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NR 667 questions with correct answer1
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NR 667 questions with correct answer1
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NR 667 questions with correct answersEtiology: Hypertension Correct Answer--No known cause in 90% of
cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal artery stenosis,
Cushing syndrome, hyper/hypo thyroidism, increased ICP, sleep apnea,
oral contraceptives, steroids, cocaine, NSAIDs, decongestants,
sympathomimetics, alcohol, antidepressants, caffeine
Risk Factors: Hypertension Correct Answer--Modifiable: smoking, DM,
high cholesterol, obesity (single most important factor in children),
physical inactivity, poor diet, excessive sodium intake, excessive alcohol
consumption
-Non-modifiable: CKD, family hx, increased age (>55 men, > 65
women), low socioeconomic status, low educational status, male sex,
OSA, stress, pregnancy
Assessment: Hypertension Correct Answer--Most are asymptomatic;
occipital headache, headache upon waking, blurry vision, fundoscopic
exam (AV nicking, exudates, papilledema), left vent. hypertrophy,
pregnancy w/HTN and proteinuria, edema, and excessive weight gain
Differential Diagnosis: Hypertension Correct Answer--Secondary HTN,
white coat HTN (artificial elevation d/t medical environment anxiety)
Final Diagnosis: Hypertension Correct Answer--Urinalysis = proteinuria
-Electrolytes, creatinine, calcium
-Fasting lipid profile and BS
,-ECG
-Measure BP twice, 5 mins apart
-Patient should be seated; use proper cuff size and application
Prevention: Hypertension Correct Answer--Maintaining healthy weight
and BMI
-Smoking cessation
-Regular aerobic exercise
-Alcohol in moderation (< 1 oz/day)
-Stress management
-Medication compliance
-Assess for and treat OSA
Non-pharm management: Hypertension Correct Answer--Stage 1: Risk
score < 10% =lifestyle modification
-Stage 2: lifestyle + medication
-DASH eating plan: high fruit, veggies, grains; low fat dairy, fish,
poultry, beans, nuts
-Reduce dietary sodium to 2,300mg/day, increase K+
-Reduce sat. fat intake
-Body weight reduction; 1kg of weight reduction = 1 mm/hg bp
reduction
-150 mins of aerobic exercise and/or 3 sessions of isometric resistance
per week
-Treat other underlying diseases
,-Check bp 2x/week during pregnancy
Pharmacological management: Hypertension Correct Answer--Start
medication for primary prevention of CVD if pt. has ASCVD risk ≥ 10%
and stage 1 HTN or if ASCVD is < 10% with bp >140/90
-Stage 2: start 2 bp-lowering medications
-African Americans: 2+ medications recommended; thiazide and CCBs
are the most effective
*DO NOT use ACE and ARB concurrently
-Beta blockers are NOT first line
-Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo
Pregnancy considerations: Hypertension Correct Answer--Can use beta
blockers (labetalol), methyldopa, CCBs (nifedipine)
-AVOID ARBs and ACEIs
Follow-up: Hypertension Correct Answer--Inquire about adherence and
any side effects
-Reassess monthly until patient reaches goal, then every 3-6 months as
needed
Expected course: Hypertension Correct Answer--Only 54% of treated
patients are at goal treatment; expect complications if under treated
-Most patients require more than one medication to reach goal bp
, Possible Complications: Hypertension Correct Answer--Stroke, CAD,
MI, renal failure, heart failure, eclampsia (seizures), pulmonary edema,
hypertensive crisis, hypertensive retinopathy, ED
Etiology: Hyperlipidemia Correct Answer--Inherited disorder, high
dietary intake, obesity, sedentary lifestyle, DM, hypothyroidism,
anabolic steroid use, hepatitis, cirrhosis, uremia, nephrotic syndrome,
stress, drug-induced (thiazide diuretics, beta blockers, cyclosporine),
alcohol, caffeine, metabolic syndrome
Risk factors: Hyperlipidemia Correct Answer--Family history, physical
inactivity, smoking, age (men > 45, women > 55 or premature
menopause without estrogen replacement), obesity, diet high in sat. fat,
DM
Assessment findings: Hyperlipidemia Correct Answer--Few physical
findings; xanthomata (fat deposits in the skin), xanthelasma (yellow
plaques on the eyelid), corneal arcus prior to age 50 (arc of cholesterol
around the iris), bruits, angina pectoris, MI, stroke
Differential diagnosis: Hyperlipidemia Correct Answer--Secondary
causes: hypothyroidism, pregnancy, DM, non-fasting state
Final diagnosis: Hyperlipidemia Correct Answer--Fasting lipid profile:
9-12 hours
-Glucose level
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