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SNWCCCD-MS2E2
Nur116 Exam 2
| Question | Answer |
|---|---|
| What are the signs and symptoms of an Abdominal Aortic Aneurysm? | Most are asymptomatic, but can present with abdominal, flank, or back pain. Abdominal pulsation, bruit. TLT |
| If a client presents with a ruptured Abdominal Aortic Aneurysm, what would you see? | Hypotension, diaphoresis, mental obtundation, oliguria, and dysrhythmias and abdominal distention. TLT |
| Clients with a rupturing abdominal aortic aneurysm are _________ and in _______ _______ _______. | critically ill, hemorrhagic (hypovolemic) shock TLT |
| What diagnostic test shows an abdominal aortic aneurysm? | Ultrasonography, CT scan, abdominal x-ray and or a lateral x-ray of the spine revealing an eggshell appearance of the aneurysm. TLT |
| Computed tomography (CT) scanning is the standard tool for assessing the ______ and ____ of an _______ or _______ aneurysm. | size, location, abdominal, thoracic TLT |
| How can a thoracic aneurysm be diagnosed? | Chest x-ray TLT |
| Why is an aortic arteriography usually performed? | for clients who are to undergo surgical repair of a thoracic aneurysm TLT |
| Which diagnostic test is noninvasive and provides an accurate diagnosis and information about the size and location of an abdominal aortic aneurysm? | Ultrasonography TLT |
| If a client has an aneurysm less than 6 cm and in poor health or an aneurysm less that 4 cm in good health, what intervention would you do? | monitor the growth of the aneurysm and maintain the blood pressure at a normal level to decrease the risk of rupture. Frequent CT scans are necessary to monitor the growth of the aneurysm. TLT |
| What is an important risk factor for aneurysm growth and why is important? | hypertension, becuase elevated blood pressure can increase the rate of aneurysmal enlargement. TLT |
| How do you treat hypertension? | antihypertensives TLT |
| What are you going to teach your client with a AAA (Abdominal Aortic Aneurysm) that they need to do? | Follow through with testing and maintenance of hypertension treatment to monitor the growth. TLT |
| An emergency surgery for aneurysms usually occurs because: | client has a rupturing abdominal aortic aneurysm or a thoracic aneurysm. TLT |
| What is the most common procedure traditionally performed for clients with an AAA? | Aneurysmectomy - AAA resection or repair TLT |
| What is the mortality rate for elective AAA resection? | 2%-5% TLT |
| What is the mortality rate for emergency surgery for expanding AAA's? | 5%-15% TLT |
| What is the mortality rate for emergency surgery for ruptured AAA's? | 50% TLT |
| What are endothelial stent graphs? | wirelike devices that are inserted percutaneously. TLT |
| What is an aneurysm? What are the two types? | permanent dilation of an artery. Fusiform and Sacural TLT |
| What is a fusiform aneurysm? | An aneurysm affecting the entire circumference of the artery. TLT |
| What is a sacural aneurysm? | a bulging affecting only one side or portion of the artery. TLT |
| An aneurysm is true if it is what? | the arterial wall is weakened but the layers are still connected TLT |
| An aneurysm is false if it is what? | from injury or trauma to all three layers of the arterial wall where it has been cut or broken. TLT |
| What is the most common aneurysm? | abdominal aortic aneurysm, about 75% of all aneurysms. TLT |
| How does an aneurysm form? | when the middle layer (media) of the artery is weakened, stretching the inner layer (intima) and outer layers (adventitia) of the artery. TLT |
| What is the most common cause of all aneurysms? What are the two most common contributing factors? | Atherosclerosis, hypertension and cigarette smoking. TLT |
| What happens during an Abdominal Aortic Aneurysm Resection? | The aneurysm is removed from the abdominal aorta to prevent or repair the rupture. TLT |
| What is a mycotic aneurysm and what causes it? | small, tiny aneurysm due to localized infection. TLT |
| Cushing's disease, which is excessive glucocorticoid excretion from the adrenal cortex, is contraindicated to which type of hypertension? tc | Secondary hypertension |
| Which medications can cause Secondary Hypertension? tc | Estrogen, glucocorticoids, mineralocorticoids, sympathomimetics, cyclosporing, and erythropoietin. |
| What is Malignant hypertension? tc | A severe type of elevated blood pressure that rapidly progresses - systolic >200 and diastolic >150 (without pre-existing conditions) or >130 (with). |
| What are the S/S for Malignant hypertension? What are late symptoms? tc | Morning headaches, blurred vision, dyspnea and/or uremia. If left untreated, may result in renal failure, left ventricular failure, or stroke. |
| What secondary hypertensive disorder is characterized by elevation of blood pressure in the arms, delayed/absent femoral pulses, yet with normal or low blood pressure in the lower extremities? tc | Coarctation of the Aorta. |
| DX: urinary lab results with presence of protein, RBC, pus cells, elevated BUN and Creatnine indicate what? tc | Renal Disease |
| List some lifestyle modifications hypertensive patients should consider. tc | Sodium restriction, weight reduction, moderate alcohol intake, exercise, relaxation techniques, sustain from tobacco use, and avoid caffeine. |
| What are the signs and symptoms of a thoracic arotic aneurysm? | back pain, SOB, Hoarseness, and difficulty swallowing TLT |
| What will you see if a thoracic aneurysm ruptures? | sudden and excruciating back or chest pain. TLT |
| What is a dissecting aneurysm? | AKA: aortic dissections. Formed when blood accumulates in the wall of the artery. TLT |
| What will you assess for in the preop of a AAA resection? | Peripheral pulses to obtain a baseline. Mark the pulse spots to easily find them postop. TLT |
| If a patient is brought to the OR from the ER for a ruptured aneurysm, what are you going to do first? | administer large volumes of IV fluids to maintain tissue perfusion. TLT |
| What are the complications of a AAA repair? | MI, graft occlusion or rupture causing hemorrhage, hypovolemia, respiratory distress and paralytic ileus. TLT |
| What is monitored immediately postop after a AAA repair? | clients BP with an arterial catheter. TLT |
| What are other things you are going to monitor/assess for postop after a AAA repair? | Continuous cardiac monitoring, hemodynamic monitering, vital signs every 15 mins for the first hour, then hourly. Pulses distal to graft site, urine output hourly, respiratory rate and depth qh, and auscultate breath sounds q4h. Bowel sounds Q8H. TL |
| What are the signs of an MI? | Chest pain, SOB, c/o dyspnea, diaphoresis, anxiety and restlessness. TLT |
| What are the signs of a graft occlusion or rupture? | Changes in pulses, white/blue and cool/cold extremities below graft, severe pain, abdominal distention and decreased urine output. TLT |
| What degree should you limit the head of the bed to be after a AAA repair and why? | 45 degrees to avoid flexion of the graft. TLT |
| Why would we assess for urine output after a AAA repair surgery? | Because blood lost during surgery or before from a rupture can cause hypovolemia and renal failure. Urine output less than 50ml/hr NOTIFY PHYSICIAN! TLT |
| What might be necessary during a Thoracic aortic aneurysm repair? | Total cardiopulmonary bypass is needed for the repair on an ascending aorta and partial bypass is needed for the descending aorta. TLT |
| Abruptly stopping anti-hypertensive medications (such as beta blockers) can result in? tc | Teach patients to report unpleasant side effects, but to continue medication as prescribed because stopping can cause angina, MI or rebound hypertension. |
| Anti-hypertensive drugs act as _________, which _________ BP. tc | vasodilators; decrease |
| What are the common characteristics of people with essential (primary) hypertension? tc | >60 years, family history, high calorie consumption, inactivity, excessive alcohol use, hyperlipidemia, African-American, high intake of salt and/or caffeine, reduced intake of potassium, calcium or magnesium, obesity, smoking, and stress. |
| The presence of abdominal bruits is typical of clients with: tc | Renovascular disease. |
| Tachycardia, sweating and pallor may suggest a: tc | Pheochromocytoma or adrenal medulla tumor. |
| Laboratory tests may detect ______ hypertension, but not ______ hypertension. tc | Secondary: Essential (primary) |
| When teaching patients about eating a low sodium diet, we must stress importance on proper use of salt-substitutes, because: tc | They are high in potassium, which may be contraindicative to patients taking potassium-sparing diuretics. There could be an increased risk of becoming hyperkalemic. |
| A weight-reduction plan may be formulated for patients with a BMI of: tc | BMI >25 |
| What are the general limits (Total Fat, Saturated Fat, Cholesterol) of a typical weight-reduction plan? tc | Total Fat: <30% of daily caloric intake Saturated Fat: <10% of daily caloric intake Cholesterol: <300 mg/day |
| Essential hypertension produces medial thickening of the arterioles. This "thickening" is referred to as: tc | Hyperplasia |
| What is coarctation of the aorta, where does it occur, and how is it treated? tc | Congenital narrowing of the aorta that may cause hypertension. It can occur at any level of the thoracic or abdominal aorta, where it restricts blood flow, resulting in an elevated pressure. Hypertension subsides with surgial repair. |
| Which type of hypertension is associated with other neurogenic disturbances, such as brain tumors, encephalitis, and psychiatric disturbances? tc | Secondary hypertension. |
| What is a funduscopic examination, and why is it done? tc | The eyes are examined to observe vascular changes in the retina. The appearance of the retina can be a reliable index of the severity and prognosis of hypertension. |
| Left atrial and ventricular hypertrophy is the first ECG sign of: tc | cardiac involvement resulting from hypertension. |
| Clients should be instructed to limit alcohol intake to ______ daily, because: tc | 1 oz. ethanol (2 oz liquor, 8 oz wine, 24 oz beer) daily. Excessive alcohol consumption elevates arterial blood pressure and can add "empty" calories. |
| What are the modifiable risk factors for PAD and PVD? DL | Smoking, dietary, level of exercise, obesity, cholesterol level, triglyceride, stress level, and hypertension |
| What are the signs and symptoms of acute arterial insufficiency? DL | Extremity will be cool or cold,mottled, areas of toes can be blackened or gangrenous, Six"P's" can be present. |
| What are the six "P's"? DL | Pain, pallor, pulselessness, paraesthsia, paralysis, and poikilothermia |
| What is the most common cause of chronic altered blood flow? DL | Atherosclerosis |
| What are the obstruction classifications of peripheral arterial disease? DL | Inflow and Outflow |
| What is the defining characteristic for arterial disorders? DL | Intermittent claudication |
| A patient presents with pain in lower back and buttocks, what type of the arterial obstruction diseases would be seen? DL | Inflow disease |
| After assessing a patient's feet, the nurse makes note of two small round sores that are on top of the toes. What type of ulcer could this be? DL | Arterial ulcer |
| If a patient is diagnosed with acute arterial insufficiency, what type of treatment would the nurse perform? DL | Ambulation and Burger-Allen exercise to promote collateral circulation. |
| What type of objective data would the nurse look for with peripheral arterial disease? DL | Decrease pulse in lower extremity, capillary refill greater than 3 seconds (adult),bruits, and pain. |
| What non-invasive diagnostic tests would be performed to diagnose peripheral vascular disease? DL | Doppler, Ankle-brachial index, Duplex Ultrasonography, exercise stress test, and CT scan. |
| A patient is post-op from a angioplasty, what interventions would the nurse do? DL | Apply pressure to puncture sight (sandbag), legs need to stay straight, monitor - pulse (pedal), puncture site for thrombus, and bleeding. |
| What is the most common surgical procedure to increase arterial blood flow? DL | Arterial revascularization |
| What are the classifications of blood pressure in relation to hypertension (from normal to severe/urgency)? Tc | Normal = 120/80 Pre-HTN = 120-139/80-89 Stage 1 HTN = 140-159/90-99 Stage 2 HTN = >160/100 HTN Urgency (Classic Malignant Hypertension) = >220/120 |
| What is the cause of essential/primary/idiopathic hypertension? Tc | While there are risk factors, there is actually no known cause. |
| What affect do Alpha-Blockers have on the vascular system? Tc | Alpha-Blockers decrease blood pressure, and increase heart rate. |
| What affect do Beta-Blockers have on the vascular system? Tc | Beta-Blockers decrease blood pressure, and decrease heart rate. |
| List 5 (five) therapeutic agents used to treat hypertension: tc | Alpha-Blockers, Beta-Blockers, Calcium Antagonists, Diuretics, and Vasodilators. |
| Effects of Beta Adrenergic Blockers: tc | Decrease CO, decrease HR, decreased strength of contractions, and decreased renin secretion by the kidneys. |
| Effects of Alpha Adrenergic Blockers: tc | Promotes arteriole/venous dilation, blocks peripheral alpha adrenergic receptors |
| Effects of Beta Blockers: tc | Promotes vascular dilation and decreased HR |
| Effects of Calcium Channel Blockers: tc | Promotes peripheral vascular dilation and decreases HR |
| Effects of Central Adrenergic Antagonists: tc | Promotes vasodilation and inhibits sympathetic outflow from CNS |
| Effects of Direct vasodilators: tc | Promotes vasodilation and acts directly on the arteriole smooth muscle |
| Effects of Spironolactone: tc | Decreases fluid volume, decreases the reabsorption of sodium/water, blocking the effect of aldosterone, and it is potassium-sparing |
| Effects of Thiazide diuretics: tc | Decreased fluid volume, decreases sodium/water reabsorption in the Loop of Henle and/or distal tubules, but it depletes potassium |
| How is angiotensin involved with hypertension? Tc | The body converts angiotensin I to angiotensin II, which is one of the most powerful vasoconstrictors in the body. |
| What is the common side effect when initiating ACE Inhibitor therapy? Tc | Orthostatic hypotension, which should decrease with subsequent doses. |
| Considering an elderly hypertensive patient, when should use of ACE Inhibitors be discontinued? Tc | When orthostatic hypotension does not decrease with subsequent doses, if the orthostatic hypotension is severe, or if the patient develops a cough. |
| What is an easy, effective strategy in reducing the risk of fainting and falls in the older hypertensive patient? Tc | Wearing elastic venous compression stocking (TED Hose). |
| What is the recommended dosage of Eplerenone (Inspra – ACE Inhibitor) and what are the adverse reactions of high doses? Tc | The recommended dosage is 50mg daily, up to 100mg daily. It is generally well tolerated, but can have adverse effects of hypertriglyceridemia, hyponatremia, and hyperkalemia. |
| How often should potassium levels be evaluated during hypertensive therapy? Tc | Initially every 2 weeks for the first three months, then monthly thereafter. |
| True or false: Grapefruit juice and St. John’s Wort can increase the chance of undesirable effects of antihypertensives. Tc | TRUE |
| Clients with diabetes who take beta blockers may be asymptomatic to hypoglycemia because: tc | The sympathetic nervous system is blocked, and counterregulatory responses to hypoglycemia, such as gluconeogenesis, may also be inhibited by certain beta blockers. |
| Common side effects of beta blockers include: tc | Fatigue, weakness, depression, and sexual dysfunction. |
| What body organ is the most common target of end-organ damage with hypertension? Tc | The heart |
| What is the best medication practice for controlling hypertension in post-MI clients? Tc | A combination of beta blockers, ACE inhibitors, and aldosterone antagonists plus intense management of lipids and the use of aspirin. |
| Why tell patients to refrain from taking low doses of Aspirin until their high blood pressure is under control? Tc | While low-dose Aspirin is included in most antihypertensive drug plans, it should only be considered once the blood pressure is controlled because of the increased risk for hemorrhagic stroke. |
| True or false: A client can stop taking antihypertensive medications if they’ve been symptom-free for at least 3 months. | FALSE. Clients who (at any time) require pharmacologic treatment to control essential hypertension usually need to take medication for the rest of their lives. |
| What is a ABPM? Tc | ABPM is an ambulatory blood pressure monitor device that is often used in the home. If one cannot be obtained, the patient (and family members) should be taught how to obtain manual blood pressure readings. |
| What are the nursing interventions for hypertensive crises? Tc | Semi-Fowlers, O2, IV Nitro, BP every 5-15 min until diastolic is <90 but not <75, then monitor every 30 minutes thereafter. Monitor for neurologic or cardiovascular complications, numbness/tingling or weakness of extremities, dysrhythmias, or chest pain |
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