and elevation of the leg Anticoagulants, immobilization, and elevation of the affected extremity are used in the treatment of DVT. Interventions that are used to prevent DVT (ambulation; compression stockings; compression devices) may be harmful when a DVT is present. Surgery is not normally required, and massage has the potential to dislodge a DVT.
The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which testing procedures could the practitioner prescribe to diagnose this condition? Select all that apply. Ascending venography Duplex ultrasonography Plasma D-dimer Echocardiogram White blood cell count
Ascending venography Duplex ultrasonography Plasma D-dimer Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an indication of inflammation or infection. An echocardiogram is a test that evaluates heart structure and function.
The client has swelling in his right leg and foot and reports calf pain and tenderness. Pedal pulses are present. Which testing procedures could the practitioner prescribe to diagnose this condition? Select all that apply. Ascending venography Duplex ultrasonography Plasma D-dimer Echocardiogram White blood cell count
Ascending venography Plasma D-dimer Duplex ultrasonography Several tests are useful for the detection of deep vein thrombosis (DVT). They are ascending venography, ultrasonography, and plasma D-dimer. The most common signs and symptoms of DVT are related to the inflammatory process. An elevated white blood cell count is an indication of inflammation or infection. An echocardiogram is a test that evaluates heart structure and function.
A nurse is teaching a client newly prescribed with an angiotensin-converting (ACE) inhibitor. Which information is very important to include in the teaching plan? Avoid salt substitutes and foods high in potassium. Due to photosensitivity, avoid direct sunlight. Monitor pulse rate before taking this medication. Watch for unusual bruising or bleeding.
Avoid salt substitutes and foods high in potassium. Because ACE inhibits aldosterone secretion, these agents also can increase serum potassium levels and cause hyperkalemia. Salt substitutes are high in potassium.
The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which test will the practitioner order? LDL level HDL level C-reactive protein (CRP) Serum homocysteine
LDL level 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.
In pregnancy, which diagnostic findings are characteristic for preeclampsia-eclampsia? Blood pressure 160/100 mm Hg and platelet count 25,000/μL (25 ×109/L) Blood pressure 140/90 mm Hg and glucose in the urine Blood pressure 130/88 mm Hg and fasting blood glucose level of 180 mg/dL (9.99 mmol/L) Blood pressure 90/60 mm Hg and serum creatinine level of 2.1 mg/dL (160.13 µmol/L)
Blood pressure 160/100 mm Hg and platelet count 25,000/μL (25 ×109/L) Preeclampsia and eclampsia have these characteristics: an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg); Platelet counts <100,000/µL (<100 ×109/L); elevated liver enzymes; creatinine levels >1.1 mg/dL (83.88 µmol/L); vision or cerebral disturbances, edema, and proteinuria.
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 Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy Blood pressure 90/60 and proteinuria in the second trimester
Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy Preeclampsia-eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation.
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 legs 20 mm Hg higher than in the arms Widened pulse pressure in the legs Prominent femoral pulses Blood pressure in arms 20 mm Hg higher than in the legs
Blood pressure in arms 20 mm Hg higher than in the legs 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 nurse recognizes which blood pressure levels are normal, age-related levels? Select all that apply. Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure at age 10 days is 78 mm Hg systolic. Blood pressure at age 18 years is 90 mm Hg systolic. Blood pressure at age 25 years is ideal at 120 mm Hg systolic. Beyond age 50 years, systolic and diastolic pressures both increase.
Blood pressure in newborn infants is approximately 50 mm Hg systolic. Blood pressure at age 10 days is 78 mm Hg systolic. Blood pressure at age 25 years is ideal at 120 mm Hg systolic. Blood pressure of 50 mm Hg in newborn infants rises to approximately 78 mm Hg at 10 days of age. At the end of adolescence, around age 18 years, blood pressure usually has reached adult readings of 120 mm Hg. Beyond age 50 years, systolic pressure usually rises while diastolic pressure falls or remains the same.
Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? Leukocytosis Homocysteine Serum lipoprotein C-reactive protein
C-reactive protein C-reactive protein (CRP) synthesized in the liver that is a marker for systemic inflammation. A number of population-based studies have demonstrated that baseline CRP levels can predict future cardiovascular events among apparently healthy individuals. High-sensitivity CRP (hs-CRP) may be a better predictor of cardiovascular risk than lipid measurement alone. Homocysteine and serum lipoprotein are also serum markers, but they do not identify inflammation. Leukocytosis is an indicator of infection rather than inflammation alone.
An adult's documented blood pressure (BP) readings over the past 2 years include: 140/82 mm Hg, 144/82 mm Hg, 150/82 mm Hg, 160/82 mm Hg, and 162/82 mm Hg. Which interpretation(s) of these BP trend will the provider discuss with this client? Select all that apply. Client has decreased pulse pressure. Client's systolic BP is hypertensive. Client has increased risk for future cardiovascular events. Client's diastolic BP is normotensive.
Client's systolic BP is hypertensive. Client has increased risk for future cardiovascular events. The provider's interpretation of the results should include that the client's systolic BP is hypertensive and that the diastolic BP is stage 1 hypertension. This leads to increased pulse pressure, placing the client at increased risk for future cardiovascular events.
A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure? Cardiac output and systemic vascular resistance Heart rate and peripheral resistance Blood volume and renal blood flow Myocardial contractility and arteriolar constriction
Cardiac output and systemic vascular resistance 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.
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? Peripheral edema in the lower legs from renal disease Crackles in bilateral lung bases caused by left-sided heart failure Ascites due to liver damage Confusion due to atherosclerosis of the carotid arteries
Crackles in bilateral lung bases caused by left-sided heart failure Systolic hypertension has been defined as a systolic pressure of 140 mm Hg or greater and a diastolic pressure of less than 90 mm Hg. Elevated pressures during systole favor the development of left ventricular hypertrophy, increased myocardial oxygen demands, and eventual left-sided heart failure. Peripheral edema and ascites are usually associated with right-sided failure. Confusion due to blockages in carotid arteries can occur independent of hypertension.
Hypertension in older adults is a common finding. This is because of the age-related rise in systolic blood pressure. Among the aging processes, what is a contributor to hypertension? Decreased baroreceptor sensitivity Aortic softening Decreased peripheral vascular resistance Increased renal blood flow
Decreased baroreceptor sensitivity Among the aging processes that contribute to an increase in blood pressure are a stiffening of the large arteries, particularly the aorta; decreased baroreceptor sensitivity; increased peripheral vascular resistance; and decreased renal blood flow.
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process? Decreased elasticity in arterial connective tissue Increased elasticity in arterial connective tissue Decreased elasticity in venous connective tissue Increased elasticity in venous connective tissue
Decreased elasticity in arterial connective tissue With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant. Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and afterload. Elasticity does not increase in arterial tissue or venous tissue.
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate? The endocardium over an acute myocardial infarction Deep vein thrombophlebitis of the leg An atherosclerotic plaque in the aorta The hepatic vein in chronic passive congestion of the liver
Deep vein thrombophlebitis of the leg Deep vein thrombosis (DVT) may be a precursor to pulmonary embolism. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT.
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? Stasis ulcerations Arterial insufficiency Primary varicose veins Deep vein thrombosis
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.
Which function is performed by arteries such as the coronary and renal arteries? Transport of blood Distribution of blood to organs that are controlled by contraction and relaxation of these vessels Regulation of capillary blood flow Transport of blood from capillary beds toward the heart
Distribution of blood to organs that are controlled by contraction and relaxation of these vessels There are three types of arteries: large, including the aorta; medium-sized arteries, such as the coronary and renal arteries; and small arteries and arterioles. The large arteries function in the transport of blood. The medium-sized arteries distribute blood flow to the various organs and tissues. The distribution is controlled by contraction and relaxation of the smooth muscle of these vessels. The small arteries and arterioles regulate capillary blood flow. Venules transport blood from capillary beds toward the heart.
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 Ultrasound of the kidney CT of the head Chest x-ray
Echocardiogram Most acute arterial occlusions are the result of an embolus or thrombus. Most emboli arise in the heart and are caused by conditions (such as atrial fibrillation) that cause blood clots to develop on the wall of a heart chamber or valve surface. An echocardiogram looks at the structure of the heart. The other tests do not demonstrate blood clots in the heart.
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 Decreased low-density lipoproteins Decreased triglycerides Normal cholesterol and triglycerides
Elevated total cholesterol Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? Elevation of triglycerides Elevation of HDL Decreased LDL Decreased VLDL
Elevation of triglycerides 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 client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect? Elevation of triglycerides Elevation of HDL Decreased LDL Decreased VLDL
Elevation of triglycerides 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.
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? Contacting the health care provider immediately Keeping the client in a supine position throughout the day Encouraging the client to maintain hydration throughout the day Administering oxygen as prescribed
Encouraging the client to maintain hydration throughout the day Significant drops in systolic blood pressure on assumption of the upright position (orthostatic hypotension) is more common in older adults due to compensatory cardiovascular mechanisms that are delayed or insufficient. Appropriate interventions by the nurse include encouraging the client to change positions slowly to decrease the risk of falls. Measures designed to help people prevent symptomatic orthostatic drops in BP include gradual ambulation to allow the circulatory system to adjust. Correcting the fluid deficit may help. Avoiding excess diuresis, diaphoresis, or loss of body fluids will help. There is no indication that the physician needs to be contacted, that the client needs to be placed in a supine position, or that oxygen needs to be administered at this time.
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise? Exercise is not recommended in this population. Clients with intermittent claudication should exercise only their arms. Aerobic exercise is not recommended but isometric exercise is. Exercise can increase blood vessel growth and help to decrease symptoms.
Exercise can increase blood vessel growth and help to decrease symptoms. Adaptation to exercise induces angiogenesis with an increased growth of vessels to support blood flow to the exercising muscle. Exercise may help to decrease pain in clients with peripheral vascular disease.
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: Fatty streak Fibrous atheromatous plaque Complicated lesion Thrombus
Fibrous atheromatous plaque 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.
Which one of the following is an example of hyperemia? Finger redness in Raynaud phenomenon Anemia Congestive heart failure Obstructed venous return in varicose veins
Finger redness in Raynaud phenomenon In Raynaud disease and Raynaud phenomenon, ischemia due to vasospasm causes changes in skin color that progress from pallor to cyanosis, a sensation of cold, and changes in sensory perception, such as numbness and tingling. The color changes usually are first noticed in the tips of the fingers, later moving into one or more of the distal phalanges. After the ischemic episode, there is a period of hyperemia with intense redness, throbbing, and paresthesias. The period of hyperemia is followed by a return to normal color. Although all of the fingers usually are affected symmetrically, in some cases only one or two digits are involved, or only a portion of the digit is affected.
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? Berry Fusiform Dissecting Saccular
Fusiform 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; a dissecting aneurysm is a false aneurysm and a berry aneurysm is a true aneurysm that consists of a small, spherical dilation of the vessel at a bifurcation.
The nurse knows that hypertension can lead to nephrosclerotic damage. Which of the following occurs first in nephrosclerosis? Glomerular sclerosis Tubulointerstitial fibrosis Glomerular hypoperfusion Diabetic nephropathy
Glomerular hypoperfusion Hypertension causes thickening of the renal blood vessels, which impedes renal blood flow. Glomerular sclerosis and tubulointerstitial fibrosis follow. Diabetic nephropathy, a different type of kidney disease, may have an accelerated onset in persons who are also hypertensive.
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 Talking to a friend about using more saturated and less unsaturated fats when cooking Encouraging a friend to be tested for familial hypercholesterolemia Encouraging a friend to cook with trans fats, as they extend the shelf life of foods
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise. Dietary measures to reduce LDL levels include decreasing the use of saturated fats and trans fats. Testing for familial hypercholesterolemia is not a modifiable risk factor.
The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which test will the practitioner order? LDL level HDL level C-reactive protein (CRP) Serum homocysteine
LDL level 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.
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? LDL VLDL IDL HDL
HDL HDL is known as the "good" cholesterol because it transports cholesterol back to the liver for metabolism. LDL, VLDL, and IDL transport cholesterol to the tissues.
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? Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. HDL cholesterol is often characterized as being beneficial to health. Cholesterol is a metabolic waste product that the liver is responsible for clearing. The goal of medical treatment is to eliminate cholesterol from the vascular system.
HDL cholesterol is often characterized as being beneficial to health. 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.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: 55 years of age Being male Family history of heart disease Hypertension
Hypertension 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. The other options are nonmodifiable risk factors for atherosclerosis.
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? Dry mouth Restlessness Constipation Hypotension
Hypotension Particular caution should be used in people who are at risk for orthostatic hypotension (e.g., those with diabetes, autonomic nervous system dysfunction, and older adults).
In addition to direct invasion of the vascular wall by an infectious agent, what pathogenic mechanism is a common cause of vasculitis? Necrotizing granulomas Tissue necrosis Mononuclear cells Immune-mediated inflammation
Immune-mediated inflammation The two most common pathogenic mechanisms of vasculitis are direct invasion of the vascular wall by an infectious agent and immune-mediated inflammation. The most common mechanisms that initiate noninfectious vasculitis are pathologic immune responses that result in endothelial activation, with subsequent vessel obstruction, and ischemia of the dependent tissue. In almost all forms of vasculitis, the triggering event initiating and driving the inflammatory process is unknown. --Medium-size vessel vasculitides produce necrotic tissue damage. Large-vessel vasculitides involve mononuclear cells. Granulomatosis with polyangiitis (formerly Wegener's granulomatosis) is characterized by a triad of acute necrotizing granulomatous lesions of the upper respiratory tract (ear, nose, sinuses, and throat); necrotizing vasculitis of the affected small- to medium-sized vessels of the lungs and respiratory airways; and renal disease in the form of focal necrotizing glomerulonephritis.
A nurse on a geriatric medicine unit has noted that a significant majority of the clients on the unit are prescribed antihypertensive medications. Which phenomenon is the nurse most justified in ruling out as a contributing factor? Stiffening of large arteries like the aorta Increased sensitivity of the renin-angiotensin-aldosterone system Decreased baroreceptor sensitivity and renal blood flow Increased peripheral vascular resistance
Increased sensitivity of the renin-angiotensin-aldosterone system 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.
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? Promotes vasodilation and decreases peripheral resistance, thereby increasing cardiac workload Decreases serum lipid levels and increases inflammation, thereby promoting hyperlipidemia Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development Increases serum HDL levels, thereby promoting fat oxidation
Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development 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 nurse knows that which of the following would put a client at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply. Intravascular fluid retention Reduced blood viscosity Elevated renin levels Systemic vasoconstriction Reduced heart rate
Intravascular fluid retention (this is also known as increased blood volume) Elevated renin levels Systemic vasoconstriction Increased blood volume and systemic vasoconstriction will increase blood pressure. Elevated renin will increase levels of angiotensin II and aldosterone, resulting in vasoconstriction and sodium and water retention. Reduced heart rate will lower blood pressure. Blood viscosity is not a major factor in regulating blood pressure.
The client reports a sudden onset of excruciating pain in the anterior chest and describes it as "tearing or ripping." The physician is unable to palpate a pulse in the client's right arm. Based on the client's history and physical examination, which treatment would be implemented? Intravenous sodium nitroprusside Intravenous epinephrine Intravenous heparin Intravenous atropine
Intravenous sodium nitroprusside Diagnosis of aortic dissection is based on history and physical examination. The major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain described as tearing or ripping. Medical treatment focuses on control of hypertension and the use of drugs that lessen the force of systolic blood ejection from the heart. Two commonly used drugs, given in combination, are intravenous sodium nitroprusside and a beta-adrenergic blocking drug (beta-blocker). IV epinephrine and atropine both increase cardiac output. Heparin, an anticoagulant, is not indicated, especially due to the risk of aneurysm rupture.
Which statement is characteristic of a thrombus? It forms on the wall of a vessel. It has no internal architecture. It is a normal phenomenon associated with clotting. Formation depends initially on the clotting process.
It forms on the wall of a vessel. 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.
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. It is the most common cardiovascular disorder. The incidence increases with age. It is often associated with individuals of normal weight. The diastolic pressure is equal to 80 mm Hg. The systolic pressure is ≥140 mm Hg.
It is the most common cardiovascular disorder. The incidence increases with age. The systolic pressure is ≥140 mm Hg. 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, and it may be associated with a family history of high blood pressure, metabolic syndrome, obesity, and increased sodium intake.
The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following? Kawasaki disease Takayasu arteritis Microscopic polyangiitis Granulomatosis with polyangiitis (formerly Wegener's granulomatosis)
Kawasaki disease Kawasaki disease involves large, medium-sized, and small arteries (frequently the coronaries) and usually occurs in small children. Takayasu arteritis, a large vessel vasculitis, is a granulomatous inflammation of the aorta, usually in people younger than 50 years of age. Microscopic polyangiitis and granulomatosis with polyangiitis, both small vessel vasculitides, involve the respiratory and renal systems.
Which lipoprotein is the main carrier of cholesterol? Intermediate-density lipoprotein (IDL) High-density lipoprotein (HDL) Low-density lipoprotein (LDL) Very-low-density lipoprotein (VLDL)
Low-density lipoprotein (LDL) Although all of the lipoproteins contain cholesterol and triglycerides, LDL is the main carrier of cholesterol.
Which statements are true concerning deep-vein thrombosis (DVT)? Select all that apply. Many individuals with DVT have no symptoms. Deep muscle tenderness is a common symptom of DVT. Sedimentation rates are a common diagnostic test for DVTs. Inflammation is the root cause of many of the symptoms of DVTs. White blood cell counts tend to decrease with the presence of a DVT.
Many individuals with DVT have no symptoms. Deep muscle tenderness is a common symptom of DVT. Sedimentation rates are a common diagnostic test for DVTs. Inflammation is the root cause of many of the symptoms of DVTs. Many people with venous thrombosis are asymptomatic; as much as 50% of people with DVT are asymptomatic. Lack of signs and symptoms is probably because the vein is not totally occluded or because of collateral circulation. When present, the most common signs and symptoms of venous thrombosis are those related to the inflammatory process, including pain, swelling, and deep muscle tenderness. Fever, general malaise, and an elevated white blood cell count and erythrocyte sedimentation rate are accompanying indications of inflammation.
At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for: Pulmonary hypertension Left ventricular hypertrophy Organ damage and hypovolemic shock Orthostatic hypotension
Organ damage and hypovolemic shock The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. The fact that this client's MAP is falling at a time when it should be at its daily peak is cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk.
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? Nervousness and periodic severe headache Variability in blood pressure and weight loss Excessive sweating and pallor Periodic severe headache and marked variability in blood pressure
Periodic severe headache and marked variability in blood pressure 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.
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 Electrical impulses in the heart Release of stress hormones Rigidity of the ventricular walls
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.
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 Vasculitis Polyarteritis nodosa Arterial insufficiency
Pulmonary embolism Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.
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 Acute myocardial infarction Loss of pulses in the limb Cerebrovascular accident
Pulmonary embolism The most common site of a deep vein thrombosis (DVT) is in the venous sinuses in the soleus muscle and posterior tibial and peroneal veins. The risk of pulmonary embolism emphasizes the need for early detection and treatment of DVT. The other options are caused by occlusions in the arterial system.
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client? Deep vein thrombosis Raynaud disease Atherosclerotic occlusive disease Frostbite related to hypothermia
Raynaud disease The symptoms of this client represent Raynaud disease. Frostbite would most likely have affected the feet and the hands. The others apply more to the lower extremities.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse questions the prescription of ACE inhibitors for a client with which condition? Renal artery stenosis Coronary artery disease Diabetes Heart failure
Renal artery stenosis ACE inhibitors are contraindicated in renal artery stenosis, since blocking of efferent glomerular capillaries will interfere with normal compensation for the stenosis and cause a further frop in glomerular filtration pressure. The kidney 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.
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? Surgical or fibrotherapy Sclerotherapy or surgery Trendelenburg therapy or sclerotherapy Surgery or Trendelenburg therapy
Sclerotherapy or surgery Sclerotherapy, which often is used in the treatment of small residual varicosities, involves the injection of a sclerosing agent into the collapsed superficial veins to produce fibrosis of the vessel lumen. Surgical treatment consists of removing the varicosities and the incompetent perforating veins, but it is limited to persons with patent, deep venous channels. Sclerotherapy produces fibrosis of the vessel lumen. There is no fibrotherapy for varicose veins. There is no Trendelenburg therapy for varicose veins. There is a Trendelenburg test that is diagnostic for primary or secondary varicose veins.
Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm termed abdominal aortic aneurysms? Select all that apply. Berry aneurysms Dissecting aneurysms Saccular aneurysms Fusiform aneurysms Bifurcating aneurysms
Saccular aneurysms Fusiform aneurysms Abdominal aortic aneurysms can involve any part of the vessel circumference (saccular) or extend to involve the entire circumference (fusiform). Berry aneurysms typically occur in the circle of Willis. Dissecting aneurysms are false aneurysms and typically occur in the thoracic aorta. Aneurysms can occur at the bifurcation of a blood vessel but are not termed bifurcating aneurysms.
The nurse knows that which statements regarding sodium and hypertension are correct? Select all that apply. Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. Reduction in sodium intake often produces a reduction in blood pressure. Older persons are less sensitive to sodium than younger persons. Added table salt accounts for most of the sodium in the diet. In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated.
Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. Reduction in sodium intake often produces a reduction in blood pressure. In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated. The mechanism by which sodium contributes to hypertension is not clear. It may involve the responsiveness of the cardiovascular system to adrenergic stimulation. Reduction of salt intake will lower blood pressure. Older persons are more sensitive to the effect of salt on blood pressure. Seventy-five percent of sodium intake is from processed foods, 15 percent from cooking and table salt, and 10 percent from natural sodium content of foods.
The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system? Sympathetic Parasympathetic Central Peripheral
Sympathetic A network of vasomotor nerves of the sympathetic component of the autonomic nervous system supplies the smooth muscle in the blood vessels. These nerves and circulating hormones are responsible for vasoconstriction of the vessel walls.
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 Tonic-clonic seizures Chest pain radiating to the right arm Late hypertensive crisis
Tearing or ripping-type pain in the chest or back A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
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? The client's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. 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.
A 28-year-old client who is a heavy smoker tells the practitioner that he has been experiencing pain in his feet and lower legs for several months. The practitioner notes that pulses in the feet are diminished and believes the client may have: Thromboangiitis obliterans Raynaud phenomenon Thrombophlebitis Acute arterial occlusion
Thromboangiitis obliterans Thromboangiitis obliterans, or Buerger disease, is an inflammatory arterial disorder that affects medium-sized arteries, usually the plantar and digital vessels in the foot and lower leg. Usually the disease is seen in people less than 35 years of age who are heavy smokers. Pain is the predominant symptom and peripheral pulses are diminished or absent. Raynaud phenomenon is a functional disorder of the arteries and arterioles in the fingers and, less often, the toes. Thrombophlebitis is the presence of a thrombus in a vein; while pain may be a symptom, pedal pulses are present. In acute arterial occlusion the onset of pain is acute.
Which blood vessel layer is composed primarily of smooth muscle cells? Tunica externa Tunica media Tunica intima Endothelium
Tunica media The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells.
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is: Pheochromocytoma Decreased renal blood flow Unknown Hyperaldosteronism
Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels? Vascular smooth muscle cells (SMCs) Extracellular matrix cells Endothelial cells Collagen tissue
Vascular smooth muscle cells (SMCs) Vascular SMCs, which form the predominant cellular layer in the tunica media, produce vasoconstriction and/or dilation of blood vessels.
Which of the following is associated with stasis of blood, increased blood coagulability, and vessel wall injury? Venous thrombosis Varicose veins Chronic venous insufficiency Peripheral artery disease (PAD)
Venous thrombosis Venous thrombosis is associated with stasis of blood, increased blood coagulability, and vessel wall injury. Varicose veins are dilated, tortuous veins of the lower extremities and lead to venous insufficiency. PAD is caused by atherosclerosis in arteries of the lower extremities.
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 Oral administration of beta-adrenergic blockers Restriction of dietary sodium Cautious use of over-the-counter diuretics
Vigilant blood pressure monitoring Sodium restriction is not normally recommended during pregnancy. Most medications are contraindicated during pregnancy except in cases where the mother's life is threatened. Close monitoring is the initial focus of care.
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement? apply sequential pneumatic compression devices to lower extremities apply ice compresses to the site of the DVT hourly ensure that the client remains on bed rest massage legs to maintain blood flow
apply sequential pneumatic compression devices to lower extremities 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.
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension? decreased elasticity of the aorta and large arteries decreased elasticity of the venous connective tissue increased elasticity of the arterial connective tissue increased elasticity of the venous connective tissue
decreased elasticity of the aorta and large arteries In aging adults, there is a decrease in the elasticity of the aorta and large arteries making them more rigid, thereby increasing systolic blood pressure. This can lead to increased cardiac afterload and hypertension.
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. The nurse teaches the client that this medication lowers blood pressure through what effect? decreasing vascular volume decreasing heart rate increasing renin release increasing vasoconstriction
decreasing vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion). This reduces preload, which will decrease cardiac output and thereby reduce blood pressure. An increase in vasoconstriction will increase blood pressure. Beta blockers reduce blood pressure by decreasing heart rate to reduce cardiac output. Increasing the release of renin will increase the activity of the renin-angiotensin-aldosterone system (RAAS). The release of renin increases the conversion of angiotensin 1 to angiotensin 2, causing vasoconstriction. The increased amount of angiotensin 2 will promote the release of aldosterone, which will increased retention of sodium and water and increase blood volume and blood pressure. Suppression of RAAS is a primary target of antihypertensives, such as angiotensin converting enzyme (ACE) inhibitors.
A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen? increased low-density lipoproteins increased high-density lipoproteins lowered high-density lipoproteins increased blood glucose levels
increased high-density lipoproteins A goal in prescribing exercise and diet control in clients with hypercholesterolemia is to lower the level of low-density lipoproteins (LDL) and increase the high-density lipoproteins (HDL). Elevated blood glucose is evidence of possible diabetes mellitus.
