Perfusion

Question 1

hypertension

Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)?

a. Release of norepinephrine
b. Secretion of prostaglandins
c. Stimulation of the sympathetic nervous system
d. Stimulation of the parasympathetic nervous system
e. Activation of the renin-angiotensin-aldosterone system

Answer 1

a,c,d

Question 2

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is

a. a low-calcium diet.
b. excessive alcohol intake.
c. a family history of hypertension.
d. consumption of a high-protein diet.

Answer 2

b

Question 3

In teaching a patient with hypertension about controlling the illness, the nurse recognizes that

a. all patients with elevated BP require medication.
b. obese persons must achieve a normal weight to lower BP.
c. it is not necessary to limit salt in the diet if taking a diuretic.
d. lifestyle modifications are indicated for all persons with elevated BP.

Answer 3

d

Question 4

A priority consideration in the management of the older adult with hypertension is to

a. prevent primary hypertension from converting to secondary hypertension.
b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult.
c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption.
d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

Answer 4

d

Question 5

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient?

a. Medication will be required because the BP is still not at goal.
b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension.
c. Lifestyle changes are less important, since they were not effective, and medications will be started.
d. More vigorous changes in the patient’s lifestyle are needed for a longer time before starting medications.

Answer 5

a

Question 6

A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be most appropriate for this patient (select all that apply)?

a. Measuring hourly urine output
b. Decreasing the MAP by 50% within the first hour
c. Continuous BP monitoring with an arterial line
d. Maintaining bed rest and providing tranquilizers to lower the BP
e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

Answer 6

a,c,e

Question 7

Hypertensive crisis

Answer 7

is a term used to indicate either a hypertensive urgency or emergency. Hypertensive crisis occurs at systolic BP greater than 180 mm Hg and/or diastolic BP greater than 110 mm Hg. BPs can often be greater than 220/140 mm Hg. The difference between a hypertensive urgency and emergency is the absence or presence of target organ damage.

Question 8

Orthostatic hypotension

Answer 8

occurs when a patient moves from a supine to standing position, and there is a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in the HR of 20 beats/minute. Common causes of orthostatic hypotension include dehydration and inadequate vasoconstrictor mechanisms related to disease or drugs.

Question 9

Blood pressure

Answer 9

Blood pressure (BP) is the force exerted by the blood against the walls of the blood vessel. It must be adequate to maintain tissue perfusion during activity and rest. The maintenance of normal BP and tissue perfusion requires the integration of both systemic factors and local peripheral vascular effects. BP is primarily a function of cardiac output (CO) and systemic vascular resistance (SVR)

Question 10

Hypertension

Answer 10

Hypertension is defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP (DBP) of 90 mm Hg or more, or current use of antihypertensive medication.9 Prehypertension is defined as SBP of 120 to 139 mm Hg or DBP of 80 to 89 mm Hg.

Question 11

Isolated systolic hypertension (ISH)

Answer 11

Isolated systolic hypertension (ISH) is defined as an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg.10 SBP increases with aging.

Question 12

Primary (essential or idiopathic) Hypertension

Answer 12

Primary (essential or idiopathic) hypertension is elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. Although the exact cause of primary hypertension is unknown, there are several contributing factors.

Question 13

Secondary Hypertension

Answer 13

Secondary hypertension is elevated BP with a specific cause that often can be identified and corrected (Table 32-3). This type of hypertension accounts for 5% to 10% of hypertension in adults. Secondary hypertension should be suspected in people who suddenly develop high BP, especially if it is severe.

Question 14

DASH diet

Answer 14

DASH Eating Plan. The DASH eating plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars, and sugar-containing beverages. The DASH eating plan significantly lowers BP, and these decreases compare with those achieved with BP-lowering medication

Question 15

Atherosclerosis

Answer 15

atherosclerosis comes from two Greek words: athere, meaning “fatty mush,” and skleros, meaning “hard.” This combination means that atherosclerosis begins as soft deposits of fat that harden with age. Consequently, atherosclerosis is commonly referred to as “hardening of the arteries.” Although this disease can occur in any artery in the body, the atheromas (fatty deposits) prefer the coronary arteries. The terms arteriosclerotic heart disease, cardiovascular heart disease, ischemic heart disease, coronary heart disease, and CAD all describe this disease process.

Question 16

Modify lifestyle

Answer 16

Question 17

What are the blood vessels?

Answer 17

Question 18

What is the sympathitic system involved with perfusion?

Answer 18

Question 19

Lifespan considerations with infants?

Answer 19

Question 20

Lifespan considerations with pregant women?

Answer 20

Question 21

Lifespan Considerations with older adults?

Answer 21

Question 22

Health history

What assessments are important?

Answer 22

Question 23

What are diagnostics that we use for perfusion?

Answer 23

Question 24

What are non-modifiable risk factors?

Answer 24

Question 25

Medically treatable modifiable risk factors?

Answer 25

Question 26

Total cholesteral ranges?

Answer 26

Question 27

Fasting glucose

Answer 27

Question 28

Smoking

Answer 28

Question 29

Diet and Nutrition

Answer 29

Question 30

Physical Inactivity

Answer 30

Question 31

Stress

Answer 31

Question 32

Cardiac Health Factors

Answer 32

Question 33

Mr. Smith is a 63 year old African American male presenting to the clinic after having an elevated blood pressure reading when he checked his blood pressure at a local pharmacy. Mr. Smith explains that he was told he had high blood pressure about 10 years ago and was started on a blood pressure pill. However, he lost his health insurance a few months later and stopped filling his prescription to save money since he felt perfectly fine. Mr. Smith explains that recently one of his coworkers was telling him about a friend that “dropped dead” of a heart attack because of their high blood pressure. This really scared him, so he went to the pharmacy and got his blood pressure checked. He reports he checked his blood pressure twice, the first time it was 165/95 and the second time it was 173/99. Mr. Smith has since got a new job and currently has health insurance. Today in the office his blood pressure is 162/89.

1. What assessment questions would you want to ask Mr. Smith about his current health and his risk factors?

Answer 33

• What blood pressure medication did you take previously?
• Do you have any other CV, cerebrovascular, renal, or thyroid disease? Any other history like diabetes, high cholesterol?
• Do you take any other medications? Were you ever prescribed any other medications? Any herbals or OTC meds?
• Any family history of HTN, heart disease, stroke, etc.
• Any tobacco use? Any recreational drug use? Alcohol use?
• Any symptoms like fatigue, dyspnea with exertion, palpitations, chest pain, muscle cramps, blurred vision, headaches, dizziness?

Question 34

The emergency department nurse is caring for a patient with an elevated troponin level. The nurse knows that an elevated troponin level indicates:

A. Inflammation of the myocardial tissue

B. Increased calcium deposits in the myocardial vessels

C. Myocardial injury

D. Atherosclerosis

Answer 34

C. Myocardial Injury

Rationale: Troponin is a myocardial muscle protein. It is released after myocardial injury. Elevated blood levels are indicative of a myocardial infarction.

Question 35

The nurse is caring for a patient with an elevated Brain-type natriuretic peptide. What is an elevated BNP most indicative of?

A. Myocardial infarction

B. Myocardial ischemia

C. A cerebrovascular accident

D. Heart failure

Answer 35

D. Heart failure

Rationale: BNP is a natriuretic peptide hormone. It is secreted from cardiac cells in high amounts when pressures are high and is used to detect heart failure.

Question 36

The nurse is caring for a patient with an elevated HDL cholesterol level. What is the most appropriate action of the nurse?

A. Notify the patient that she will likely be started on a medication to lower her cholesterol

B. Encourage her to incorporate more aerobic exercise into her routine

C. Encourage her to continue her healthy lifestyle

D. Educate her about foods that are high in cholesterol

Answer 36

C. Encourage her to continue her healthy lifestyle

Rationale: An elevated HDL cholesterol is protective. You want your HDL cholesterol to be greater than 40 in men and greater than 50 in women. HDL can be increased through aerobic activity. Individuals with an HDL level greater than 60 are at low risk for CAD. Individuals with an HDL less than 40 are at higher risk for CAD.

Question 37

Which of the following statements if made by the patient indicate the need for FURTHER teaching about a heart healthy diet.

A. I should use coconut oil for cooking instead of olive oil

B. I will limit my daily saturated fat intake.

C. I will consume fat free and low fat dairy products instead of whole milk products

D. I should increase my daily vegetable intake.

Answer 37

A. I should use coconut oil for cooking instead of olive oil

Rationale: Tropical vegetable oils are high in saturated fat which can contribute to elevated cholesterol. It is important to limit saturated fat in the diet. Consuming low fat and fat free products are preferred over whole milk products. It is recommended to eat 2.5 to 3 cups of vegetables per day.

Question 38

Your patient is prescribed a thiazide diuretic for HTN. The nurse knows that this type of medication lowers blood pressure by:

A. Increasing excretion of sodium and chloride resulting in decreased SVR

B. Causing generalized vasodilation

C. Blocking alpha1 adrenergic effects

D. Decreasing heart rate and slowing AV conduction

Answer 38

A

Thiazide diuretics inhibit sodium chloride reabsorption in the distal convoluted tubule of the kidneys. They increase excretion of sodium and chloride and cause an initial decrease in extracellular fluid volume. Causes a sustained decrease in systemic vascular resistance.

Question 39

Your patient has been taking Lisinopril, an ACE inhibitor for about 3 weeks for the treatment of HTN. Today the patient’s blood pressure is 118/65 and heart rate is 64. He also reports a dry, hacking cough. What is the most appropriate action by the nurse?

A. Notify the provider that the patient may need his Lisinopril dose decreased due to the normal blood pressure reading.

B. Notify the provider that the patient may be experiencing an adverse medication side effect

C. Educate the patient that a cough is a normal reaction to an ACE inhibitor, and it will go away in a few weeks.

D. Educate the patient to increase daily fluid intake

Answer 39

B

Rationale: A dry hacking cough is a common adverse drug reaction of the ACE inhibitor class. It is also a common reason that patient’s stop taking this medication. The provider should be notified as the patient may need a medication change.

Question 40

The nurse is caring for a patient recently prescribed a HMG-CoA reductase inhibitor medication (statin) for treatment of high cholesterol. The patient asks how this drug will lower her cholesterol. Which is the most appropriate response by the nurse?

A. Statins increase conversion of cholesterol to bile acid, promoting cholesterol elimination.

B. Statins inhibit the absorption of dietary and biliary cholesterol

C. Statins interfere with LDL and triglyceride synthesis

D. Statins inhibit the synthesis of cholesterol in the liver and increase hepatic LDL receptors.

Answer 40

D

Rationale: Statins inhibit the synthesis of cholesterol in the liver and increase the number of hepatic LDL receptors. This allows the liver to remove more LDL from the blood. A is describing bile acid sequestants. B is describing Ezetimibe. C is describing niacin

Question 41

Which of the following is a potential adverse effect of statin drugs?

A. Facial flushing

B. Muscle pains

C. Altered taste sensation

D. Orthostatic hypotension

Answer 41

B

Rationale: Statins can cause myopathy, or muscle pains. This can potentially lead to breakdown of skeletal muscles (rhabdomyolysis). Facial flushing and orthostatic hypotension is commonly seen with the medication niacin. Altered taste sensation can be seen with bile acid sequestrants.

Question 42

The patient is prescribed a beta blocker medication for treatment of hypertension. The nurse knows teaching has been effective if the patient makes the following statement:

A. I will notify my provider if I am thinking about stopping this medication for any reason.

B. I may experience a racing heartbeat if I take too much of this medication.

C. I can hold my beta blocker medication if I am running errands in the morning so I don’t have to use the restroom frequently.

D. I will notify my provider if I develop a cough.

Answer 42

A

Rationale: It is important to not abruptly discontinue a beta blocker due to the possibility of rebound hypertension. Beta blockers cause bradycardia, not tachycardia. A beta blocker will not cause increased urination, this is associated with diuretic use. A cough is associated with ACE inhibitors, not beta blockers.

Question 43

Jerry is a 73 year old male with a past medical history of stable angina. The nurse knows that stable angina symptoms occur when:

A. Myocardial oxygen demand exceeds the supply

B. When there is irreversible damage to the myocardium

C. There is spasming of a major coronary artery

D. When there is increased myocardial oxygen supply

Answer 43

A

Rationale: Ischemia occurs when the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen. Ischemia is often reversible. Myocardial infarction causes irreversible damage. Spasming of coronary artery = Printzmetals’s angina.

Question 44

When Beta 1 adrenergic receptors in the heart are stimulated by norepinephrine and epinephrine, what is the resulting effect? Select all that apply

A. Increased heart rate

B. Vasoconstriction

C. Increased force of contraction

D. Increased speed of conduction

Answer 44

A,C,D

Question 45

What is the role of angiotensin-converting enzyme (ACE) in blood pressure regulation?

A. ACE causes vasoconstriction

B. ACE converts angiotensin I to angiotensin II

C. ACE stimulates the secretion of renin in response to SNS stimulation

D. ACE converts angiotensinogen to angiotensin I

Answer 45

B

Rationale: ACE converts angiotensin I to angiotensin II. Angiotensin II increases BP by causing vasoconstriction and stimulating the adrenal cortex to stimulate aldosterone. Angiotensin II also acts at the local tissue level in the heart and vessels that can result in remodeling of the vessel walls which can lead to the development of HTN. ACE inhibitors target this enzyme to prevent these changes from occurring.

The juxtaglomerular cells of the kidney secrete renin in response to SNS stimulation. Renin converts angiotensinogen to angiotensin I.

Question 46

The nurse knows that a potential side effect of many of the antihypertensive medications is orthostatic hypotension. Which of the following patients is experiencing orthostatic hypotension based on their BP and HR measurements? Select ALL that apply

A. BP supine: 145/60 and BP standing: 135/58, HR supine: 76 and HR standing: 89

*B. BP supine: 140/80 and BP standing 118/70, HR supine: 80 and HR standing: 102

*C. BP supine: 90/50 and BP standing: 84/52, HR supine: 90 and HR standing 115

*D. BP supine: 112/80 and BP standing: 109/65, HR supine: 67 and HR standing 84

Answer 46

B,C,D

Rationale: Orthostatic hypotension occurs when a patient moves from supine to standing and there is a decrease of 20 or more in SBP, a decrease of 10 or more in DBP, and/or an increase in the heart rate of 20 bmp or more.

Question 47

Which of the following is characteristic of the complicated lesion stage of development of atherosclerosis?

A. Streaks of fat develop within the smooth muscle cells

B. Collagen covers the fatty streak leading to a fibrous plaque

C. Collateral circulation is established

D. Thrombus development and enlargement of thrombus due to platelet aggregation

Answer 47

D

Rationale: The complicated lesion stage is the final stage of atherosclerosis development. In the complicated lesion stage the fibrous plaque grows, leading to continued inflammation and may result in plaque instability, ulceration, and rupture. When the integrity of the vessel’s inner wall is compromised, platelets adhere to it, resulting in thrombus formation. Platelet aggregation occurs and the thrombus is enlarged, leading to a complicated lesion. Answer A occurs in the fatty streak stage and answer B occurs in the fibrous plaque stage.

Question 48

Which of the following are potential precipitating events to chest pain caused by myocardial ischemia? Select all that apply.

*A. Shoveling the driveway

B. Sitting for prolonged periods with legs below heart level

C. Getting locked out of the car and having to wait in the cold for 15 minutes

D. Use of supplemental oxygen as needed

E. Going through a divorce

F. Taking a brisk walk

Answer 48

C,E,F

Rationale: physical exertion, cold exposure, and emotional distress are common precipitating events to myocardial ischemia. These events increase myocardial oxygen demand.

Question 49

. Which of the following patients is most likely experiencing inadequate central perfusion?

A. A patient with capillary refill of 5 seconds to the left lower extremity and a diminished dorsalis pedis pulse

B. A patient with a blood pressure of 80/50 and heart rate of 113

C. A patient with bounding peripheral pulses and a blood pressure of 160/90

D. A patient with polyuria, polydipsia, and polyphagia

Answer 49

B

Rationale: B shows signs of poor central perfusion: tachycardia and hypotension. A is showing signs of diminished peripheral perfusion. C is showing signs of increased fluid volume. D is signs of diabetes

Question 50

A parent brings their 5 year old child into the clinic. They state they have noticed that the child has not been as active as usual and the child’s teacher has noticed him squatting often while outside on the playground. The nurse recognizes that the child may be experiencing an alteration in:

A. Peripheral perfusion

*B. Central perfusion

C. Endocrine function

D. Developmental milestones

Answer 50

B

Rationale: children with impaired central perfusion will have poor activity tolerance and may be seen squatting to compensate for altered perfusion.

Question 51

Which of the following patients should the nurse assess FIRST?

A. An infant with a heart rate of 150

B. An infant with a blood pressure of 65/45

C. An infant with pallor and cyanosis

D. An infant who is crying loudly with a blood pressure of 89/55 and HR of 166

Answer 51

C

Rationale: Pallor and cyanosis in an infant are signs of poor perfusion and need prompt assessment and intervention. A and B are normal ranges for infant VS. An infant who is crying may have elevated BP and HR readings, but the readings should normalize.

Question 52

Maria is 28 weeks pregnant and has not been feeling well. In the clinic she is found to have proteinuria and a blood pressure of 150/90. The nurse knows that these findings are signs of:

A. Gestational hypertension

B. Preeclampsia

C. Eclampsia

D. This is a normal finding at this stage of pregnancy

Answer 52

B - Preclampsia

Rationale: Preeclampsia is HTN after 20 weeks gestation with proteinuria.

Gestational HTN is HTN after 20 weeks without proteinuria.

Eclampsia involves convulsions, usually precipitated by headaches and hyperreflexia.

Question 53

The nursing assistant notifies you that your patient has a blood pressure reading of 196/110. Which of the following symptoms would be MOST concerning if reported by the patient?

A. Fatigue and pruritus

B. Headache and nausea

C. Generalized weakness

D. Increased joint pain related to osteoarthritis

Answer 53

B

This is indicative of hypertensive emergency with symptoms

Question 54

Your patient is on spironolactone. What lab value should you be monitoring?

Answer 54

potassium

Question 55

Name one way smoking negatively impacts cardiovascular health?

Answer 55

Decreases HDL

Question 56

Cardiac output is HR x stroke volume. What three factors impact stroke volume? (Perfusion)

Answer 56

Preload
Afterload
Contractility

Question 57

What is the medical term for how infants generate heat in response to cold? (Thermoregulation)

Answer 57

a. Thermogenesis

Question 58

A patient is questioning the nurse about circulation and perfusion. What is the nurse’s best response?

Perfusion assists the body by preventing clots and increasing stamina.

Perfusion assists the cell by delivering oxygen and removing waste products.

Perfusion assists the heart by increasing the cardiac output.

Perfusion assists the brain by increasing mental alertness.

Answer 58

Perfusion assists the cell by delivering oxygen and removing waste products.

Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness.

Question 59

A patient is experiencing periods of confusion, and the family is concerned. The patient’s son asks the nurse for an explanation and recommendation. What is the nurse’s best response?

“Your father may be having mini-strokes; I will notify his physician.”

“Your father is just confused about some things since he is in the hospital.”

“The confusion will pass. Your father just has to get up and move around.”

“Talk with your father about past events, and that will help with the confusion.”

Answer 59

“Your father may be having mini-strokes; I will notify his physician.”

Periods of confusion may be related to mini-strokes, or transient ischemic attacks (TIAs). Confusion during hospitalization does not occur with every patient. Talking with the patient or thinking the confusion may pass is not a viable solution. The patient should be assessed and the reason for the confusion identified.

Question 60

The nurse is assessing a patient for sleep patterns. The patient reports that he has trouble sleeping when lying flat. The best response from the nurse is

open a window to let fresh air into the room.

use nasal strips to assist with breathing.

sleep in a side-lying position.

use pillows to prop yourself up while sleeping.

Answer 60

use pillows to prop yourself up while sleeping.

Using pillows to prop himself up during sleep allows the patient to breathe more easily and comfortably. Nasal strips will help with breathing, but they do not always bring relief when one is lying flat. Sleeping in a side position or opening a window does not help one to breathe more easily when one is lying flat.

Question 61

The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of “feeling tired all the time.” The nurse knows that fatigue may be an underlying symptom of which condition?

Ischemia

Pneumonia

Myocardial infarction

Peptic ulcer disease

Answer 61

Myocardial infarction

Fatigue is an atypical symptom of myocardial infarction in women. Ischemia is associated with pain. Pneumonia is associated with pain and shortness of breath. Peptic ulcer disease is associated with pain and intestinal discomfort.

Question 62

Exercise and activity are included in a cardiac rehabilitation program for which purposes?

Select all that apply.

Increase cardiac output

Increase serum lipids

Increase blood pressure

Increase blood flow to the arteries

Increase muscle mass

Increase flexibility

Answer 62

Increase cardiac output

A cardiac rehabilitation program seeks to increase cardiac output, blood flow to the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure.