NURS-304 (U4) - Chapter 26: Blood Flow & Blood Pressure

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in:

(a) arterial wall weakening resulting in aneurysm formation.

(b) contraction of the underlying smooth muscles within the vessels.

(c) overproduction of growth factors resulting in new vessel production.

(d) release of excess fatty plaque causing numerous pulmonary emboli.

(b) contraction of the underlying smooth muscles within the vessels.

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?

(a) Nitric Oxide

(b) Norepinephrine

(c) Fibroblast growth factor

(d) Adrenal glands

(b) Norepinephrine

In which of the following hospital clients would the care team most realistically anticipate finding normal cholesterol levels?

(a) A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy

(b) A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and has a history of hypothyroidism

(c) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

(d) A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

(c) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

When a 55-year-old client's routine blood work returns, the nurse notes that the client's C-reactive protein (CRP) is elevated. The client asks what that means. The nurse responds:

(a) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels."

(b) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

(c) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein."

(d) "This means you have high levels of HDL to balance the LDL found in animal proteins."

(b) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

A client is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which excerpt from the educational brochure warrants correction?

(a) "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease."

(b) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."

(c) "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women."

(d) "High blood pressure often accompanies, or even causes, clogging of the arteries."

(b) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."

A client arrives at the ED complaining of numbness in left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses non-palpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that:

(a) submersion in a whirlpool with warm water will improve the venous blood flow and restore pulses.

(b) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs.

(c) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow.

(d) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion.

(c) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow.

A 70-year-old male client presents to the emergency department reporting pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which medical diagnosis/possible treatment plan listed below?

(a) Atherosclerotic occlusive disease necessitating thrombolytic therapy

(b) Giant cell temporal arteritis that will be treated with corticosteroids

(c) Acute arterial occlusion that will be treated with angioplasty

(d) Raynaud disease that will require antiplatelet medications

(a) Atherosclerotic occlusive disease necessitating thrombolytic therapy

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

(a) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too."

(b) "This likely won't have a huge effect on your quality of life and I'll prescribe anti-clotting drugs to prevent attacks."

(c) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity."

(d) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

(d) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

An older adult client arrives to the health care provider's office complaining of a "sore" that won't heal on the lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the client that the usual treatment is:

(a) long-term antibiotic therapy to facilitate healing of the wound.

(b) initiation of warfarin therapy to maintain an INR of 2-3.0 above norm.

(c) hydrotherapy treatments to facilitate improvement in circulation.

(d) compression therapy to help facilitate blood flow back to the vena cava.

(d) compression therapy to help facilitate blood flow back to the vena cava.

A physician is explaining to a group of medical students the concept of Virchow's triad as it applies to venous thrombosis. Which clinical observation of a 50-year-old male client is most likely unrelated to a component of Virchow's triad?

(a) The man has decreased cardiac output and an ejection fraction of 30%.

(b) There is bilateral, brown pigmentation of his lower legs.

(c) The man's prothrombin time and international normalized ratio (INR) are both low.

(d) The man has a previous history of a dissecting aneurysm.

(a) The man has decreased cardiac output and an ejection fraction of 30%.

A 74-year-old man is being assessed by a nurse as part of a weekly basic health assessment at the long term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure?

(a) The relationship between total blood volume and resting heart rate

(b) The cardiac reserve, or possible increase in cardiac output over normal resting level

(c) Blood volume, resistance, and flow

(d) The amount of blood that his heart ejects from the left ventricle during each beat

(d) The amount of blood that his heart ejects from the left ventricle during each beat

The nurse practitioner is working in an overnight sleep lab assessing and diagnosing clients with sleep apnea. During this diagnostic procedure, the nurse notes that a client's blood pressure is 162/97 mm Hg. The nurse explains this connection to the client based on which pathophysiologic principle?

(a) During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.

(b) When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

(c) When the client starts to snore, the epiglottis is closed over the trachea.

(d) Specialized cells are located in the back of the throat that signal when the airway is obstructed; this sends signals to the kidney to increase the pulse rate.

(a) During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate?

(a) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."

(b) "High blood pressure is largely controllable, except for those with a significant family history or black persons."

(c) "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."

(d) "It's important to minimize the amount of potassium and, especially, sodium in your diet."

(a) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."

When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share?

(a) "All you need to do is stop drinking sodas and sugary drinks."

(b) "An increased waist-to-hip" ratio can lead to too much pressure on the liver and intestines."

(c) "If your leptin [hormone] level is too low, you are at increased risk for developing high BP."

(d) "A 10-pound loss of weight can produce a decrease in blood pressure."

(d) "A 10-pound loss of weight can produce a decrease in blood pressure."

A physician is providing care for several clients on a medical unit of a hospital. In which situation would the physician be most likely to rule out hypertension as a contributing factor?

(a) A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

(b) A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

(c) A 61-year-old man who has a heart valve infection and recurrent fever

(d) An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

(c) A 61-year-old man who has a heart valve infection and recurrent fever

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure?

(a) "Vessel wall changes suggestive of venous stasis are evident."

(b) "Bilateral renal hypertrophy noted."

(c) "Scarring of urethra suggestive of recurrent urinary tract infections is evident."

(d) "Arterial sclerosis of subcortical brain regions noted."

(d) "Arterial sclerosis of subcortical brain regions noted."

During a routine physical exam for a client diagnosed with hypertension, the nurse practitioner will be most concerned if which assessment is found?

(a) Inability to locate kidneys with deep palpation to abdomen.

(b) Unable to feel vibrations when tuning fork placed on skull.

(c) Noted hemorrhages and microaneurysms during evaluation of internal eye.

(d) Slight increase in number of varicose veins noted bilaterally.

(c) Noted hemorrhages and microaneurysms during evaluation of internal eye.

A physical assessment of a 28-year-old female client indicates that the blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which possibility would her care provider be most likely to suspect?

(a) Coarctation of the aorta

(b) Essential hypertension

(c) Pheochromocytoma

(d) An adrenocortical disorder

(a) Coarctation of the aorta

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?

(a) Plasma angiotensin I and II and renin

(b) Platelet count; serum creatinine; liver enzymes

(c) Urinary catecholamines and metabolites

(d) Urinary sodium and potassium

(b) Platelet count; serum creatinine; liver enzymes

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a client who has been admitted to the hospital following a syncopal episode and recent falls. Which fact about the client best relates to these health problems?

(a) The client is 89 years old and takes a diuretic medication for his congestive heart failure.

(b) The client is male and has a history of hypertension.

(c) The client has a history of acute and chronic renal failure.

(d) The client's cardiac ejection fraction was 40% during his last echocardiogram.

(a) The client is 89 years old and takes a diuretic medication for his congestive heart failure.

A 78-year-old male client has undergone a total knee replacement. He just doesn't feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and lightheadedness. These symptoms are primarily caused by which pathophysiologic principle? Select all that apply.

(1) Client is so stressed that he is releasing too many endorphins.

(2) Client has loss all of his muscle tone.

(3) Client is experiencing a reduction in plasma volume.

(4) Peripheral vasoconstriction mechanism has failed.

(5) Client is still bleeding from the surgical procedure.

(3) Client is experiencing a reduction in plasma volume.

(4) Peripheral vasoconstriction mechanism has failed.

Which client should the emergency department staff suspect to be high risk for the development of a thoracic aortic aneurysm?

(a) A 66-year-old client with facial edema, a cough, and neck vein distention

(b) An 81-year-old man with acute cognitive changes as well as difficulty speaking and swallowing

(c) A 70-year-old woman with jugular venous distention, shortness of breath, and pulmonary edema

(d) A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor

(a) A 66-year-old client with facial edema, a cough, and neck vein distention

Which medication will likely be prescribed for a client with elevated LDL and triglyceride levels?

(a) Cholestyramine, a bile acid sequestrant

(b) Simvastatin, an HMG-CoA reductase inhibitor or 'statin'

(c) Nicotinic acid, a B vitamin

(d) Fenofibrate, a fibric acid.

(b) Simvastatin, an HMG-CoA reductase inhibitor or 'statin'

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) A client reporting painful urination and experiencing fever and chills.

(b) Athletic client reporting the kneecap popping in and out of socket.

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

(d) A client with a history of chronic obstructive pulmonary disease (COPD) experiencing a productive cough with green sputum.

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

Following physical assessment, which abnormality(ies) leads the health care provider to suspect the client has metabolic syndrome? Select all that apply.

(1) Fasting high-density lipoprotein (HDL) level of 80 mg/dL (2.07 mmol/L)

(2) Fasting triglyceride level of 230 mg/dL 92.6 mmol/L)

(3) Blood glucose level of 100 mg/dL (5.6 mmol/L)

(4) Sitting blood pressure reading of 145/96 mm Hg

(5) Five foot (1.5 meter) tall female with abdominal waist measurement of 45 inches (114 cm)

(2) Fasting triglyceride level of 230 mg/dL 92.6 mmol/L)

(4) Sitting blood pressure reading of 145/96 mm Hg

(5) Five foot (1.5 meter) tall female with abdominal waist measurement of 45 inches (114 cm)