Prep U Porth chapter 26 blow flow & pressure
The health care team proposes a treatment plan for a client with peripheral artery disease. Which treatment measures are likely included?
Exercise training like walking to increase collateral circulation Explanation: Because of the effects of exercise training on vascular function and collateral circulation, it has been proposed as a mechanism for improving blood flow and decreasing exercise-related leg pain (claudication) in persons with peripheral artery disease (PAD). The vastus lateralis is the large muscle on the lateral thigh. Weight training will strengthen this muscle, but is not recommended for people with PAD. Isometric exercise does not increase the endurance of the heart. Aerobic exercise does not decrease respiratory stress.
MAP formula
(SBP + 2DBP)/3
what is MAP indicative of and is is measuring systemic or pulmonic circulation?
-tissue perfusion -mean arterial pressure, represents the average blood pressure in the systemic circulation,
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 (consequence of hypertension)?
61-year-old man who has endocarditis and recurrent fever Explanation: 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.
Which statement is characteristic of a Thrombus vs Thrumbi
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.
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 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 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?
Activation of the renin-angiotensin-aldosterone mechanism Explanation: 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.
The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?
C-reactive protein.
A 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 Explanation: 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.
critical care nurse is carefully monitoring a client's mean arterial pressure. Which combination of factors is responsible for mean arterial blood pressure?
Cardiac output multiplied by systemic vascular resistance Explanation: Mean arterial blood pressure is determined by cardiac output multiplied by systemic vascular resistance. Heart rate multiplied by stroke volume yields cardiac output, but not mean arterial pressure. Multiplying stroke volume by cardiac output or multiplying systemic vascular resistance by heart rate will not provide the client's mean arterial blood pressure.
A client has developed secondary hypertension. The nurse knows that which factors may be a cause of secondary hypertension? Select all that apply.
Cushing syndrome Oral contraceptives Aortic coarctation Pheochromocytoma Explanation: In secondary hypertension, an underlying cause can be identified. Excess glucocorticoid secretion as in Cushing syndrome enhances sodium and water retention, which elevates blood pressure. Pheochromocytoma is a tumor which secretes epinephrine and norepinephrine, which produce vasoconstriction and increased rate and force of myocardial contraction, increasing blood pressure. Coarctation is a narrowing of the aorta that decreases blood flow to the lower body and increases flow and systolic pressure in the upper body. Oral contraceptive drugs cause sodium and water retention, increasing blood volume and pressure. Advanced age is a risk factor for essential or primary hypertension
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?
Deep vein thrombosis Explanation: 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?
Distribution of blood to organs that are controlled by contraction and relaxation of these vessels Explanation: 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 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?
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.
What will elevated renin will increase levels of in regards to RAAS
Elevated renin will increase levels of angiotensin II and aldosterone, resulting in vasoconstriction and sodium and water retention.
An older adult client's blood pressure (BP) is 120/80 mm Hg when in a lying position. When the nurse retakes the client's BP in a sitting position, the BP is 92/60 mm Hg. Which intervention is appropriate for the nurse to implement?
Encouraging the client to maintain hydration throughout the day
Hypertension is a risk factor for atherosclerosis. The nurse knows that which of the following is the initial lesion in the pathogenesis of atherosclerosis?
Endothelial damage Explanation: 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 (collect) at sites of vascular wall damage.
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion Explanation: Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client?
Hypertension is a frequent modifiable contributor to aneurysms. Explanation: Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
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.
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?
Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development Explanation: 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 Elevated renin levels Systemic vasoconstriction Explanation: 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.
A client is diagnosed with systolic hypertension. The nurse knows that this client is at risk for:
Left ventricular hypertrophy Explanation: Elevated systolic pressure forces the heart to work harder and can thus provoke left ventricular hypertrophy, increased myocardial oxygen demand, and eventual left-sided heart failure. Left-sided heart failure may lead to right-sided failure, which can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension
client is diagnosed with systolic hypertension. The nurse knows that this client is at risk for:
Left ventricular hypertrophy Explanation: Elevated systolic pressure forces the heart to work harder and can thus provoke left ventricular hypertrophy, increased myocardial oxygen demand, and eventual left-sided heart failure. Left-sided heart failure may lead to right-sided failure, which can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension.
Several steps characterize the development of atherosclerosis. Which is the correct order in which atheromas develop?
Lipoprotein oxidation, foam cells produced, fibrous plaques develop, a thrombus forms Explanation: In the development of atherosclerosis, activated macrophages release toxic oxygen species that oxidize LDL; they then ingest the oxidized LDL to become foam cells. Lipids released from necrotic foam cells accumulate to form the lipid core of unstable plaques. Rupture, ulceration, or erosion of an unstable fibrous cap may lead to hemorrhage into the plaque or thrombotic occlusion of the vessel lumen.
The nurse knows that peripheral vascular resistance is an important factor in blood pressure regulation. Which statements regarding peripheral vascular resistance are correct? Select all that apply.
Mean arterial pressure is determined by cardiac output and peripheral vascular resistance. Peripheral resistance is influenced by blood viscosity. Blood pressure can be maintained despite changes in cardiac output and resistance. Peripheral resistance is influenced by arteriolar constriction.
Which would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL?
Obesity with high-calorie intake increases the production of VLDL, with triglyceride elevation and high conversion of VLDL to LDL. Excessive cholesterol intake reduces formation of LDL receptors. Diabetes is associated with high triglycerides and minimal elevation of LDL. Bile salt-binding resin is one treatment used to lower cholesterol levels.
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.
A client is admitted to the outpatient diagnostic unit for further testing to identity the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which diagnostic procedure will provide the most definitive diagnosis?
Renal arteriography Explanation: With the dominant role that the kidney assumes in blood pressure regulation, it is not surprising that the largest single cause of secondary hypertension is renal disease. Renal arteriography remains the definitive test for identifying renal artery disease. Ultrasound, CT, and MRA are other tests that can be used to screen for renovascular hypertension.
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:
Stasis of blood, hypercoagulability, vessel wall injury Explanation: 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 nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?
The kidneys Explanation: The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.
Which blood vessel layer is composed primarily of smooth muscle cells?
Tunica media Explanation: 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
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II Explanation: Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.
can Left-sided heart failure may lead to right-sided failure,
YES and right sided heart failure can affect the kidneys. Systolic hypertension can exist apart from diastolic hypertension
Which drug(s) may cause secondary hypertension? Select all that apply.
amphetamines oral contraceptives cocaine decongestants
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:
apply sequential pneumatic compression devices to lower extremities Explanation: 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.
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?
decrease vascular volume
Hospitalization and bed rest predispose to
dehydration and low blood volume.
What can right sided heart failure lead to
right-sided failure, which can affect the kidneys.
Which hypertensive individual is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?
51-year-old man who has been diagnosed with glomerulonephritis Explanation: Damage to the organs that control and mediate the blood pressure, most notably the kidneys, is associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.
A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which assessment would the nurse be most justified in eliminating during a busy morning on the unit?
Measuring the pulse of a client taking an ACE inhibitor. Explanation: ACE inhibitors act on the renin-angiotensin-aldosterone system and are thus not significant influences on heart rate. They can, however, induce hyperkalemia and it would be prudent for the nurse to check potassium levels. β-adrenergic blockers affect a client's heart rate, and diuretics can affect electrolyte levels.
Which of the following are characteristic signs of acute arterial embolism?
Pallor, pulselessness, and pain Explanation: The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse knows that ACE inhibitors are contraindicated by which clinical condition?
Renal artery stenosis Explanation: 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.
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 Explanation: Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with dyslipidemia. All the other answers are normal findings.
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?
HDL cholesterol is often characterized as being beneficial to health. Explanation: 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
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:
Organ damage and hypovolemic shock Explanation: 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
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include:
Stasis of blood, hypercoagulability, vessel wall injury Explanation: 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 nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?
Varicose veins develop from prolonged standing and increased abdominal pressure (heavy lifting). The risk of development would greatly increase with weight gain and prolonged standing and would not be affected by bone structure
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.
Stiffening of large arteries like the aorta Decreased baroreceptor sensitivity and renal blood flow Increased peripheral vascular resistance Explanation: 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.
Which type of aortic aneurysm is the most common?
Abdominal aortic Explanation: 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.
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client?
Hypertension is a frequent modifiable contributor to aneurysms. Explanation: Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is most accurate?
With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."
