Unit6: Ch 26 (Porth's 5th Ed) - Disorders of Blood Flow

Question 1

1. 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) release of excess fatty plaque causing numerous pulmonary emboli.
   C) contraction of the underlying smooth muscles within the vessels.
   D) overproduction of growth factors resulting in new vessel production.

Answer 1

Ans: C
Feedback:
Endothelial dysfunction describes several types of potentially reversible changes in
endothelial function that occur in response to environmental stimuli. Inducers of
endothelial dysfunction include cytokines, bacterial, viral, and parasitic products that
cause inflammation. They also influence the reactivity of underlying smooth muscle
cells through production of both relaxing factors (nitric oxide) and contracting factors
(e.g., endothelins).

Question 2

2. 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) Adrenal glands
   C) Fibroblast growth factor
   D) Norepinephrine

Answer 2

Ans: D
Feedback:
Nerve cells and circulating hormones are responsible for vasoconstriction of the vessel
walls. Because they do not enter the tunica media of the blood vessel, the nerves do not
synapse directly on the smooth muscle cells. Instead, they release the neurotransmitter,
norepinephrine, which diffuses into the media and acts on the nearby smooth muscle
cells, resulting in contraction of the entire muscle cell layer and thus reducing the radius
of the vessel lumen. This increases the systemic circulation.

Question 3

3. 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 of
   the following aspects of hyperlipidemia would the physician most likely take into
   account when teaching the patient?
   A) Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.
   B) HDL cholesterol is often characterized as being beneficial to health.
   C) Cholesterol is a metabolic waste product that the liver is responsible for clearing.
   D) The goal of medical treatment is to eliminate cholesterol from the vascular
   system.

Answer 3

Ans: B
Feedback:
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 physiological processes, and complete elimination is
neither realistic nor desirable.

Question 4

4. Which of the following patients will likely experience difficulty in maintaining
   lipoprotein synthesis resulting in elevated LDL levels?
   A) A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary
   disease (COPD)
   B) A 44-year-old female admitted for hysterectomy due to cervical cancer with
   metastasis
   C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver
   disease
   D) A 27-year-old patient with pancreatitis related to alcohol abuse

Answer 4

Ans: C
Feedback:
There are two sites of lipoprotein synthesis—the small intestine and the liver. The liver
synthesizes and releases VLDL and HDL. IDL are taken to the liver and recycled to
form VLDL or converted to LDL in the vascular compartment. Liver disease will result
in this mechanism not working as expected. COPD, cervical cancer, and pancreatitis are
not involved in elevated LDL levels.

Question 5

5. In which of the following hospital patients 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 with 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

Answer 5

Ans: C
Feedback:
Hemorrhagic stroke is not a pathology noted to be associated with secondary
hypercholesterolemia. Diabetes, thyroid medications, estrogen therapy, obesity, and
beta-blocker medications are all correlated with hypercholesterolemia.

Question 6

6. A nurse practitioner is instructing a group of older adults about the risks associated with
   high cholesterol. Which of the following teaching points should the participants try to
   integrate into their lifestyle after the teaching session?
   A) “Remember the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low
   danger to your health.”
   B) “Having high cholesterol increases your risk of developing diabetes and irregular
   heart rate.”
   C) “Smoking and being overweight increases your risk of primary
   hypercholesterolemia.”
   D) “Your family history of hypercholesterolemia is important, but there are things
   you can do to compensate for a high inherited risk.”

Answer 6

Ans: D
Feedback:
There is a genetic basis to high cholesterol, but lifestyle modification can compensate
for many of the increased risks. LDL is more deleterious to health than HDL, and
diabetes contributes to high cholesterol but not necessarily vice versa.
Hypercholesterolemia resulting from other factors is secondary rather than primary.

Question 7

7. Which of the following medications will likely be prescribed for a patient with elevated
   LDL and triglyceride levels?
   A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or “statin”
   B) Cholestyramine (Questran), a bile acid sequestrant
   C) Nicotinic acid (Niacin), a B vitamin
   D) Fenofibrate (Tricor), a fibric acid

Answer 7

Ans: A
Feedback:
The statins can reduce or block the hepatic synthesis of cholesterol and are the
cornerstone of LDL-reducing therapy. Statins also reduce triglyceride levels and
increase HDL levels.

Question 8

8. When a 55-year-old patient’s routine blood work returns, the nurse notes that his
   C-reactive protein (CRP) is elevated. The patient 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) “You are consuming high levels of folate, which works with the B vitamins and
   riboflavin to metabolize animal protein.”
   C) “This means you have high levels of HDL to balance the LDL found in animal
   proteins.”
   D) “This means you have elevated serum markers for systemic inflammation that has
   been associated with vascular disease.

Answer 8

Ans: D
Feedback:
CRP is a serum marker for systemic inflammation. Elevated levels are associated with
vascular disease. The normal metabolism of homocysteine requires adequate levels of
folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat
consumption. LDL is an independent risk factor for the development of premature
coronary heart disease

Question 9

9. A patient is reading a brochure on atherosclerosis while in the waiting room of medical
   clinic. Which of the following excerpts from the educational brochure warrants
   correction?
   A) “Because smoking causes a permanent increase in your risk of heart disease, it’s
   best not to start.”
   B) “All things being equal, men have a higher risk of coronary heart disease than
   perimenopausal women.”
   C) “High blood pressure often accompanies, or even causes, clogging of the arteries.”
   D) “Every bit that you can lower your cholesterol means that you’ll have a lower risk
   of developing heart disease.”

Answer 9

Ans: A
Feedback:
Cessation of smoking is associated with a decrease in the risk of CHD. Males have an
increased risk of atherosclerosis. Atherosclerosis is often associated with hypertension.
Lowering cholesterol levels brings a commensurate reduction in risk of CHD.

Question 10

10. When trying to educate a patient about the release of free radicals and the role they play
    in formation of atherosclerosis, which of the following statements is most accurate?
    A) The end result of oxidation is rupture of the plaque resulting in hemorrhage.
    B) Activated cells that release free radicals oxidize LDL, which is harmful to the
    lining of your blood vessels.
    C) Oxidized free radicals produce toxic metabolic waste that can kill liver cells.
    D) Activated cells roam in the vascular system looking for inflammatory cells to
    engulf.

Answer 10

Ans: B
Feedback:
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.

Question 11

11. A nurse is providing care for a client who has a history of severe atherosclerosis. Which
    of the following clinical manifestations of the client’s illness should the nurse anticipate
    and assess in the client?
    A) Motor deficits in muscles distal to plaque formation
    B) Peripheral vasodilation to compensate for ischemia
    C) Cognitive deficits due to ischemia or thrombosis
    D) Aneurysm formation due to weakening of blood vessel walls
    E) Necrosis of the vessel wall

Answer 11

Ans: D
Feedback:
Aneurysm can be a manifestation of atherosclerosis as a consequence of weakened
vessel walls. Motor and cognitive deficits as well as vasodilation are not common
manifestations of atherosclerosis. Necrosis of the vessel wall is associated with
vasculitis.

Question 12

12. Which of the following assessment findings of a newly admitted 30-year-old male client
    would be most likely to cause his physician to suspect polyarteritis nodosa?
    A) The man’s blood work indicates polycythemia (elevated red cell levels) and
    leukocytosis (elevated white cells).
    B) The man’s blood pressure is 178/102, and he has abnormal liver function tests.
    C) The man is acutely short of breath, and his oxygen saturation is 87%.
    D) The man’s temperature is 101.9°F, and he is diaphoretic (heavily sweating).

Answer 12

Ans: B
Feedback:
Polyarteritis nodosa is associated with abnormal liver function and acute hypertension.
Anemia, not elevated red cells, is a manifestation, while respiratory symptoms,
diaphoresis, and fever are not noted to be accompaniments

Question 13

13. A patient arrives at the ED complaining of numbness in the left lower leg. Upon
    assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior
    tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse’s next
    action is based on the fact that
    A) acute arterial occlusion is a medical emergency requiring immediate intervention
    to restore blood flow.
    B) submersion in a whirlpool with warm water will improve the venous blood flow
    and restore pulses.
    C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the
    problem and should only be used for CVAs.
    D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery
    to restore perfusion.

Answer 13

Ans: A
Feedback:
The presentation of acute arterial embolism is often described as that of the seven “P’s”:
pistol shot, pallor, polar, pulselessness, pain, paresthesia, and paralysis. Treatment is
aimed at restoring blood flow. Embolectomy, thrombolytic therapy, and anticoagulant
therapy (heparin) are usually given. Application of cold should be avoided.

Question 14

14. A 70-year-old male client presents to the emergency department complaining of 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 of the following medical diagnosis/possible treatment
    plans listed below?
    A) Acute arterial occlusion that will be treated with angioplasty
    B) Raynaud disease that will require antiplatelet medications
    C) Atherosclerotic occlusive disease necessitating thrombolytic therapy
    D) Giant cell temporal arteritis that will be treated with corticosteroids

Answer 14

Ans: C
Feedback:
The client’s symptoms of calf pain with intermittent claudication and diminished pulses
are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are
not as closely associated with acute arterial occlusion or giant cell temporal arteritis and
are not related to Raynaud disease.

Question 15

15. 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) “This likely won’t have a huge effect on your quality of life, and I’ll prescribe
    anticlotting drugs to prevent attacks.”
    B) “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.”
    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

Answer 15

Ans: D
Feedback:
Ensuring total body warmth and the use of vasodilators are the normal treatment
modalities for Raynaud disease.

Question 16

16. During a routine physical examination of a 66-year-old woman, her nurse practitioner
    notes a pulsating abdominal mass and refers the woman for further treatment. The nurse
    practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms.
    Which of the following aspects of the pathophysiology of aneurysms would underlie the
    explanation the nurse provides?
    A) Aneurysms are commonly a result of poorly controlled diabetes mellitus.
    B) Hypertension is a frequent modifiable contributor to aneurysms.
    C) Individuals with an aneurysm are normally asymptomatic until the aneurysm
    ruptures.
    D) Aneurysms can normally be resolved with lifestyle and diet modifications.

Answer 16

Ans: B
Feedback:
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.

Question 17

17. In which of the following patients is the emergency department staff most likely to
    suspect an abdominal aortic aneurysm?
    A) A 60-year-old client with diminished oxygen saturation, low red blood cell levels,
    and pallor
    B) A 70-year-old woman with jugular venous distention, shortness of breath, and
    pulmonary edema
    C) A 66-year-old client with facial edema, cough, and neck vein distention
    D) An 81-year-old man with acute cognitive changes as well as difficulty in speaking
    and swallowing

Answer 17

Ans: C
Feedback:
Facial edema, cough, and neck vein distention are associated with abdominal aortic
aneurysms. Low red cells, pulmonary edema, and cognitive changes are not associated
with abdominal aortic aneurysms.

Question 18

18. A 44-year-old female who is on her feet for the duration of her entire work week has
    developed varicose veins in her legs. What teaching point would her care provider be
    most justified in emphasizing to the woman?
    A) “Once you have varicose veins, there’s little that can be done to reverse them.”
    B) “Your varicose veins are likely a consequence of an existing cardiac problem.”
    C) “If you’re able to stay off your feet and wear tight stockings, normal vein tone can
    be reestablished.”
    D) “The use of blood thinners medication will likely relieve the backflow that is
    causing your varicose veins.”

Answer 18

Ans: A
Feedback:
Treatment of varicose veins focuses on prevention and slowing of the progression of the
problem; it is not normally possible to reverse existing varicose veins. Staying off one’s
feet and wearing antiembolic stockings may prevent, but not reverse, the condition.
While cardiac problems may coexist with varicose veins, this does not necessarily
account for the woman’s condition. Blood thinners will not resolve her varicose veins.

Question 19

19. An elderly patient arrives to the health care provider’s office complaining of a “sore”
    that would not heal on his 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 patient that the usual treatment is
    A) hydrotherapy to facilitate improvement in circulation.
    B) compression therapy to help facilitate blood flow back to the vena cava.
    C) initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm.
    D) long-term antibiotic therapy to facilitate healing of the wound.

Answer 19

Ans: B
Feedback:
: Treatment of venous ulcers includes compression therapy with dressings and inelastic
or elastic bandages. Medications that help include aspirin and pentoxifylline.
Occasionally skin grafting may be required. Hydrotherapy, Coumadin therapy, and
long-term antibiotic therapy are usually not required for venous ulcers.

Question 20

20. A physician is explaining to a group of medical students the concept of Virchow triad as
    it applies to venous thrombosis. Which of the following clinical observations of a
    50-year-old male client is most likely unrelated to a component of Virchow triad?
    A) The man has decreased cardiac output and an ejection fraction of 30%.
    B) The man’s prothrombin time and international normalized ratio (INR) are both
    low.
    C) The man has a previous history of a dissecting aneurysm.
    D) There is bilateral, brown pigmentation of his lower legs

Answer 20

Ans: A
Feedback:
Cardiac output is not a component of Virchow triad. However, decreased INR and
prothrombin time indicate hypercoagulability; a dissecting aneurysm is an example of
vessel wall injury; and pigmentation in the lower legs indicates stasis of blood.

Question 21

21. 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) Blood volume, resistance, and flow
    B) The cardiac reserve or possible increase in cardiac output over normal resting
    level
    C) The amount of blood that his heart ejects from the left ventricle during each beat
    D) The relationship between total blood volume and resting heart rate

Answer 21

Ans: C
Feedback:
Pulse pressure is a reflection of the amount of blood that the heart ejects from the lef t
ventricle during each beat combined with the distensibility of the atrial tree. Othe r
factors such as blood flow characteristics, cardiac reserve, heart rate, and blood vol ume
are less directly associated with pulse pressure.

Question 22

22. 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
    A) pulmonary hypertension.
    B) left ventricular hypertrophy.
    C) organ damage and hypovolemic shock
    D) orthostatic hypotension.

Answer 22

Ans: C
Feedback:
The mean arterial pressure, which represents the average blood pressure in the systemi c
circulation, is a good indicator of tissue perfusion. Hospitalization and bed re st
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 clie nt’s
MAP is falling at a time when it should be at its daily peak is the cause for gra ve
concern; blood volume is likely low, and vital organs, which depend on adequa te
perfusion, are at risk.

Question 23

23. The nurse practitioner working in an overnight sleep lab is assessing and diagnosing
    patients with sleep apnea. During this diagnostic procedure, the nurse notes that a
    patient’s blood pressure is 162/97. The nurse explains this connection to the patie nt
    based on which of the following pathophysiological principles?
    A) During apneic periods, the patient experiences hypoxemia that stimula tes
    chemoreceptors to induce vasoconstriction.
    B) When the patient starts to snore, his epiglottis is closed over the trachea.
    C) When the airway is obstructed, specialized cells located in the back of the throa t
    send signals to the kidney to increase pulse rate.
    D) When airways are obstructed, the body will retain extracellular fluid so that thi s
    fluid can be shifted to intravascular space to increase volume.

Answer 23

Ans: A
Feedback:
People with sleep apnea also may experience an increase in BP because of the
hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are
located in carotid bodies and aortic bodies of the aorta. Retention of fluid is not the
cause of increased BP during sleep apnea episodes.

Question 24

24. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeti ng
    with his physician. The patient’s physician would anticipate that which of the following
    phenomena is most likely occurring?
    A) The patient’s juxtaglomerular cells are releasing aldosterone as a result of
    sympathetic stimulation.
    B) Epinephrine from his adrenal gland is initiating the renin–angiotensin–aldosterone
    system.
    C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors
    resulting in vasoconstriction.
    D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in
    blood pressure and sodium reabsorption.

Answer 24

Ans: D
Feedback:
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

Question 25

25. A group of novice nursing students are learning how to manually measure a clie nt’s
    blood pressure using a stethoscope and sphygmomanometer. Which of the following
    statements by students would the instructor most likely need to correct?
    A) “I’ll inflate the cuff around 30 mm Hg above the point at which I can’t palpa te the
    client’s pulse.”
    B) “If my client’s arm is too big for the cuff, I’m going to get a BP reading that ‘s
    artificially low.”
    C) “The accuracy of the whole process depends on my ability to clearly hear the
    Korotkoff sounds with the bell of my stethoscope.”
    D) “With practice, my measurement of clients’ blood pressures with this method will
    be more accurate than with automated machines.”

Answer 25

Ans: B
Feedback:
Undercuffing yields a blood pressure reading that is overestimated. The cuff should
indeed be inflated to 30 mm Hg above palpated systolic pressure and is both dependent
on clear auscultation of the Korotkoff sounds. The properly performed manual method
is more accurate than automated measurement.

Question 26

26. 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. W hich of
    the leader’s following teaching points is most accurate?
    A) “It’s important to minimize the amount of potassium and, especially, sodium in
    your diet.”
    B) “High blood pressure is largely controllable, except for those with a significant
    family history or African Americans.”
    C) “Too much alcohol, too little exercise, and too much body fat all contribute to
    high blood pressure.”
    D) “Hypertension puts you at a significant risk of developing type 2 diabetes later in
    life.”

Answer 26

Ans: C
Feedback:
Obesity, excess alcohol consumption, and a sedentary lifestyle are all linked with
hypertension. Inadequate, rather than excessive, potassium intake is thought to be
causative, and while race and family influence an individual’s predisposition to
hypertension, it does not render the condition untreatable or uncontrollable. Diabetes is
thought to be a contributor to hypertension, not vice versa.

Question 27

27. When advising a morbidly obese patient about the benefits of weight reduction, whic h
    of the following statements would be most accurate to share?
    A) “All you need to do is stop drinking sodas and sugary drinks.”
    B) “A 10 lb loss of weight can produce a decrease in blood pressure.”
    C) “An increased ‘waist-to-hip’ ratio can lead to too much pressure on the liver a nd
    intestines.”
    D) “If your leptin (hormone) level is too low, you are at increased risk for developi ng
    high BP.”

Answer 27

Ans: B
Feedback:
Weight reduction of as little as 4.5 kg (10 lb) can produce a decrease in BP in a large
proportion of overweight people with hypertension. There are no data to suggest this
patient has a history of high intake of sodas. An increased waist-to-hip ratio is
associated with hypertension. Leptin acts on the hypothalamus to increase BP by
activating the SNS.

Question 28

28. A physician is providing care for several patients on a medical unit of a hospital. In
    which of the following patient situations would the physician most likely rule out
    hypertension as a contributing factor?
    A) A 61-year-old man who has a heart valve infection and recurrent fever
    B) An 81-year-old woman who has had an ischemic stroke and has consequent
    one-sided weakness
    C) A 44-year-old man awaiting kidney transplant who requires hemodialysis three
    times per week
    D) A 66-year-old woman with poorly controlled angina and consequent limited
    activity tolerance

Answer 28

Ans: A
Feedback:
While cardiac complications are common sequelae of hypertension, a heart valve
infection would be less likely to be so. Stroke, kidney failure, and angina are all
identified as consequences of hypertension.

Question 29

29. An autopsy is being performed on a 44-year-old female who died unexpectedly of hea rt
    failure. Which of the following components of the pathologist’s report is m ost
    suggestive of a possible history of poorly controlled blood pressure?
    A) “Scarring of the urethra suggestive of recurrent urinary tract infections is evident.”
    B) “Bilateral renal hypertrophy is noted.”
    C) “Vessel wall changes suggestive of venous stasis are evident.”
    D) “Arterial sclerosis of subcortical brain regions is noted.”

Answer 29

Ans: D
Feedback:
Neurological consequences of hypertension include narrowing and scle rosis of
subcortical regions. Urethral scarring and impaired venous return would be less likely to
derive from hypertension, and while nephrosclerosis and glomerular damage a re
associated with hypertension, hypertrophy of the kidneys themselves is not noted as a n
indicator.

Question 30

30. During a routine physical exam for a patient diagnosed with hypertension, the nurse
    practitioner will be most concerned if which of the following assessments are found?
    A) Noted hemorrhages and microaneurysms during evaluation of the internal eye
    B) Unable to feel vibrations when a tuning fork is placed on the skull
    C) Inability to locate the kidneys with deep palpation to the abdomen
    D) Slight increase in the number of varicose veins noted bilaterally

Answer 30

Ans: A
Feedback:
Hypertension affects the eye in sometimes devastating ways. If there are acute increase s
in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations re late
to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not
associated with hypertension

Question 31

31. 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 pre ssure
    control. Which of the following assessments would the nurse be most justifie d in
    eliminating during a busy morning on the unit?
    A) Checking the recent potassium levels of a client receiving an ACE inhibitor
    B) Measuring the heart rate of a client who takes a -adrenergic blocker
    C) Measuring the pulse of a client taking an ACE inhibitor
    D) Noting the sodium and potassium levels of a client who is receiving a diuretic

Answer 31

D) Noting the sodium and potassium levels of a client who is receiving a diureti c
Ans: C
Feedback:
ACE inhibitors act on the renin–angiotensin–aldosterone system and thus d o not
significantly influence heart rate. They can, however, induce hyperkalemia, and it would
be prudent for the nurse to check potassium levels. -adrenergic blockers affect a
client’s heart rate, and diuretics can affect electrolyte levels.

Question 32

32. Which of the following hypertensive individuals is most likely to have his or her high
    blood pressure diagnosed as secondary rather than essential?
    A) A 51-year-old male who has been diagnosed with glomerulonephritis
    B) An African American man who leads a sedentary lifestyle
    C) A 69-year-old woman with a diagnosis of cardiometabolic syndrome
    D) A 40-year-old smoker who eats excessive amounts of salt and saturated fat s

Answer 32

Ans: A
Feedback:
Damage to the organs that control and mediate the control of blood pressure, mos t
notably the kidneys, is associated with secondary hypertension. Race, lifestyle, sodi um
intake, and associated cardiac and metabolic sequelae are associated with essentia l
hypertension.

Question 33

33. A patient is admitted to the outpatient diagnostic unit for further testing to identify the
    cause of the uncontrolled secondary hypertension. In preparation, the nurse shoul d
    anticipate that which of the following diagnostic procedures will provide the most
    definitive diagnosis?
    A) Routine ultrasound of kidney
    B) Renal arteriography
    C) Echocardiography
    D) Serum creatinine level

Answer 33

Ans: B
Feedback:
: With the dominant role that the kidney assumes in blood pressure regulation, it i s not
surprising that the largest single cause of secondary hypertension is renal disease. Rena l
arteriography remains the definitive test for identifying renal artery disease. Ultra sound,
CT, and MRA are other tests that can be used to screen for renovascular hypertension.

Question 34

34. A physical assessment of a 28-year-old female patient indicates that her blood pre ssure
    in her legs is lower than that in her arms and that her brachial pulse is weaker in her le ft
    arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the
    following possibilities would her care provider most likelysuspect?
    A) Pheochromocytoma
    B) Essential hypertension
    C) Coarctation of the aorta
    D) An adrenocortical disorder

Answer 34

Ans: C
Feedback:
The differences in blood pressure between the upper and lower extremities combine d
with weak femoral pulses and unilateral brachial pulse weakness are associated mos t
strongly with coarctation of the aorta.

Question 35

35. During a prenatal education class, an expectant mother tells the group about a frie nd
    whose blood pressure became so high during pregnancy that she had to be admitted to
    hospital. Which of the following statements should the nurse include in response to this?
    A) “A large increase i n blood pressure is a normal part of the changes in blood
    circulation that accompany pregnancy.”
    B) “By avoiding salt, staying active, a nd minimizing weight gain, you can prevent
    this during your pregnancy.”
    C) “Essentially, experts don’t really know why so many pregnant women develop
    high blood pressure.”
    D) “I’m sure this was hard for your friend, but rest assured that it won’t affect y our
    baby even if it affects you.”

Answer 35

Ans: C
Feedback:
The root causes of pregnancy-induced hypertension are not known. It is pathological
rather than normal, however, and it cannot necessarily be avoided by lifestyle
modifications. It can be pernicious to both the mother and the fetus.

Question 36

36. A formerly normotensive woman, pregnant for the first time, develops hypertension a nd
    headaches at 26 weeks’ gestation. Her blood pressure is 154/110 mm Hg, and she ha s
    proteinuria. What other lab tests should be ordered for her?
    A) Plasma angiotensin I and II and renin
    B) Urinary sodium and potassium
    C) Platelet count, serum creatinine and liver enzymes
    D) Urinary catecholamines and metabolites

Answer 36

Ans: C
Feedback:
This woman shows signs and symptoms of preeclampsia. A low platelet count wit h
elevated serum creatinine and liver enzymes would reinforce this diagnosis. The o ther
tests might indicate kidney problems or the presence of a pheochromocytoma, but he r
symptoms do not indicate a need for these tests.

Question 37

37. A 16-year-old adolescent who received a kidney transplant at the age of 10 has recentl y
    developed a trend of increasing BP readings. Of the following list of medications, whic h
    may be the primary cause for the development of hypertension?
    A) Furosemide (Lasix)
    B) Cyclosporine (Sandimmune)
    C) Isotretinoin (Accutane)
    D) Hydrochlorothiazide (Hydrodiuril)

Answer 37

Ans: B
Feedback:
The nephrotoxicity of the drug cyclosporine, an immunosuppressant used in transpla nt
therapy, may cause hypertension in children after bone marrow, heart, kidney, or live r
transplantation.

Question 38

38. 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 proce ss, which
    of the following phenomena are primarily the contributing factors to hypertension i n the
    elderly population? Select all that apply.
    A) Stiffening of large arteries like the aorta
    B) Increased sensitivity of the renin–angiotensin–aldosterone system
    C) Decreased baroreceptor sensitivity and renal blood flow
    D) Increased peripheral vascular resistance
    E) Increase in renal perfusion

Answer 38

Ans: A, C, D
Feedback:
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 a ll
accompaniments of aging.

Question 39

39. A physiotherapist is measuring the lying, sitting, and standing blood pressure of a
    patient who has been admitted to hospital following a syncopal episode and recent fall s.
    Which of the following facts about the patient best relates to these health problems?
    A) The patient is male and has a history of hypertension.
    B) The patient’s cardiac ejection fraction was 40% during his last echocardiogram.
    C) The patient has a history of acute and chronic renal failure.
    D) The client is 89 years old and takes a diuretic medication for his congestive heart
    failure.

Answer 39

Ans: D
Feedback:
Old age and diuretic use are strongly associated with orthostatic hypotension, which is
normally marked by falls and syncope. Gender, hypertension, stroke volume, and
kidney disease are less likely to be causative factors

Question 40

40. A 78-year-old male patient has undergone a total knee replacement. He jus t does not
    feel like getting out of bed and moving around. After 3 days of staying in be d, the
    physical therapist encourages him to get out of bed to the chair for meals. He starts t o
    complain of dizziness and light-headedness. These symptoms are primarily caused by
    which of the following pathophysiological principles? Select all that apply. The
    patient(‘s)
    A) is experiencing a reduction in plasma volume.
    B) peripheral vasoconstriction mechanism has failed.
    C) is so stressed that he is releasing too many endorphins.
    D) is still bleeding from the surgical procedure.
    E) has lost all of his muscle tone.

Answer 40

Ans: A, B
Feedback:
Prolonged bed rest promotes a reduction in plasma volume, a decrease in venous tone ,
failure of peripheral vasoconstriction, and weakness of the skeletal muscles that support
the veins and assist in returning blood to the heart. Endorphins make one feel better in
mood. Three days post-op, there should be no further bleeding from the surgical site. I f
there is, then this is a complication that must be addressed immediately. L oss of
vascular and skeletal muscle tone is less predictable but probably becomes maximal
after 2 weeks.